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Pain Control > 2/27 - GA > Flashcards

2/27 - GA Flashcards

1
Q

IV sedation definiti

A

administration of a drug which results in the depression of the CNS

the goal is to produce a state of sedation in which the patient maintains protective reflexes, and the respiratory and caridovscular systems are minmially affected

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2
Q

rapid onset of IV?

A

yes - the arm to brain circulation is approx 20-25 seconds

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3
Q

advantages of IV sedation

A
  1. rapid onset
  2. titration
    - the drug dosage may be tailored
    - suitable level of sedation
    - shorter recovery periods
  3. continous IV infusion
    - patent vein is maintained throughout procedure
  4. side effects of nausea and vomiting
    - rare when administrated as suggested (titrated)
  5. salivation
    - control of salivary secretions is possible through the administration of antcholinergics
  6. gag reflex
    - is diminished
  7. diminish motor disturbances
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4
Q

titration

A

titration

  • the drug dosage may be tailored
  • suitable level of sedation
  • shorter recovery periods

advantage of IV sedation

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5
Q

titration

A

titration

  • the drug dosage may be tailored
  • suitable level of sedation
  • shorter recovery periods

advantage of IV sedation

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6
Q

disadvantages of IV

A

venipuncture is necessary

complications may arise at the site of venipuncture

monitoring **– must be more intensive than that rewuired in most other conscious sedation techniques

revoery not complete – Escort is needed

most IV agents CAN NOT BE reversed – have to be metabolized first

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7
Q

indications for IV sedation

A
  1. anxiety
  2. amnesia
  3. med compromised patients
    - angina
    - HBP
    - previous myocardial infarcatin
    - previous cerebrovascular accident
    - epilepsy
  4. control of secretions
  5. analgesia
  6. diminished gagging
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8
Q

contraindications so IV sedation

A

lack of proper training

pregnancy - relative contra

  1. hepatic disease
  2. thyroid dysfunctin
    hyper - thyroid strom could develop
  3. adrenal insufficiency
  4. adrenal insufficiency

patients receiing MAOI’s or TCA’s
- go into seratonin syndrome

extremley obese

inadequte veins

allergy to medications

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9
Q

preganncy in IV sedaion

A

relative contraindication – bcause most CNS depressants cross the placenta – into the fetus and may produce birth defects in the developing fetus

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10
Q

briefly exaplin anesthesia as a continuum

A

can eassily move from a deep sedation to GA

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11
Q

ultra-light GA

A

outpatient general anesthesia using IV barbiturates

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12
Q

advantages of general anesthes eia

A

cooperation not essential

patient is unconscious

patient does not respond to pain

amnesia is present

GA may be the only technique that will prove successful for certain patients

rapid onset

tritration is possible

success rate is 100%

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13
Q

disadvantages of GA

A

patinet unconscious

protective reflexes are depressed

vital signs are depressed

advanced training

anesthesia team is required

special equipment

recovery area must be available

intra-operative and postanestetic complications are more common

patient receiving GA must receive nothing by mouth for 6 hours beore the procedure

patients receiving GA must be evaluated more extensively preoperatively than patients receiving minimal or moderate sedation

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14
Q

contraindications to GA

A

lack of trining

lack of adequatley trained personnel

lack of adequate equipment or facilitities

ASA IV and certain ASA III medically compromised patients

Hx of poliomyelitit in which chest muscles have been involved

Hx of Myasthenia gravis

obese

patients with significantly decreased cardiac and / or pulmonary reserve

patients with a history of malignant hyperthermia

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15
Q

ASA types contraindicated in GA

A

ASA IV and some ASA III

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16
Q

indications for GA

A

extreme anxiety o fear

mentally or physiclly disabled

age - infants and children

short or long traumatic procedures

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17
Q

benefits of outpatient GA vs inpatient

A

economics
psychological benefits

reduced exposure to nonsocomial infections

parental preference

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18
Q

types of GA

A

in - office outpateitn GA
- IV anesthesia - less than 30 minutes
conventional operating theater type of GA more than 30 mins - less than 4 hours

inpatient type

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19
Q

outpatient GA IV using?

