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OMC V, Module II > 4. Ambulatory Anesthesia > Flashcards

4. Ambulatory Anesthesia Flashcards

1
Q 
Potential Candidates
• \_\_\_\_ or fearful
• Young children
• Behaviorally \_\_\_\_
• Hyperactive gag reflex
• Those undergoing an \_\_\_\_ or extensive procedure
A

anxious
challenged
invasive

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2
Q

Mortality rates
• Range from 7.9 per 10,000 to 1 per 400,000
anesthetic cases
This is something that is ____
• 65 to 87% of them is due to ____ error
• The most common problem is failure to ____ a
patient

A

correctable
human
ventilate

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3
Q
  • From 1988 to 2004, performed 29.6 million
  • 40 deaths, 2 brain dead
  • 1:7____
A

700,000

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4
Q

Continuum of Consciousness
• when you think of sedation you want to think of it on an continuum of ____
• On this end, it’s going to be the ____ patient, totally conscious
• And on the other end, general anesthesia, the patient with be completely
____

A

consciousness
awake
unconscious

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5
Q

Levels of Sedation
• Minimal sedation is equivalent to ____, that is, a ____- induced relief of apprehension with ____ effect on sensorium.

  • Moderate sedation is a depression of consciousness in which the patient can ____ to external stimuli (verbal or tactile). Airway reflexes, spontaneous ventilation, and cardiovascular function are ____.
  • Deep sedation is a depression of consciousness in which the patient ____ be aroused but responds purposefully to repeated or painful stimuli. The patient may not be able to maintain ____ reflexes or spontaneous ventilation, but ____ function is preserved.
  • General anesthesia is a state of ____; the autonomic nervous system is ____ to respond to surgical or procedural stimuli.
A

anxiolysis
drug
minimal

respond
maintained

cannot
airway
cardiovascular

unconsciousness
unable

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6
Q 
Assessment by Observation
• Fully \_\_\_\_
• Drowsy
• Response to \_\_\_\_ 
• Response to touch 
• Response to \_\_\_\_ 
• No response
A

awake
voice
pain

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7
Q 
Routes of Administration
• \_\_\_\_
• Inhalation
• \_\_\_\_
• Intramuscular 
• \_\_\_\_
• Submucosal
• \_\_\_\_
• Subcutaneous 
• \_\_\_\_
• Intraosseous
A 
oral
intravenous
rectal
intranasal
transdermal
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8
Q 
Oral Sedation:
Benefits
▪ Easy to \_\_\_\_
▪ Provides \_\_\_\_ relief 
▪ \_\_\_\_ to use
A

administer
anxiety
safe

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9
Q 
Oral Sedation:
Limitations
• \_\_\_\_ onset of drug action
• Less effective when compared with \_\_\_\_
administration
• Inability to \_\_\_\_ the dose
• \_\_\_\_ to administer reversal agent
A

delayed
parenteral
titrate
difficult

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10
Q

Inhalation Sedation:
Advantages
• Onset of action is more ____ than oral, rectal and intramuscular sedation
• Depth of sedation may be ____ from moment to moment
• ____ recovery time
• No ____ is required
• ____

A 
rapid
altered
rapid
injection
safe
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11
Q 
Inhalation Sedation:
Disadvantages
• \_\_\_\_
• Space requirements • Not \_\_\_\_
• Requires cooperation
A

cost

potent

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12
Q

Sedation Methods:
Inhalation Sedation

  • Nitrous oxide
  • Most ____
  • Light conscious sedation
  • Decreases ____ and anxiety
  • Analgesic properties
  • Can be used in ____ or solo
A

common
fear
combo

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13
Q

Intravenous Sedation
• NPO (nothing to eat or drink after ____ the night before the procedure)
• ____ to accompany patient after the procedure
• History and physical ____

A

midnight
escort
examination

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14
Q

Monitoring
• Patient must be ____ at all times
• A comprehensive ____ must be kept
• All patients must have a ____ and physical and baseline vitals

A

watched
record
history

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15
Q 
Monitoring:
Parameters
• \_\_\_\_ • Ventilation
• \_\_\_\_
• Temperature
A

oxygenation

circulation

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16
Q

Standards for Basic Anesthetic Monitoring
• Standard I: Qualified anesthesia personnel shall be ____ in the room throughout the conduct of all general anesthetics, regional anesthetics, and monitored anesthesia care.

