Flashcards in Quiz 6 Reverse Deck (41):
1. Analgesia2. Amnesia3. Akinesia4. Attenuation of automatic response
4 A's of anesthesia
1. Analgesia2. Excitement3. Surgical anesthesia4. Imminent death
What are the 4 stages of anesthesia?
Minimal Alveolar Concentration-conc. of the agent in the lungs that prevents mvmt in 50% of Pts**Use 1.3x the MAC
What is the MAC?
Inhaled anestheticSedation, analgesia & amnesiaAdjunct to inhalation & IV anesthesia
Use of nitrous oxide
Inhaled anestheticInduction & maintenance of general anesthesia
Use of Sevoflurane
1. Biotransformation2. TransQ loss3. Exhalation 1/2 lives are compartment specific so the times vary
How does anesthesia leave the body?
1. Venous/arterial air embolism2. Pneumothorax3. Acute intestinal obstruction w/ bowel distension4. Intracranial air5. Pulmonary air cysts6. Intraocular air bubbles7. Tympanic membrane graftiingAlso dec. MAC of volatile liquid anesthetics
Who should you be cautious with using Nitrous oxide?
1. Emergence agitation &/or delirium2. Perioperative hyperkalemia3. QT prolongation4. Potential to trigger malignant hyperthermia
Sevofluraneflammable & forms formeldahyde
Which anesthetic do you need to have fresh dessicant?
1. Nitrous oxide2 Sevoflurane
What are the inhaled anesthetics?
1. Propofol 2. Etomidate3. Ketamine4. Methohexital
What are the IV anesthetics?
Affects GABA channels to shut down nerve function1. Induction of anesthesia in Pts >3 y/o2. Maintenance of anesthsia in Pts >2 mo. 3. Adults - for monitored care sedation during procedures4. Sedation in intubated mech. vent. ICU Pts
How does Propofol work & what is it used for?
NO - has egg, lecithin & soy
Can you reuse Propofol?
Propofol Kinetics not affected by obesity, cirrhosis or kidney failure
Which drug might turn your urine or hair green?
1. HOTN 2. Resp. depressant 3. Dec. cerebral blood flow & ICP
1. Antipruritic2. Antiemetic3. Antiseizure
What are the 'good' side effects of Propofol?
Occurs ~48h of propofol infusion1. Bradycardia leading to asystole2. HF cardiogenic shock3. Rhabdo4. Hyperlipidemia5. Fatty liver FFA released into bloodstream causing acidosis
What is Propofol Infusion Syndrome?
Induction & maintenance of general anesthesiaDon't use <10 y/o
What is Etomidate used for?
O - 30-60 sec Great lipid solubilityP - 1 minD - 3-5 minsStop infusion & recover immediately
Onset, Peak & duration of Etomidate?
1. Myoclonus 2. Dec. peripheral vascular resistance3. Resp.4. N/V5. "Cortisol" effect
Induction & maintenance of general anesthesia 1. IV2. IM3. Oral4. Nasal5. Rectal6. SubQ7. Epidural
What is Ketamine used for & routes of administration?
O - 30 secD - 5-10 min
Onset& duration of Ketamine?
1. Coronary heart disease2. Uncontrolled HTN3. HF4. Arterial aneurysms
Who should you be cautious with giving Ketamine?
1. Inc. arterial BP2. Inc. HR3. Inc. CO*Emergence phenomenon - disturbing dreams & delirium
1. Induction of anesthesia2. Procedural sedationBarbiturate
Uses of Methohexital & what class of drug is it?
O - 30 secD - 20 min
Onset & duration of Methohexital
1. Dec. BP from peripheral vasodilation2. Inc. HR3. Dec. vent. response4. Dec. renal blood flow & dec. GFR5. Dec. hepatic blood flow
1. Relief of pain, preop meds, adjunct to gen. anesthesia2. Block stress response from catecholamines, cortisol, ADH3. Reduction of dose of other anesthetics like inhaled, propofol, neuromuscular blockers4. Postop analgesia
Uses of Fentanyl citrate
1. Bradycardia2. Venodilation3. Dec. sympathetic reflexes4. Depressed cardiac contractility5. Hypoxic drive dec.6. Chest wall rigidity 7. Dec. ICP
ADRs Fentanyl citrate
What should you give a shivering Pt postop?
1. Midazolam2. Diazepam3. Lorazepam
What are the Benzos for anesthesia?
aka Versed1. Induction & maintenance of gen anesthesia2. Preop sedation3. Moderate sedation prior to diagnostic or radiographic procedures4. ICU sedation
Uses for Midazolam
1. Sedation prior to &/or during surgical procedures of nonintubated Pts2. Procedural sedation prior to &/or during awake fiberoptic intubation3. Sedation of initially-intubated & mechanically-ventilated Pts during Tx in an intensive care setting
Uses for Dexmedetomidine
Depolarizing neuromuscular blockerTo facilitate RSI & routine endotracheal intubation & to relax skeletal muscles during surgery
Uses for Succinylcholine
1. Arrhythmias, BP changes, tachycardia2. Hyperkalemia3. Jaw rigidity, muscle fasciculation, postop muscle weakness4. Malignant hyperthermia
Thumb goes in - adductor pollicis
How can you tell if non-polarizing neuromusclar blockers are wearing off?
non-depolarizing neuromuscular blockerNeostigmine - acetylcholinesterase inhibitor
How do you reverse Rocuronium?
1. To facilitate RSI & routine endotracheal intubation & to relax skeletal muscles during surgery 2. Facilitate mechanical ventilation in ICU Pts
Uses for Rocuronium
Inherited metabolic disorder of skeletal muscle -Abnormal Ca hemostasis Rapid onset of extremely high fever w/ muscle rigidity
What is malignant hyperthermia?
1. Discontinuing precipitant2. Manage metabolic acidosis3. Institute cooling4. Monitor electrolytes5. Watch urinary output
Tx malignant hyperthermia