A

propofol or barbiturates

N2O2-O2

bensodiaxepine

opiods

LA

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20
Q

outpatient GA -conventional type of operating room GA

A

used in cases 30 mins to 4 hours

patient undergoes same GA prep as the inpatient

limited to ASA I and II – selected III

completed training in anesthesiology

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21
Q

inpatient GA

A

patient admitted to hospital prior to procedure

undergoes workup to determine risk , undergoes procedure and then remains in hospital post-op

ANesthesiologist is responsible for the administration for the anesthetic

22
Q

armamentarium

A 
anesthesia machine
IV equip
ancillary anesthesia equipment 
monitoring equip 
emergency equipment and drugs
23
Q

ancillary anesthesia equipment

A

face masks and appropriate connectors

laryngoscopes, blades

24
Q

monitoring equipment

A

stethoscopes

  • precordial
  • pretracheal
  • esophageal
pulse oximeter
end-tidal CO2
blood pressure cuff
ECG
temperature
25
Q

TIVA

A

total inervenous anestesethsai

26
Q

endotracheal tubes and connectors

A

part of armamentarium

27
Q

LMA

A

does not get fully patent airway

- used in the field more

28
Q

Bispecteral electroencephalographic monitoring

A

BIS monitoring

-

29
Q

intra arterial blood pressure

A

degree of accuracy is great but not really needed during outpaient sedation

indicaed in both general anesthetic proccedures involving greater degree of risk
- neuro or cardiac surgery
and when degree of risk presented by the patient (ASA IV or V) is significant

30
Q

types of benzodiazepines used

A

diazepam - valium

midazolam - versed

31
Q

mechanism of benzo’

A

becoming less excitebale

32
Q

contraindications to benzo

A

allergy to diazepam

acute narrow glaucoma and wide angle glacuoma

33
Q

contraindications to benzo

A

allergy to diazepam

acute narrow glaucoma and wide angle glacuoma

psychosis

pregnancy

34
Q

versed aka

A

midazolam - benzo

35
Q

used more versed vs valium

A

versed – need to know the comparisons of these

versed is more potent

36
Q

barbiturates?

A

not used as much today

37
Q

barbiturates?

A

not used as much today

38
Q

pentobarbital

A

barbitruate

39
Q

reversal agent to benzo

A

flumazenil

40
Q

flumazenil

A

reversal agent to benzo

contraindicated in

  • allergy to benzo or flumazenil
  • if being treated for stuff on benzo’s like status epilepticus, or control of intracranial pressure
41
Q

opioid antagonist

A

naloxone

42
Q

most commonly used

A

nitrous

43
Q

nitrous oxide not used for GA?

what is its use

A

not strong enough – not potent enough

MAC is not high enough to get to general

second gas effec**

44
Q

primary function of nitrous oxide in GA?

A

in GA it is used to potentiate the actions of the other more potent drugs (IV or inalation) and thus permits a smaller dose or lesser concentration of this drug needed to produce the desired level of GA

45
Q

neuroleptanesthesia

A

type of GA that is produced by the administration of

  • neuroleptic drug (droperidol)
  • opiod - fentanyl
  • nitrous oxide -oxygen
  • muscle relaxant
46
Q

dissociative anesthesia

A

type of GA
- dissociative anesthesia and analgesia as produced by ketamine

patient appears to be awake

maintain many reflexes

unaware of,or dissociate from the environment

47
Q

disadvantages of ketamine

A

increased heart rate, blood pressure and intraoclular pressure

eye movements and nystagmus can occur

no antagonist is available for it

can produce a confused state, associated with unpleasant dreams and frightening hallucinatins
(more common to occur with adults ) – so use with a benzzo

48
Q

disadvantages of ketamine

A

increased heart rate, blood pressure and intraoclular pressure

eye movements and nystagmus can occur

no antagonist is available for it

can produce a confused state, associated with unpleasant dreams and frightening hallucinatins
(more common to occur with adults ) – so use with a benzzo

49
Q

four mechanisms of muscle relaxants

A
  1. deficiency block
  2. nondepolarizing block
  3. depolarizing block
  4. dual block
50
Q

no drug ever exerts a single action?

A

true

Pain Control (12 decks)

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