• Standard II: During all anesthetics, the patient’s ____, ventilation, circulation, and ____ shall be continually evaluated.

A

present
oxygenation
temperature

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17
Q

Goals of Monitoring
• Improves patient outcome by allowing early recognition of potentially ____complications
• Aids in the ____ of anesthesia administration

A

life-threatening

anesthesia

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18
Q 
Emergency Equipment
• \_\_\_\_ source
• Ambu bag and mask
• \_\_\_\_
• Oral and nasal airways
• \_\_\_\_ blade and handles 
• Endotracheal tubes and stylet
• \_\_\_\_ mask airways
A

oxygen
suction
laryngoscope
laryngeal

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19
Q 
Emergency Equipment
• Drugs
• \_\_\_\_
• Flumazenil
• \_\_\_\_ 
• Epinephrine
• \_\_\_\_
• Vasopressin
• \_\_\_\_
• ASA
  • ____ Given when HR below 40 - not typically given in emergency situation
  • Glucose For hypoglycemic patient, if diabetic patient has taken insulin without eating
  • ____ For allergic reaction
  • Diazepam or midazolam For breaking seizures
  • ____, methylprednisolone, or dexamethasone ◦Also for allergic reactions
A

naloxone
succinylcholine
amiodarone
nitroglycerin

atropine
diphenhydramine
hydrocortisone

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20
Q

Anesthesia Record

  • No specific ____
  • Record must be neat, concise and coherent
  • Should document the patients ____, the preanesthetic evaluation of the patient, the ____ events, postanesthetic condition of the patient
A

format
demographics
intraoperative

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21
Q 
Intravenous Sedation:
Medications
• \_\_\_\_
• Opioids
• \_\_\_\_ Don’t really use these for sedation because they have too many AE
• \_\_\_\_ 
• Ketamine
A

benzodiazepines
antihistamines
propofol

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22
Q

Anxiolytics and Sedative-Hypnotics
• ____
Barbiturates
• ____

A

benzodiazepines

antihistamines

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23
Q 
Benzodiazepines
• \_\_\_\_ (Versed)
• Diazepam (Valium)
• \_\_\_\_ (Ativan)
• Triazolam (Halcion)
• \_\_\_\_ (Restoril)
• Alprazolam (Xanax)

• ____ is our drug of choice
• Triazolam is the drug she spoke about earlier
◦It’s the short acting drug that was given in incremental doses and patients were dying from it
• ____ is a sleep agent
◦It is given to patients in the hospital as needed for sleep after
surgery
• ____ is a shorter acting benzodiazepines
• lorazepam and alprazolam are miming(?) drug that she would use for
an oral sedation cause they are shorter acting and don’t have active
metabolites
• And again midazolam is our drug of for IV sedation procedures

A

midazolam
lorazepam
temazepam

midazolam
temazepam
xanax

24
Q 
Benzodiazepines:
Effects
• \_\_\_\_
• Sedation
• \_\_\_\_
• Anticonvulsant
• \_\_\_\_ excitation 
• \_\_\_\_ cardiovascular
  and respiratory effects
A

anxiolysis
amnesia
parodoxical
minimal

25
Q

Benzodiazepines:
Pharmacodynamics

  • Bind to ____ receptors and alter configuration of ____
  • Allow for a greater influx of ____ into cell
A

BZ
GABA
chloride

26
Q 
Benzodiazepines:
Metabolism
• Metabolized by \_\_\_\_
• Metabolites are then conjugated primarily with
\_\_\_\_
• Excreted via \_\_\_\_
A

liver
glucuronic acid
kidneys

27
Q

Diazepam (Valium)
• ____administration
• ____ administration can cause thrombophlebitis
• ____ elimination half-life (nordazepam)

A

oral and parenteral
IV
prolonged

28
Q 
Midazolam (Versed) 
• Oral and \_\_\_\_
• More \_\_\_\_ Than diazepam
• Peak plasma levels in \_\_\_\_
• \_\_\_\_ half-life This is because there is no active metabolites that exert its effect well after the post op period
• No \_\_\_\_ metabolites
• More reliable \_\_\_\_ effect
This is a very important property for ambulatory anesthesia because we don’t want our patients remembering the event.
A 
parenteral
potent
30 to 60 min
shorter
active
amnestic
29
Q

