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Anesthesia -Scott Newman & Janet King > Unit 1 Notes > Flashcards

Flashcards in Unit 1 Notes Deck (102):
1

Define anesthesia

A loss of sensation; especially to pain

2

What are the 3 basic types of anesthesia?

Local, regional, and general

3

Which basic type of anesthesia is the only one that renders the patient unconscious?

General anesthesia

4

Define local anesthesia

A loss of sensation confined to a small/limited part of the body

5

What are the two types of local anesthesia?

Topical and injectable

6

Which type of local anesthesia is most commonly used?

Injectable

7

Where are topical local anesthetics applied?

Mucous membrane areas of the body

8

Route of administration for injectable local anesthetics and how they work

*Parenteral (SQ) By blocking the transmission of nerve impulses to that area

9

Name a few surgical procedures we commonly use local anesthetics for

Skin biopsies Laceration repairs Small tumor removals

10

6 advantages of local anesthetics

Decrease in patient toxicity, Minimal patient recovery time, Cheaper, Provides analgesia, Ideal for high risk patients, Less equipment

11

3 Disadvantages for the use of local anesthetics

Patient restraint, concise placement of drug, no control of drug once injected

12

Typically, all drugs ending in "-caine" are what kind of drug?

Local anesthetics

13

Which of the "-caines" are the oldest and still most commonly used in practice today?

Lidocaine

14

Which local anesthetic is in the triple antibiotic ointment that we use on post-op incisions?

Tetricaine

15

Lidocaine =

Xylocaine (R)

16

Bupivicaine =

Marcaine (R)

17

Mepivicaine =

Carbocaine (R)

18

Procaine =

Novocaine (R)

19

Why would epinephrine EVER be added to a local anesthetic?

To provide longer duration of action of a local anesthetic.

20

Define regional anesthesia

A loss of sensation affecting an area or region of the body

21

Where are regional anesthetics typically injected?

Around a group of nerves

22

What is the most common example of regional anesthesia?

Epidural

23

Where is an epidural administered?

SQ: between L7 and Sacrum

24

Why do we use epidurals?

Provides analgesia for up to 24 hours

25

What is the form of anesthesia called that is injected along the spinal cord on either the left or right side of the spine that causes only 1/2 of the abdomen to be anesthetized?

Paralumbar nerve block

26

What procedure and animal do we commonly use paralumbar nerve blocks for?

C-sections in cattle

27

Define general anesthesia

A loss of sensation and consciousness of the patient

28

What 4 things does general anesthesia ideally include?

Hypnosis/unconsciousness, Hyporeflexia, Analgesia, Muscle relaxation

29

What is the family of drugs that typically causes muscle rigidity?

Cylohexamines

30

What are the two ways in which we can achieve general anesthesia?

via injectables or inhalants

31

Injectable general anesthesia (ex: CRI) is done by what route of administration and typically for what kind of patients?

IV/IM for fractious patients

32

What are general anesthetic inhalants?

Anesthetic gases

33

How are GA inhalants delivered to the patient?

Via mask, ET tube, or chamber

34

What are GA inhalants typically used in conjunction with?

Injectable anesthetics

35

What are the 4 components of general anesthesia?

PA Induction Maintenance & Recovery

36

Define PA period

The period of time immediately preceding induction in which you prepare yourself and your patient for the anesthetic procedure.

37

What is the induction period?

Process by which the patient leaves the normal state of consciousness and enters an unconscious state

38

How long should the induction period typically be and how is it achieved?

Less than 1 min. achieved by the use of injectable/inhalant drugs

39

Define maintenance period

Period following induction in which a stable level of anesthesia is achieved

40

Define recovery period

Period of time following the discontinuance of anesthetics and when the patient's vital signs are WNL.

41

What is surgical anesthesia?

General anesthesia at a level that allows a surgical procedure to be performed without the patient moving or consciously perceiving pain.

42

What is balanced anesthesia?

Anesthesia that uses a combination of drugs to achieve the desired effects

43

What is dissociative anesthesia?

Produced by cyclohexamine anesthetics that interupt the pathways of the brain.

44

What are the 3 effects of dissociative anesthesia?

Allows brain to dissociate bodily pain, Produces loss of sensation (but not GA), Produces cataleptic state

45

What is catalepsy?

Muscle rigidity

46

What 2 drugs, mentioned in class, cause catalepsy?

Ketamine and Tiletamine

47

What is analgesia?

Absence of stimulus that would normally produce pain

48

Wind up effect

Pain receptors called Nociceptors, once stimulated, can stimulate other pain receptors in the body. Once pain starts, non-painful stimuli can be perceived anywhere in the body (other than where it originated) as actual pain.

49

What are the 3 most commonly used analgesic drugs? Of these 3, which one is the best?

Opioids (best), NSAIDs, and local anethetics

50

What are the 2 main advantages of providing analgesia?

Patient comfort and provides more effective healing at incision site

51

What are the 3 disadvantages (myths) of analgesics?

Cost to the client, controlled substance issues, and patient reinjuring themselves

52

What is the TRUE disadvantage of analgesics?

Adverse systemic effects: respiratory depression and hepatotoxicity

53

What is the universal color for O2 tank?

Green

54

Universal color for NO2 tank?

Blue

55

How much psi can an E tank hold? An H tank?

Both can hold ~2000-2200 psi

56

How many liters of O2 can an E tank hold? An H tank?

