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Senior - Surgery 2 > 2 - Anesthesia > Flashcards

2 - Anesthesia Flashcards

1
Q

Normal pH of local anesthetics:

A

5.5 - 6.0

Do not work well in infected tissue (more acidic environment)

Can add bicarb to buffer

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2
Q

How do most local anesthetics work?

A

Block Na channels and impair propagation of action potentials

Thinner nerve fibers and myelinated fibers are more easily blocked

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3
Q

Advantages of epi in locals

A

Vasoconstrictor
Increased duration of action
Decreased bleeding
Decreased volume needed for anesthesia

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4
Q

Disadvantages of epi in locals

A

Increased myocardial activity

Tachycardia
HTN
Dysrhythmias

Avoid in pts with known cardiac dz, HTN, DM, thyroid problems

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5
Q

Describe the ideal anesthetic

A 
Short latency
Superior penetration
Non-addictive
Completely reversible
Low toxicity
Stable and water soluble
Non-irritating
Inexpensive
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6
Q

MC adverse effects of local anesthetic

A

Urticaria
Erythema
Edema
Dermatitis

Txt - O2, Epinephrine, fluids, antihistamine, steroids

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7
Q

Toxicity from locals - prodromal sxs

A

Cicrumoral numbness / mouth tingling
Tinnitus
Lightheaded / dizzy
Metallic taste in mouth

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8
Q

Toxicity from locals - CV problems

A

HTN then HOTN
Tachy or brady
CV collapse

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9
Q

Toxicity from locals - severe CNS:

A

Tonic-clonic activity

ALOC -> unconsciousness

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10
Q

What do you do prior to injecting to avoid intravascular injection?

A

Aspirate first

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11
Q

Bupivicaine not recommended for:

A

Kids under 12yrs

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12
Q

Lidocaine dosing

A

Maximum dose 4mg/Kg WITHOUT epinephrine up to 300mg

Maximum dose 7mg/Kg WITH epinephrine up to 300mg

1% lidocaine has 10mg/ml •

2% lidocaine has 20mg/ml •

Onset 2-5 minutes •

Duration 0.5-2 hours

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13
Q

Management of toxicity

A

CNS sxs? Hyperventilate

CV sxs? IV fluids for HOTN, txt the arrhythmia

Malignant hyperthermia - MC to succ - txt with rapid cooling, bicarb, dantroline

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14
Q

Method for injecting local

A

Large coverage with one puncture (longer, small gauge needle

Bent 45 degrees, hub the needle, inject as you withdraw

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15
Q

Sequence of clinical anesthesia

A

Vasodilation - loss of sympathetic tone

Loss of pain/temp sensation

Loss of pressure sensation

Loss of motor function

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16
Q

Peripheral nerve blocks - common sites?

A

Plantar aspect of foot
Palmar aspect of hand

Aseptic technique

17
Q

Max dose Bupivicaine?

A

2mg/kg up to 100mg

18
Q

Describe spinal (subarachnoid) block

A

Lower abdominal
Lower extremity
GU
GYN

Small volume of concentrated solution (anesthetic, narcotic, with or without epi)

Blocks sympathetic, sensory, motor function

19
Q

How to prevent toxicity?

A

Combine small amounts of different agents

Better than maxing out one thing

20
Q

Where is epidural anesthesia injected?

A

Into the epidural space, NOT the CSF

21
Q

Describe epidurals

A

Catheter taped to the skin

Requires continuous infusion of larger amounts of anesthetic

Blocks sensory but not necessarily motor function

Good for rib fx’s

22
Q

Acute complications of nerve blocks

A

HOTN (neurogenic shock)
- txt with fluids and pressors

High spinal - bradycardia, HOTN, arm tingling, respiratory distress (must ventilate)(diaphragm innervated by C3-C5)

Cauda equina - bladder and bowel dysfunction, motor and sensory changes in legs

23
Q

Later complications of central nerve blocks

A

MC - urinary retention
Monitor post-op UOP
May need catheterization (a foley is fine, they don’t need a suprapubic catheter)

Spinal HA 2/2 CSF leaking out of the dura - ICP decreases with postural changes - txt with IV fluids, caffeine, blood patch (autotransfuse blood into epidural space)

Epidural hematoma - compresses spinal cord - suspect if pt is anticoagulated - anesthesia will likely be avoided in these patients

24
Q

Dermatomes - Clavicles, nipples, umbilicus

A

Clavicles - C5
Nipples - T4
Umbilicus - T10

25
Q

Conscious sedation provides

A

Analgesia and anxiolysis

Minimally depressed level of consciousness

26
Q

Usual combo for conscious sedation?

A

Benzo and narcotic

OR

Propofol and narcotic

27
Q

Intubation in conscious sedation?

A

Nope - patient maintains their own airway

28
Q

Nice perks of conscious sedation?

A

Still follows commands

Doesn’t remember any of it later

29
Q

Examples of procedures in which conscious sedation is used

A 
Bronchoscopy
EGD/colonoscopy 
Thoracostomy 
Closed reduction of fx’s
Procedures in kids
30
Q

What does propofol provide (and not provide)?

A

It’s a sedative-hypnotic

So… anxiolysis, muscle relaxant, anticonvulsant

BUT

NO DIRECT ANALGESIC EFFECT

31
Q

Patient safety during conscious sedation

A

Have a crash cart there

Follow your SOP’s

NPO beforehand

ASA class I and II patients

Pt has a dedicated staff member (nurse) to monitor vitals, etc

32
Q

Crash cart:

A 
O2
Airway adjuncts
ACLS drugs
Defibrillator
Suction
Narcan
Flumazenil
33
Q

PACU

A

Home once goals are met:

  • stable out of bed for 30mins
  • stable vitals
  • fully responsive
  • ambulatory
  • oriented
  • pain / nausea controlled
  • voiding
34
Q

Goals of general anesthesia

A

Pain control
Amnesia
Muscle relaxation

35
Q

General anesthesia - airway mangement

A

Intubate or supraglottic

Laryngoscope or Glidescope

36
Q

Fluids and blood products during general anesthesia

A 
Central vs peripheral lines
Continuous vitals
IV fluids and UOP
Protect eyes and pressure points
Prevent hypothermia
37
Q

Complications of general anesthesia

A

Hypoxemia

Aspiration (NPO pre-surgery, may use antacids, Sellick during intubation)

Nerve injury (pad the pressure points, do not hyperextend joints, lubricate and tape eyes closed

38
Q

How do you feel about a local anesthetic?

A

Actually, I’d prefer an imported one.

Senior - Surgery 2 (9 decks)

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