Flumazenil (Romazicon)
• Benzodiazepine ____
• ____ agent
• ____ administration in ____ mg increments up to ____ mg

A 
antagnoist
reversal
IV
0.2
1
30
Q 
Barbiturates
• Deep \_\_\_\_ or general anesthesia (thiopental and methohexital)
• \_\_\_\_ (phenobarbital)
• Can induce paradoxical \_\_\_\_
• \_\_\_\_ therapeutic dosage range
  • No \_\_\_\_ agent
A 
sedation
anticonvulsants
excitement
limited
reversal
31
Q

Antihistamines

  • ____
  • Preoperative anxiety
  • Anti-____
  • Antagonists at histaminergic, cholinergic, and dopaminergic receptor sites
  • ____ (Vistaril), Promethazine (Phenergan)
A

insomnia
emetics
hydroxyzine

32
Q

Opioids
•Opioid includes both ____ opiates and opiate like drugs
•Classified by ____ structure or ____ on opioid receptors

A

true
chemical
action

33
Q 
◦ The agonist
‣ \_\_\_\_
‣ Codeine
‣ \_\_\_\_
‣ Hydrocodone
‣ Dilaudid
‣ These will be the top five
opioids we would use
• These are just general
• For sedation we would use: ◦ \_\_\_\_
◦ Alfentanil
◦ \_\_\_\_
◦ Remifentanil
◦ These are all synthetic opioids
◦ The opioids listed below fentanyl are
stronger derivatives of fentanyl

• Antagonist we will use ____ or Narcan
• We don’t really used the mixed agonist/antagonist
◦They are used for obstetrics and other types of procedures

A

morphine
oxycodone

fentanyl
sulfentanil

naloxone

34
Q 
Pharmacokinetics
• Significant \_\_\_\_ effect
• Metabolized in liver via \_\_\_\_ 
• Metabolites are generally \_\_\_\_
• Metabolites are excreted by the \_\_\_\_
A

first pass
glucoronidation
inactive
kidneys

35
Q

Pharmacodynamics

  • Opioid Receptors
  • ____
  • kappa
  • ____
  • Widely ____ throughout CNS
  • Found in ____ tissues
A

mu
delta

distributed
peripheral

36
Q 
Indications
• Adjuncts in \_\_\_\_ and general
anesthesia
• Postoperative \_\_\_\_
Primarily purepose of this drug is analgesia
• \_\_\_\_
 Dextromethorphan can be used to treat cough, but that’s not something we use during an anesthesia procedure
• \_\_\_\_
A

sedation
analgesia
cough
detoxification

37
Q

Opioid Effects:
Analgesia

• Increase pain ____ and tolerance
• Inhibit ____ release from synapses of the
____ ganglia
• Inhibit ____ fiber stimulation and ____ fiber stimulation

A 
threshold
substance P
dorsal root
C
A delta
38
Q

Opioid Effects:

Sedation
• Induce ____ and decreased awareness
• Take caution when combining with other ____ depressants

A

drowsiness

CNS

39
Q

Opioid Effects:
Mood Alteration
• ____
• Dysphoria

A

euphoria

40
Q

Opioid Effects:
Respiratory Depression
• Dose-dependent ____ in response to carbon dioxide in respiratory center
• ____ respiratory rate, ____ tidal volume
• Beware with patients with ____ and the ____

A 
decrease
decreased
increased
COPD
elderly
41
Q

Opioid Effects:
Tolerance
• ____ response to the same dose of a drug after repeated administration

A

decreased

42
Q

Opioid Effects:
Physical Dependence
• ____ symptoms followed by abrupt cessation of the drug
• Symptoms include ____, rhinorrhea, ____, yawning, myalgia, hyperventilation, hyperthermia, ____, vomiting, diarrhea, ____, hostility

A 
withdrawal
pilo-erection
lacrimation
mydriasis
anxiety
43
Q

Opioid Effects:
Addiction
• A ____ to continue using a substance despite a lack of medical ____

A

compulsion

necessity

44
Q

Opioid Effects:
Antitussive Effect
• Depress ____ reflex
• Dextroisomers (____)

