1 Anesthetics (General and Local)

Question 1

_________ anesthetics are usually administered during more extensive surgical procedures

Answer 1

General anesthetics are usually administered during more extensive surgical procedures

Question 2

Local anesthetics are given when analgesia is needed in a relatively _____, _____________ area, or when a patient needs to ___________________.

Answer 2

Local anesthetics are given when analgesia is needed in a relatively small, well-defined area, or when a patient needs to remain conscious during surgery

Question 3

Physical Therapists need to have a knowledge of the residual effects that may occur when the patient is recovering from anesthesia because…

Answer 3

This will help the PT understand that anesthesia may directly influence the therapy session.

Question 4

Anesthetic agents must produce each of the following conditions:

Answer 4

• Loss of consciousness and sensation
• Amnesia ( no recollection )
• Skeletal muscle relaxation ( with skeletal muscle blockers)
• Inhibition of sensory and autonomic reflexes
• A minimum of toxic side effects
• Rapid onset of anesthesia; easy adjustment of the anesthetic dosage during the procedure; and rapid, uneventful recovery after administration is treminated

Question 5

What is stage 1 of general anesthesia?

Answer 5

Analgesia

Patient lose somatic sensation
Still conscious and somewhat aware

Question 6

What is stage 2 of general anesthesia?

Answer 6

Excitement/ delirium

Unconscious and amnesiac
*agetated and restless
Undesirable
Move to stage 3 quickly

Question 7

What is stage 3 of general anesthesia?

Answer 7

Surgical anesthesia

This level is desirable for the surgical procedure and begins with the onset of regular deep respiration.

Question 8

What is stage 4 of general anesthesia?

Answer 8

Medullary Paralysis:

Cessation of spontaneous respiration because respiratory control centers located in the medulla are inhibited by excessive anesthesia.

The ability of the medually vasomotor center to regulate blood pressure is also affected. Respiratory and circulatory support must be provided or the patient will die.

Question 9

How many stages of general anesthesia are there?

Answer 9

4

Question 10

What are the 2 primary roots of administration for general anesthetics?

Answer 10

Intravenous and inhaled

Question 11

How long are general anesthesias typically stored in adipose?

Answer 11

*not starred

3-4 days

Question 12

What is dissociative amnesia?

Answer 12

Dissociative anesthesia - the patient appears detached and dissociated from their surroundings. Pt appears awake, but sedated

Twilight

Caused by ketalar

Question 13

What is a neuroleptanalgesia?

Answer 13

Neuroleptanalgesia- used for short surgical procedures.

Characterized by dissociation from surroundings with or without loss of consciousness.

Question 14

What is a common preoperative medication used to relax the patient and reduce anxiety?

Answer 14

Valium/ barbiturates

Opioids

Question 15

Which drugs are used preoperatively to decrease vomiting and produce sedation?

Answer 15

Antihistamines

Question 16

Which drugs are used preoperative to decrease pain and vomiting?

Answer 16

Anti-inflammatory/ dexamethisone

Question 17

True or false: neuromuscular blockers are used with general anesthesia because skeletal muscle paralysis is essential during surgical procedures.

Answer 17

True

Question 18

Local anesthesia produces a ___________.

Answer 18

Local anesthesia produces a loss of sensation in a specific body part or region

Question 19

The goal of a local anesthetic is…

Answer 19

Goal is to block afferent neural transmission along the peripheral nerve so the procedure is painless

Question 20

What are the advantages of local anesthetics?

Answer 20

• Rapid recovery
• Lack of residual effects
• No post operative confusion
• No lethargy
• No hospital stays
• Does not interfere with cardiovascular, respiratory, and renal functioning
• No neonatal general anesthesia

Question 21

What are the disadvantages of using a local anesthetic?

Answer 21

• Length of time required to establish an anesthetic effect.

* Risk that analgesia will be incomplete, or insufficient.

Question 22

What are some non surgical uses for local anesthetics?

Answer 22

• not starred

• Short term pain relief for musculoskeletal and joint pain

• Long term for pain relief in cancer, or
treatment of chronic pain

• Block efferent sympathetic activity in reflex sympathetic dystrophy

Question 23

What are the pharmacokinetics of local anesthetics?

