5.20 Anesthesia

Question 1

What 4 things do you need to have anesthesia

Answer 1

amnesia
hypnosis
analgesia
muscle relaxant

Question 2

Stages of Anesthesia

Answer 2

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)

Question 3

What drug do we give for amnesia

Answer 3

Versed

Question 4

What drug do we give for hypnosis

Answer 4

Propofol

Question 5

What drug do we use for analgesia

Answer 5

fentanyl

Question 6

What drug do we use for muscle relalxant

Answer 6

rocuronium

Question 7

Malignant hyperthermia

Answer 7

exposure to succinylcholine or anesthetic gases potentially deadly

• problem with ryanidine receptor so you get lots of Ca from sarcoplasmic reticulum
• Treat with Dantrolene

Question 8

Pseudocholinesterase deficiency

Answer 8

If you use some drugs, it will last a very long time

Question 9

Post op nausea/vomiting

Answer 9

tends to correlate with motion sickness

Question 10

Preop exam

Answer 10

Fam Hx
Airway - tongue, teeth, ROM neck
Veins

Question 11

Mallampati scale

Answer 11

scale based on how easy it should be to intubate based on how much of back of throat you can see

Question 12

Monitors for anesthesia

Answer 12

Pulse ox
EKG
Blood Pressure
Temp

Question 13

What is the PACU

Answer 13

Post anesthesia care unit

Question 14

Goal of PACU

Answer 14

• smooth transition back to normal
• end hyponosis, amnesia, muscle relaxation, taper/stop analgesia
• Pain management: narcotics and/or regionalanesthesia

Question 15

Narcotics examples

Answer 15

IV: fentanyl, morphine, hydromorphone (dilaudid), meperidine (Demerol)

Oral: oxycodone, hydrocodone, codeine w/ or w/o APAP and Ibuprofen

Question 16

How do narcotics work

Answer 16

takes away perception of pain; pain isn’t actually gone

Mu receptors, Kappa receptors

Question 17

Side effects of Narcotics

Answer 17

sleepy, itchy, lower tidal volume, constipation, dysphoria, urinary retention, Nausea/vomiting, tolerance, apnea

Question 18

Regional anesthesia and analgesia

Answer 18

Spinal, epidural, and nerve blocks

• can be single dose or continuous
• drugs used are local anesthetics

Question 19

2 main classes of anesthetics

Answer 19

Esters and Amides

Question 20

Amide examples

Answer 20

Lidocaine, bupivacaine , Ropivacaine

Question 21

Esters

Answer 21

Procaine (novocaine), Chloroprocaine, Tetracaine

• people get allergic to esters

Question 22

How do local anesthetics work

Answer 22

act on fast and slow Na channels

- These actually prevent you from sensing pain (don’t get catecholamines/cytokines up in that area)

Question 23

Downside to local anesthetics

Answer 23

Toxicity
Accidental IV injection
Seizures
Heart Block

Question 24

Warning signs of toxicity

Answer 24

1. Strange feeling
act/look weird
2. Numb/tingly around lips
3) ears ringing
4. tachycardia if contains EPI

Question 25

Rescue drug

Answer 25

Interlipid - give as bolus

Can stop everything but exparel!