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Flashcards in Quiz 6 Deck (41):
1

4 A's of anesthesia

1. Analgesia
2. Amnesia
3. Akinesia
4. Attenuation of automatic response

2

What are the 4 stages of anesthesia?

1. Analgesia
2. Excitement
3. Surgical anesthesia
4. Imminent death

3

What is the MAC?

Minimal Alveolar Concentration
-conc. of the agent in the lungs that prevents mvmt in 50% of Pts

**Use 1.3x the MAC

4

Use of nitrous oxide

Inhaled anesthetic

Sedation, analgesia & amnesia
Adjunct to inhalation & IV anesthesia

5

Use of Sevoflurane

Inhaled anesthetic

Induction & maintenance of general anesthesia

6

How does anesthesia leave the body?

1. Biotransformation
2. TransQ loss
3. Exhalation

1/2 lives are compartment specific so the times vary

7

Who should you be cautious with using Nitrous oxide?

1. Venous/arterial air embolism
2. Pneumothorax
3. Acute intestinal obstruction w/ bowel distension
4. Intracranial air
5. Pulmonary air cysts
6. Intraocular air bubbles
7. Tympanic membrane graftiing

Also dec. MAC of volatile liquid anesthetics

8

ADRs Sevoflurane

1. Emergence agitation &/or delirium
2. Perioperative hyperkalemia
3. QT prolongation
4. Potential to trigger malignant hyperthermia

9

Which anesthetic do you need to have fresh dessicant?

Sevoflurane

flammable & forms formeldahyde

10

What are the inhaled anesthetics?

1. Nitrous oxide
2 Sevoflurane

11

What are the IV anesthetics?

1. Propofol
2. Etomidate
3. Ketamine
4. Methohexital

12

How does Propofol work & what is it used for?

Affects GABA channels to shut down nerve function

1. Induction of anesthesia in Pts >3 y/o
2. Maintenance of anesthsia in Pts >2 mo.
3. Adults - for monitored care sedation during procedures
4. Sedation in intubated mech. vent. ICU Pts

13

Can you reuse Propofol?

NO - has egg, lecithin & soy

14

Which drug might turn your urine or hair green?

Propofol

Kinetics not affected by obesity, cirrhosis or kidney failure

15

ADRs Propofol

1. HOTN
2. Resp. depressant
3. Dec. cerebral blood flow & ICP

16

What are the 'good' side effects of Propofol?

1. Antipruritic
2. Antiemetic
3. Antiseizure

17

What is Propofol Infusion Syndrome?

Occurs ~48h of propofol infusion
1. Bradycardia leading to asystole
2. HF cardiogenic shock
3. Rhabdo
4. Hyperlipidemia
5. Fatty liver

FFA released into bloodstream causing acidosis

18

What is Etomidate used for?

Induction & maintenance of general anesthesia

Don't use <10 y/o

19

Onset, Peak & duration of Etomidate?

O - 30-60 sec
Great lipid solubility

P - 1 min

D - 3-5 mins
Stop infusion & recover immediately

20

ADRs Etomidate

1. Myoclonus
2. Dec. peripheral vascular resistance
3. Resp.
4. N/V
5. "Cortisol" effect

21

What is Ketamine used for & routes of administration?

Induction & maintenance of general anesthesia

1. IV
2. IM
3. Oral
4. Nasal
5. Rectal
6. SubQ
7. Epidural

22

Onset& duration of Ketamine?

O - 30 sec

D - 5-10 min

23

Who should you be cautious with giving Ketamine?

1. Coronary heart disease
2. Uncontrolled HTN
3. HF
4. Arterial aneurysms

24

ADRs Ketamine

1. Inc. arterial BP
2. Inc. HR
3. Inc. CO

*Emergence phenomenon - disturbing dreams & delirium

25

Uses of Methohexital & what class of drug is it?

1. Induction of anesthesia
2. Procedural sedation

Barbiturate

26

Onset & duration of Methohexital

O - 30 sec

D - 20 min

27

ADRs Methohexital

1. Dec. BP from peripheral vasodilation
2. Inc. HR
3. Dec. vent. response
4. Dec. renal blood flow & dec. GFR
5. Dec. hepatic blood flow

28

Uses of Fentanyl citrate

1. Relief of pain, preop meds, adjunct to gen. anesthesia
2. Block stress response from catecholamines, cortisol, ADH
3. Reduction of dose of other anesthetics like inhaled, propofol, neuromuscular blockers
4. Postop analgesia

29

ADRs Fentanyl citrate

1. Bradycardia
2. Venodilation
3. Dec. sympathetic reflexes
4. Depressed cardiac contractility
5. Hypoxic drive dec.
6. Chest wall rigidity
7. Dec. ICP

30

What should you give a shivering Pt postop?

Meperidine

31

What are the Benzos for anesthesia?

1. Midazolam
2. Diazepam
3. Lorazepam

32

Uses for Midazolam

aka Versed

1. Induction & maintenance of gen anesthesia
2. Preop sedation
3. Moderate sedation prior to diagnostic or radiographic procedures
4. ICU sedation

33

Uses for Dexmedetomidine

1. Sedation prior to &/or during surgical procedures of nonintubated Pts
2. Procedural sedation prior to &/or during awake fiberoptic intubation
3. Sedation of initially-intubated & mechanically-ventilated Pts during Tx in an intensive care setting

34

Uses for Succinylcholine

Depolarizing neuromuscular blocker

To facilitate RSI & routine endotracheal intubation & to relax skeletal muscles during surgery

35

ADRs Succinylcholine

1. Arrhythmias, BP changes, tachycardia
2. Hyperkalemia
3. Jaw rigidity, muscle fasciculation, postop muscle weakness
4. Malignant hyperthermia

36

How can you tell if non-polarizing neuromusclar blockers are wearing off?

Thumb goes in - adductor pollicis

37

How do you reverse Rocuronium?

non-depolarizing neuromuscular blocker

Neostigmine - acetylcholinesterase inhibitor

38

Uses for Rocuronium

1. To facilitate RSI & routine endotracheal intubation & to relax skeletal muscles during surgery
2. Facilitate mechanical ventilation in ICU Pts

39

What is malignant hyperthermia?

Inherited metabolic disorder of skeletal muscle
-Abnormal Ca hemostasis

Rapid onset of extremely high fever w/ muscle rigidity

40

Tx malignant hyperthermia

1. Discontinuing precipitant
2. Manage metabolic acidosis
3. Institute cooling
4. Monitor electrolytes
5. Watch urinary output

41

Uses of Dantrolene

1. Mgmt malignant hyperthermia
2. Prevention of malignant hyperthermia in susceptible Pts
3. Tx of spasticity assoc. w/ UMN disorders