A

cough

dextromethorphan

45
Q 
Opioid Effects:
GI system
• \_\_\_\_ and vomiting 
• Constipation
• \_\_\_\_
A

nausea

biliary spasm

46
Q 
Opioid Effects:
Other
• \_\_\_\_ release
• \_\_\_\_
• Chest wall \_\_\_\_
• Neuroendocrine effects
A

histamine
miosis
rigidity

47
Q

Morphine
• ____ lipid solubility
• Delayed onset and long duration of action
• Minimal ____ effects
• Can increase smooth muscle tone
• Can cause ____ release
• Can lead to increased intracranial pressure (ICP)
• Used for postoperative ____ and for chronic severe pain

A

poor
cardiovascular
histamine
pain

48
Q

Meperidine (Demerol)
• ____
• ____ duration of action
• Greater ____ solubility
• Cardiovascular effects
• Metabolite ____ has been associated with toxicity
• Contraindicated in patients taking ____

A 
synthetic
shorter
lipid
normeperidine
MAOIs
49
Q 
Fentanyl
• \_\_\_\_
• 75 to 125 times more potent than \_\_\_\_
• \_\_\_\_ onset
• \_\_\_\_ duration of action
• High \_\_\_\_ solubility
• High \_\_\_\_ effect
• No \_\_\_\_ release
• Contraindicated in patients taking \_\_\_\_
• \_\_\_\_, Sufentanil, and Remifentanil
A 
synthetic
morphine
rapid
short
lipid
first pass
histamine
MAOIs
alfafentanil
50
Q

◦But look how long it takes morphine to reach peak analgesic effect, ____ minutes, we don’t have that time to wait plus it will last ____ hour
◦Fentanyl reaches peak effect in ____ minutes and only last ____ minutes similar to Midazolam

A

20
4-5
3-5
30-60

51
Q 
Opioid Agonist/Antagonists
• Agonist and antagonist effects on receptors
• Lack efficacy of \_\_\_\_ agonists
• \_\_\_\_ effects on respiratory depression
• \_\_\_\_ (Talwin)
• Nalbuphine (Nubain)
• \_\_\_\_ (Stadol)
A

pure
ceiling
pentazocine
butorphanol

52
Q 
Opioid Antagonists:
Naloxone (Narcan)
• \_\_\_\_ agent
• Onset of action is \_\_\_\_ min \_\_\_\_ 
• Titrated \_\_\_\_ to effect
• Must \_\_\_\_ closely
A 
reversal
1 to 2
IV
slowly
monitor
53
Q

Clinical Considerations
• Decrease doses in ____, renal or ____ compromise
• ____
• ____-dependent patients

A

elderly
hepatic
allergy
opioid

54
Q 
Propofol
• Appears as \_\_\_\_ oil in water emulsion
• Cardiorespiratory effects
• Elimination half-life \_\_\_\_ hours
• \_\_\_\_ distributed to tissues
• \_\_\_\_ onset
• \_\_\_\_ recovery
• \_\_\_\_ effects
• Does not cause \_\_\_\_ 
• No \_\_\_\_ effect
A 
white
2 to 24
rapidly
short
quick
amnestic
nausea
analgesic
55
Q 
Ketamine
• Non-competitive \_\_\_\_-antagonist
• Derivative of the hallucinogen \_\_\_\_
• Produces deep dissociative \_\_\_\_, analgesia, and \_\_\_\_
• \_\_\_\_
A 
NMDA
phencyclidine
sedation
amnesia
IV and IM
56
Q

Ketamine
• Highly ____ soluble
• Short onset
• ____ elimination half-life
• Bronchodialation Respiration will approve on this — ideal for asthmatics
• Preserves ability to ____ spontaneously
• Protective reflexes remain intact
• Increase airway ____ Makes it difficult to suture - may have to give an antisialagogue
• Stimulatory effect on ____ system
• Random ____ are common

A 
lipid
short
breathe
secretions
cardiovascular
movements
57
Q 
Guidelines for discharge
• Patients should be \_\_\_\_ and oriented
• \_\_\_\_ signs should be stable
• \_\_\_\_ time should have elapsed after the last administration of reversal agent
• \_\_\_\_
• \_\_\_\_ instructions
A 
alert
vital
sufficient
escort
written

OMC V, Module II (9 decks)

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