5.20 Anesthesia Flashcards
What 4 things do you need to have anesthesia
amnesia
hypnosis
analgesia
muscle relaxant
Stages of Anesthesia
1: hypnosis and amnesia (painful stimuli will wake you up; give propofol)
2: respond inappropriately to a painful stimuli (laryngospasm, posturing, etc)
3: Surgical plane of anesthesia (you will not respond to painful stimuli)
4: Brain stem depression, lose autonomic function (hypotension, bradycardia, apnea, death)
What drug do we give for amnesia
Versed
What drug do we give for hypnosis
Propofol
What drug do we use for analgesia
fentanyl
What drug do we use for muscle relalxant
rocuronium
Malignant hyperthermia
exposure to succinylcholine or anesthetic gases potentially deadly
- problem with ryanidine receptor so you get lots of Ca from sarcoplasmic reticulum
- Treat with Dantrolene
Pseudocholinesterase deficiency
If you use some drugs, it will last a very long time
Post op nausea/vomiting
tends to correlate with motion sickness
Preop exam
Fam Hx
Airway - tongue, teeth, ROM neck
Veins
Mallampati scale
scale based on how easy it should be to intubate based on how much of back of throat you can see
Monitors for anesthesia
Pulse ox
EKG
Blood Pressure
Temp
What is the PACU
Post anesthesia care unit
Goal of PACU
- smooth transition back to normal
- end hyponosis, amnesia, muscle relaxation, taper/stop analgesia
- Pain management: narcotics and/or regionalanesthesia
Narcotics examples
IV: fentanyl, morphine, hydromorphone (dilaudid), meperidine (Demerol)
Oral: oxycodone, hydrocodone, codeine w/ or w/o APAP and Ibuprofen
How do narcotics work
takes away perception of pain; pain isn’t actually gone
Mu receptors, Kappa receptors
Side effects of Narcotics
sleepy, itchy, lower tidal volume, constipation, dysphoria, urinary retention, Nausea/vomiting, tolerance, apnea
Regional anesthesia and analgesia
Spinal, epidural, and nerve blocks
- can be single dose or continuous
- drugs used are local anesthetics
2 main classes of anesthetics
Esters and Amides
Amide examples
Lidocaine, bupivacaine , Ropivacaine
Esters
Procaine (novocaine), Chloroprocaine, Tetracaine
- people get allergic to esters
How do local anesthetics work
act on fast and slow Na channels
- These actually prevent you from sensing pain (don’t get catecholamines/cytokines up in that area)
Downside to local anesthetics
Toxicity
Accidental IV injection
Seizures
Heart Block
Warning signs of toxicity
1. Strange feeling act/look weird 2. Numb/tingly around lips 3) ears ringing 4. tachycardia if contains EPI
Rescue drug
Interlipid - give as bolus
Can stop everything but exparel!
