[216B] Anesthesia (Zoom Lec) Flashcards

1
Q

Define anesthesia.

A

Sedation of a pt for a medical procedure/intervention.

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2
Q

List the 4 types of anesthesia. Which are systemic?

A
  1. Local anesthesia.
  2. Regional anesthesia.
  3. General anesthesia: systemic.
  4. Monitored anesthesia care (MAC): systemic.
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3
Q

Is it possible to administer regional anesthesia systemically?

A

Yep :)

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4
Q

MAC is sedation at ____ levels to maintain the pt’s ___ without __________ them.

A

low; vitals; intubating.

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5
Q

Local anesthetics are also known as:

A

Sodium channel blockers.

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6
Q

Describe the mechanism of action for local anesthetics.

A

Block Na+ influx into neurons > no action potential/depolarization = no communication of sensory info to brain.

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7
Q

Do local anesthetics affect the efferent or afferent nervous system?

A

Both c:< but depending on the drug, it may have more affinity for one pathway vs the other.

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8
Q

Local anesthetics are lipo_____, meaning they have a:

A

lipophilic = high VD.

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9
Q

Which now-street drug was the original local anesthetic?

A

Cocaine :D

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10
Q

Cocaine ________ dopamine, resulting in:

A

increases = CNS stimulation.

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11
Q

Which 3 routes of admin may be used with local anesthetics?

A
  1. Topical.
  2. Infiltration (SC injection into tissue).
  3. Nerve block (SC injection near a large nerve bundle).
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12
Q

List 3 adjunct medications for local anesthesia.

A
  1. Epinephrine (adrenalin).
  2. Sodium bicarbonate.
  3. Opioids.
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13
Q

Why is epinephrine a good adjunct medication for local anesthesia? (2)

A
  1. Localized vasoconstriction = bleeding control.

2. Increased duration of action for the anesthetic.

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14
Q

Why is sodium bicarbonate a good adjunct medication for local anesthesia?

A

Alkalization of tissue in case of bacterial environment.

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15
Q

Epidurals are a form of _______ anesthesia.

A

Local.

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16
Q

How do we verify the location of our epidural injection?

A

Check that there is no CSF return in the needle.

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17
Q

If a pt has had an epidural, we should assess their ______ & ______ ability before mobilizing them.

A

Sensory & motor.

18
Q

Onset of epidural: __-__ mins.

A

20-30 mins.

19
Q

Spinals (“intrathecals”) are a type of _______ anesthesia.

A

Local.

20
Q

In a spinal, the drug is delivered directly to the ______ in the _________/_________ space.

A

CSF; intrathecal/subarachnoid space.

21
Q

How many doses can we give in a spinal? Why?

A

Only 1 to prevent infection - need sufficient anesthetic in that one dose.

22
Q

We should always inject spinals below ___ to:

A

L2 to avoid spinal cord damage

23
Q

Why does the tonicity of our injection matter in a spinal?

A

The higher the tonicity, the lower it will stay (because it’s “heavier” than its surroundings). We need it to stay at or below the injection site, so the tonicity of the injection will be site-dependent.

24
Q

Spinals are often used for procedures being done in the ____________ region.

A

Abdominopelvic.

25
Q

With spinals, there is a risk of _______ ________ if the ________ is accidentally affected.

A

Respiratory depression; diaphragm.

26
Q

Epidurals continuously infuse via an ________ _________. What should we monitor while using this device?

A

Indwelling catheter.

Monitor placement of catheter for potential migration.

27
Q

Which requires a higher dose of anesthetic: spinal or epidural? Why?

A

Epidural, because spinals are directly into the CSF, so a lower dose is needed to be effective.

28
Q

The 2 goals of general anesthesia are:

A
  1. Analgesia.

2. Unconsciousness.

29
Q

Which analgesic class might we use in general anesthesia? Which drug specifically?

A

Opioids (ex: morphine, fentanyl).

Fentanyl is fairly common: very potent = lower dose needed = decreased side effects.

30
Q

List the 2 steps in achieving unconsciousness in general anesthesia.

A
  1. Induction: beginning of the loss of consciousness.

2. Maintenance.

31
Q

General anesthetics causing unconsciousness may be: (2 routes)

A
  1. Inhaled.

2. IV.

32
Q

General anesthetics ________ GABA.

A

increase.

33
Q

List 3 meds that may be used as inhaled general anesthetics.

A
  1. NO (“laughing gas”).
  2. Halothane.
  3. Isoflurane.
34
Q

Which drug is a commonly used IV general anesthetic? What drug class is it similar to?

A

Propofolol (Diprivan) - barbituate-like.

35
Q

List 4 considerations when using propofol (Diprivan).

A
  1. Rapid onset.
  2. Short t1/2.
  3. Intubation required.
  4. Monitor vitals (hypotension).
36
Q

Paralytics block ___ (neurotransmitter) binding at _______ receptors.

A

Ach at nicotinic receptors.

37
Q

Nicotinic receptors are found in: (3)

A
  1. The SNS.
  2. The PNS.
  3. Skeletal muscle junctions.
38
Q

Do paralytics help with sedation?

A

No :0 they don’t cross the BBB.

39
Q

Do pts on paralytics need to be intubated?

A

Yes – drugs will paralyze all muscles, including the diaphragm.

40
Q

Name 5 paralytics.

A
  1. Vecuronium.
  2. Rocuronium.
  3. Pancuronium.
  4. Succinylcholine.
  5. Botox.
41
Q

What class of drugs is used for MAC?

A

CNS depressants: ketamine, benzos (ex: midazolam (Versed).