E tank= 600-660L O2, H tank= ~7000L O2

57

How are O2 tanks sized?

By alphabet (A is the smallest)

58

What is the formula for finding out how many liters are left in a E tank?

psi x 0.3 = liters of O2/Patient's O2 flow rate in L = min (round to whole min) or hours (round to 10ths)

59

When is it recommended to change out an O2 tank?

When O2 pressure gauge reaches >500 psi

60

What is the function of the O2 pressure regulator?

To reduce the pressure from the compressed gas cylinders to a working constant pressure of about 45-50 psi

61

What is the function of the flow meter?

To reduce the pressure in the system to 12-15 psi and to deliver calculated O2 to the patient

62

What are the 2 different styles of flow meters?

Ball or column

63

How many kgs should a patient be for use of a rebreathing system? Non-rebreathing sytem?

Rebreather= >7kg, Non-rebreather=

64

2 other names for a rebreathing system

Semi-closed (partial rebreathing) or circle system

65

What is the flow rate formula for patients >7kg? Patients

>7kg= 30 ml O2/kg/min,

66

What is a VOC?

Vaporizer-out-of-circuit / Precision vaporizer

67

What kind of gases are VOC/Precision vaporizers used in?

High vapor pressure gases

68

What does it mean when it is said that the patient is receiving "fresh gas"?

Patient is receiving O2 saturated with anesthetic gas

69

If a precision vaporizer is VOC, then a non-precision vaporizer is ______

VIC (Vaporizer-in-circuit)

70

How does a VIC (non-precision vaporizer) differ from a VOC (precision vaporizer)?

*VIC is a draw over vaporizer, which means that the patient's breathing moves the O2 through the vaporizer and then volatizes gases (pt's breathing controls the % of anesthetic)

71

True or False: High vapor pressure gases may be used in a VIC (non-precision vaporizer)

False: Only low vapor pressure gases should be used in a non-precision vaporizer

72

What is the function of the reservoir bag?

Stores gases entering the system (patient can breath more easily from), allows for respiration rate, depth, and character to be observed during surgery, and allows us to manually ventilate our patient

73

What is PPV?

1. Positive Pressure Ventilation/ manual ventilation of the patient/ "bagging" the patient

74

Name the 2 main reasons why we need to do PPV

2. To blow-off excess CO2 for the patient and to prevent atalectasis

76

Formula for reservoir bag size

60ml x kg = nearest whole L

78

Why is the use of both unidirectional valves required on a breathing circuit?

To prevent the patient from rebreathing exhaled gases that contain CO2

79

What is the function of the inhalation unidirectional flutter valve?

To allow a one-way flow of gases to the patient

80

What is the function of the exhalation unidirectional flutter valve?

To allow a one-way flow of exhaled gases to re-enter the anesthetic machine

81

What is the function of the scavenge?

Prevents exhaled gases (that are in excess to the patient's requirements) from escaping into room air by safely directing and removing them from the patient, the breathing circuit and the anesthetic machine into the scavenger. OSHA required.

82

What are the 2 types of scavenge systems?

Active and Passive

83

How does the active scavenge work?

By using suction to draw gas from the machine and into the scavenger

84

How does the passive scavenge work?

By using the positive pressure of the gas in the machine to push the exhaled gases into the scavenge

85

What is the brand name for the passive scavenge?

F-air Canister

86

What common substance is the passive scavenge made up of?

Charcoal

87

When should an F-air canister be changed?

After 12 total hours of use or once canister reaches 50 grams of waste

88

How should an F-air canister be stored?

In an upright position (especially when in use) without the bottom holes covered

89

What is the technical name for the "pop-off" valve?

Positive pressure relief valve

90

What is the function of the pop-off valve?

To vent excess gas, To prevent the build up pf pressure within the system

91

Name the only 4 reasons for the pop-off valve to ever be closed

1.To ventilate the patient* 2.To check for leaks in the system* 3.If using a 6 step NRB system 4.If using closed system anesthesia

92

What is the function of the CO2 absorbing canister?

To prevent the patient from rebreathing CO2

93

What are the 2 different kinds of granules that can be used in the CO2 absorbing canister?

Soda Lime granules or barium hydroxide lime granules

94

What is the function of the pressure manometer?

To measure the pressure of gases within the patient's breathing system, and therefore patient's airway and lungs.

95

When is the pressure manometer most often used?

When ventilating the patient and during leak checks

96

What pressure should not be exceeded when we ventilate or check for leaks in the system?

15-20cm H2O

98

What is the negative pressure relief valve for?

It is a safety device only. It allows room air to enter the circuit.

99

What is another name for an F-circuit and what is it used for?

*Uni-limb system

100

What is the name of the system when the pop-off is completely closed and all gases exhaled remain in the system?

Closed circle system (total rebreathing)

101

Two names for non-rebreathing systems

Ayres T Piece or Bain Circuit

102

3 steps to non-rebreathing system hook-up

1. adapter to outlet port from vaporizer 2. hook up scavenge 3. open pop-off valve on RB tubing

103

What is the disadvantage to a non-rebreathing system?

Does not incorporate the negative pressure relief valve

104

Why is the 6 step NRB system the safest of all 3?

It incorporates the use of the negative pressure relief valve

105

What is the purpose of performing a pressure check?

To ensure that the circuit is tightly sealed so that there's no leakage of gases into the room air