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Surgery Two > 2 - Anesthesia > Flashcards

2 - Anesthesia Flashcards

1
Q

Normal pH of local anesthetics:

A

5.5 - 6.0
Doesn’t work well w/ infected tissue (more acidic)
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 AP

Thinner myelinated nerve fibers are more easily BLK

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3
Q

Advantages of epi in locals

A

Vasoconstrictor
Increased duration of action
Decreased bleeding and volume needed to anesthesia

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4
Q

Disadvantages of epi in locals

A

Increased myocardial activity

Tachycardia
HTN
Dysrhythmias

Avoid pts w/ known CV dz, HTN, DM, thyroidtoxicosis

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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

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7
Q

Toxicity from locals - prodromal sxs

A

Cicrumoral numbness
Tinnitus
Lightheaded / dizzy
Tingling Metallic taste in mouth

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8
Q

Toxicity from locals - CV problems

A

HTN then HOTN
Tachy or brady
V-fib - 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

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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13
Q

Sequence of clinical anesthesia

A

Vasodilation - loss of symp tone

Loss of

  1. Pain/temp sensation
  2. Pressure sensation
  3. Motor fx
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14
Q

Peripheral nerve blocks - common sites?

A

Digit blocks - (Common w/ rib blocks as well)
Plantar aspect of foot
Palmar aspect of hand

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15
Q

Max dose Bupivicaine?

A

2mg/kg up to 100mg

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16
Q

Where is epidural anesthesia injected?

A

Into the epidural space, NOT the CSF

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17
Q

Describe epidurals

A

Skin taped Cath - Req continuous inf of LRG anesthetic volume

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18
Q

Acute complications of nerve blocks

A

HOTN (neurogenic shock) - txt w/ IVF/pressors (v-con)

High spinal - brady-c, HOTN, arm tingling, and respiratory distress (txt-ventilate)(diaphragm C3-C5)

Cauda equina - bladder/bowel dysfx, m/s alts in legs

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19
Q

Dermatomes - Clavicles, nipples, umbilicus

Diaphragm innervation

A

Diaphragm inervation C3-C5
Clavicles - C5
Nipples - T4
Umbilicus - T10

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20
Q

Conscious sedation provides

A

Analgesia and anxiolysis

Minimally depressed LOC

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21
Q

Usual combo for conscious sedation?

A

Benzo + narcotic
OR
Propofol + narcotic

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22
Q

Intubation in conscious sedation?

A

Nope - patient maintains their own airway

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23
Q

Nice perks of conscious sedation?

A

Still follows commands (verbal stimuli)

Doesn’t remember any of it later (antegrade amnesia)

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24
Q

Examples of procedures in which conscious sedation is used

A 
Bronchoscopy
EGD/colonoscopy 
Thoracostomy 
Closed reduction of fx’s
Procedures in kids
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25
Q

What does propofol provide (and not provide)?

A

It’s a sedative-hypnotic
So… anxiolysis, muscle relaxant, anticonvulsant
BUT
NO DIRECT ANALGESIC EFFECT

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26
Q

Patient safety during conscious sedation

A

Req crash cart

  1. Follow SOP’s
  2. NPO prior
  3. ASA class I and II patients
  4. Dedicated staff
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27
Q

Crash cart:

A 
O2
Airway adjuncts
ACLS drugs
Defibrillator
Suction
Narcan - (narc rev)
Flumazenil - (Benzo rev)
28
Q

PACU

A

Home w/ chaperone once goals are met: (ADMIT if not)

  • stable - out of bed for 30mins/amulatory/vitals
  • A/O x3
  • pain / nausea controlled
  • voids
29
Q

Goals of general anesthesia

A

Pain control
Amnesia
Muscle relaxation

30
Q

General anesthesia - airway/breathing mangement

A

Intubate/ventilate Laryngoscope or Glidescope

31
Q

Concerns about eyes w/ general anesthesia

A

Protect eyes (lubricate and tape close)

32
Q

Complications of general anesthesia

A

Hypoxemia
CV events
Aspiration
Nerve injury

33
Q

TXT of MC adverse effects of local anesthetic

A

Txt - O2, Epinephrine, fluids, antihistamine, steroids

34
Q

Lidocaine dosing w/out EPI?

A

4mg/kg up to 300mg

35
Q

Lidocaine dosing WITH Epi

A

7mg/kg up to 300mg

36
Q

1% Lidocaine conc?

A

10mg/mL

37
Q

2% Lidocaine conc?

A

20mg/mL

38
Q

Lidocaine onset?

A

2-5m

39
Q

Lidocaine duration?

A

0.5-2hrs

40
Q

Management of CNS toxicity

A

Hypercarbia - Hyperventilate

Seizures - Benzo

41
Q

Management of CV toxicity

A

HOTN - IVF

Arrythmias - Wide = Shock and Narrow = Rx

42
Q

Management of Malignant hyperthermia toxicity

A

TXT - Cool rapidly, Bicarb, Dantroline

43
Q

Malignant hyperthermia pathophys

A

Hypermetabolism > Fever, Tetany, Hyperkalemia

44
Q

Malignant hyperthermia etiology?

A

Rare inherited condition (MC) from colatile agents and succinylcholine

45
Q

How to prevent toxicity

A

Administer locals in combinations of SML volumes of different agents (Do not max out one thing)

46
Q

Bupivicaine onset?

A

5-10m

47
Q

Bupivicaine duration?

A

2-4hrs

48
Q

Purpose of local anesthetic?

A

Minor surgery/laceration repair

49
Q

What to ensure prior to PNB?

A

Eval neurovascular status prior to injection

50
Q

What procedures is a spinal (subarachnoid) block generally for?

A

GYN
GU
Low ABD
LE

51
Q

Where is a spinal (subarachnoid) block injected?

A

Into the sub-arachnoid space (the CSF)

52
Q

Describe spinal (subarachnoid) block Rx attributes?

A

Anesthetic and Narcotic +/- Epi

53
Q

What does a spinal (subarachnoid) block do to the nervous system?

A

Blocks - Sympathetic, Sensory, and Motor fx (everything)

54
Q

Epidurals block?

A

Blocks sensory but not necessarily motor function

55
Q

Rib fracture preferred anesthesia?

A

Epidurals

56
Q

Late complications of CNB

A

MC - urinary retention

Spinal HA 2/2 CSF leaking out of the dura - ICP decreases with postural changes

Epidural hematoma - compresses spinal cord - suspect if pt is anticoagulated

57
Q

MC late complication of a CNB?

A

Urinary retention -

Monitor UOP post-op (cath w/ foley even w/ BPH)

58
Q

Late CNB complication of Spinal HA TXT

A

txt with IV fluids, caffeine, blood patch (autotransfuse blood into epidural space)

59
Q

Late CNB complication of Epidural hematoma primary concern? And 2nd line anesthesia?

A

Anticoagulanted patient = anesthesia will likely be avoided in these patients (Endotracheal anesthesia)

60
Q

How does a epidural hematoma usually present?

A

Compressed spinal cord causes Loss of neuro fx below infusion site (bladder/legs)

61
Q

Narcotics reversal

A

Narcan

62
Q

Benzo reversal

A

Flumazenil

63
Q

General anesthesia prevention

A 
Protect eyes (lube/tape) 
Pressure points (pad)
PVT hypothermia
Do not hyperextend joints
64
Q

Mitigating aspiration complications during general surgery

A

NPO prior
Antacids
Cricoid pressure during intubation (Sellick maneuver)

65
Q

Sellick maneuver is?

A

A way of reducing aspiration by putting pressure onto the cricoid during intubation.

Surgery Two (9 decks)

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