Answer 23

• Variety of administration techniques
• Drug should remain it the site of administration

• A vasoconstricting agent is often
administered simultaneously to help
prevent washout from the desired site

• Local anesthetics can cause toxic side effects when sufficient amounts reach the systemic circulation

• Local anesthetics are eliminated by
hydrolyzing or breaking apart the drug molecule

• Kidneys then excrete the drug metabolites

Question 24

True or false: a local anesthetic can be topically applied to the skin, mucus membrane or cornea.

Answer 24

True

Question 25

When would a topical local anesthetic be used?

Answer 25

- Used for symptomatic relief of minor surface irritation and injury - Used to reduce pain prior to minor surgical procedures – wound care - used to improve motor function in muscle hyertonicity after a CVA or TBI

Question 26

Transdermal administration of local anesthetics are enhanced with _________.

Answer 26

electrical current; iontophoresis, | phonophoresis

Question 27

How are infiltration local anesthetics are administered? What is their use?

Answer 27

• Drug is injected directly into selected tissue, allowing it to diffuse to sensory nerve endings within the tissue • It saturates the area, so that minor procedures can be performed

Question 28

What is a peripheral nerve block?

Answer 28

Anesthetic is injected close to the nerve trunk | so that transmission along the peripheral nerve is interrupted

Question 29

When are peripheral nerve blocks commonly used?

Answer 29

Common in dental procedures, and block | peripheral nerves to allow surgical procedures of the hand, foot, and shoulder

Question 30

What's the difference between a minor nerve block and a major nerve block?

Answer 30

Minor block = one distinct nerve major block = several peripheral nerves

Question 31

What is a central neural blockage?

Answer 31

Drug is injected into space surrounding spinal cord.

Question 32

What are the two types of central neural blockades?

Answer 32

• Epidural blockade – injection of drug into epidural space • Spinal nerve block – injection into subarachnoid space • Usually between L3-L4 or L4-L5 • Risk of neurotoxicity

Question 33

True or false: A spinal nerve block allows for motor function to continue and is used for birthing.

Answer 33

False: epidural blocks allow for motor function and are used for birthing. Spinal nerve blocks are used for c sections and stop motor and sensory sensations

Question 34

What is a sympathetic block?

Answer 34

Break pain cycle • Used for selective interruption of efferent discharge * Used for complex regional pain syndrome CRPS, and RSDS * Injection into the sympathetic chain ganglion * Performed in series of 4 • Goal is not to provide analgesia, but to impair efferent sympathetic oitflow

Question 35

What is another name for a bier block?

Answer 35

Intravenous regional anesthesia

Question 36

What is intravenous regional anesthesia?

Answer 36

Intravenous Regional Anesthesia ( Bier block) * injected into a peripheral vein * Local vasculature carries the drug to the nerves in the limb * Can be applied with a tourniquet to prevent drug from reaching systemic circulation

Question 37

Local anesthetics work by blocking ______ ______ _______ along ________ ______ ( working on _____ _____)

Answer 37

Local anesthetics work by blocking action potential propagation along neuronal axons ( working on sodium channels)

Question 38

Local anesthetics can inadvertenly _______________ and ___________ if drug reaches the systemic circulation

Answer 38

Local anesthetics can inadvertenly disrupt | the excitability of the CNS and cardiac tissue if drug reaches the systemic circulation

Question 39

What are the side effects of local anesthetics?

Answer 39

• Side effects: confusion, agitation, excitation, seizure, impaired respiratory function, cardiac depression

Question 40

What are the symptoms of CNS toxicity?

Answer 40

• Symptoms of CNS toxicity: ringing/buzzing in the ears, agitation, restlessness, decreased sensation around the mouth

Question 41

Working with pt with neural blocks, PT | must be aware of pts ______________ to avoid harm with __________.

Answer 41

PT must be aware of pts decrease sensation | to avoid harm with modalities

Question 42

Working with pt with neural blocks, PTs must be aware of _______ ________ for ambulation training

Answer 42

PTs must be aware of decrease motorfunction for ambulation training

Question 43

Choose: Local anesthetics block (afferent/efferent) (sympathetic/parasympathetic) activity.

Answer 43

Efferent sympathetic activity