6. Deep Sedation and General Anesthesia Flashcards by J L

General Anesthesia
■
A ____ state of unconsciousness produced by anesthetic agents with loss of the ____ of pain over the entire body.

reversible

sensation

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Effects
  ■ ■ ■ ■ ■ ■
Loss of \_\_\_\_
Loss of protective laryngeal reflexes 
Loss of \_\_\_\_ tone 
Analgesia
\_\_\_\_
Cardiovascular depression

consciousness
skeletal muscle
amnesia

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Advantages
  ■ ■ ■ ■
Patient \_\_\_\_ is not essential 
The patient is \_\_\_\_
\_\_\_\_ of action is rapid
\_\_\_\_ is possible

cooperation
unconscious
onset
titration

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Disadvantages

The patient is ____
Protective reflexes are depressed
Vital signs are ____
Advanced training is required
An anesthesia ____ is required Specialized equipment is necessary
____ area must be present
Intraoperative and postoperative problems are more common

unconscious
depressed
team
recovery

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Indications

Extremely ____ or fearful
____ children
____ challenged
Those undergoing an ____ or extensive procedure

anxious
young
behaviorally
invasive

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Contraindications

Lack of adequate training, personnel, equipment, or facilities
ASA ____ and certain ASA ____ patients

III

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Routes of Administration
■ ■
____
____

inhalation

intravenous

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Armamentarium
  ■ ■ ■ ■ ■
Anesthesia machine
\_\_\_\_ equipment
Ancillary anesthesia equipment \_\_\_\_ equipment Emergency equipment and drugs

intravenous

monitoring

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Anesthesia Machine

Delivers ____ and inhaled anesthetics to the patient

____ (BP, EKG, pulse oximeter, end-tidal CO2 monitor, temperature)

Attached to the unit is a ____

oxygen
monitors
ventilator

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Ancillary Equipment

Full \_\_\_\_
Laryngoscopes
\_\_\_\_ and nasopharyngeal airways 
\_\_\_\_
Intubation forceps
\_\_\_\_

face-masks
oropharyngeal
suction
stethoscope

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Face Masks

____ or silicone
Cover ____ and mouth
Use to deliver ____
and inhaled anesthetics

rubber
nose
O2

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Laryngoscopes

Assists in the visualization of the \_\_\_\_ during intubation
Consists of a \_\_\_\_ and a blade
A small \_\_\_\_ is attached to the blade
\_\_\_\_ and Miller blades
Held in the left \_\_\_\_

trachea
handle
light bulb
macintosh
hand

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Endotracheal tubes

\_\_\_\_
Orotracheal or nasotracheal
Mostly \_\_\_\_
Variety of diameters
Contain an \_\_\_\_ that seals the trachea from the pharynx
\_\_\_\_

rubber tubes
disposable
inflatable cuff
connectors

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Oropharyngeal and nasopharyngeal airways

Assist in ____ a patent airway
Displace the ____ from the pharynx
____ airway is better tolerated

maintaining
tongue
nasopharyngeal

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Inhalation

A technique of administration in which a ____ or volatile agent is introduced into the ____ and whose primary effect is due to absorption through the ____.

gaseous
pulmonary tree
pulmonary bed

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Composition of Respiratory Gases

O2
% in inspired: ____

CO2
% in inspired: ____

N2
% in inspired: ____

Inhalation anesthetics

Most frequently used to produce ____
Uptake an elimination by ____

general anesthesia

ventilation

Properties of an ideal anesthetic

Predictable \_\_\_\_
Rapid onset of induction and emergence 
Provide \_\_\_\_ relaxation
Cardiostability
\_\_\_\_
Does not trigger significant side effects 
\_\_\_\_
Does not undergo transformation in the body

action
muscle
bronchodilation
inflammable

Inhaled anesthetics

\_\_\_\_ 
Enflurane 
\_\_\_\_ 
Desflurane 
\_\_\_\_ 
Cyclopropane 
\_\_\_\_ 
Ether

halothane
isoflurance
sevoflurane
chloroform

Halothane

Introduced in 1956
Causes myocardial \_\_\_\_
Cardiac sensitization to \_\_\_\_ 
Possible \_\_\_\_
Use phased out in the 80’s

depression
catecholamines
hepatotoxicity

Desflurane

____ induction and emergence Less ____
____ irritant

fastest
potent
airway

Sevoflurane

____ fastest emergence and induction
____ smelling
Should be avoided in patients with ____ insufficiency

second
sweet
renal

Solubility (Partition Coefficients)

Determines the time necessary for equilibration between two ____ to occur
____ solubility = ____ onset and recovery

phases
low
rapid

\_\_\_\_ blood gas coefficient
>
\_\_\_\_ solubility
>
\_\_\_\_ onset of action and rapid elimination

low
low
fast

Comparison of Blood: gas partition coefficients ____ > desflurane > sevoflurane > isoflurane > enflurane > ____

N2O | halothane

Concentration Effect Occurs when ____ concentrations of a gas are administered The higher the ____ the more rapidly the arterial tension of the gas increases

high | inspired partial pressure (Pi)

Second Gas Effect Administration of high volumes of a gas, i.e. ____ accelerates the rate of concomitantly inhaled gases ____ is often used as a “carrier” gas to decrease the anesthetic requirement of other drugs

N2O | nitrous oxide

Potency of Anesthetic Gases MAC = the minimal ____ concentration of anesthetic that prevents movement in ____% of patients in response to a surgical stimulus Measured as partial pressure or a percentage at ____ atmosphere Dose at which an anesthetic gas produces its ____ Loss of consciousness typically precede the absence of ____ movement ____ effect (0.5 MAC of nitrous oxide plus 0.5 MAC of isoflurane = ____ MAC of isoflurane

``` alveolar 50 1 effect stimulus-induced additive 1.0 ```

MAC for inhaled anesthetics ____ > desflurane > ____ > isoflurane > ____ > halothane

N2O sevoflurane enflurane

The standard deviation of MAC is ~____%. ____ MAC prevents movement in 95% of patients, and ____ MAC prevents movement in 99% of patients.

10 1. 2 1. 3

``` Factors that decrease MAC or decrease anesthetic requirement ■ ____ Hypothermia ____ Other CNS depressants ____ Pregnancy ```

elderly hypoxia antihypertensives

Factors that increase MAC or increase anesthetic requirement ____ Infant Chronic ____ abuse

hyperthermia | EtOH

``` Propofol Appears as ____ oil in water emulsion ____ effects Elimination half-life 2 to 24 hours ____ distributed to tissues Short onset ____ recovery Amnestic effects Does not cause ____ No analgesic effect ```

``` white cardiorespiratory rapidly quick nausea ```

Neuromuscular blocking agents cause muscle ____ facilitate ____ intubation optimize ____ conditions concomitant use of ____ is indicated

paralysis tracheal surgical sedative-hypnotic

Depolarizing muscle relaxants ``` ____ Depolarize the muscle fiber More resistant to degradation than ____ Depolarizing and desensitizing phases Provide most ____ onset Duration of blockade is only 5 to 10 minutes ```

succinylcholine acetylcholine rapid

Non-depolarizing muscle relaxants - competitive antagonists at the ACh receptor - short-acting - - ____ - - ____ - intermediate-acting - - ____ - - ____ - long-acting - - ____

mivacuronium rocuronium vecuronium atracurium pancuronium

Reversal agents Can be used to reverse effects of ____ muscle relaxants ____ inhibitors ____, pyridostigmine, and edrophonium

non-depolarizing acetylcholinesterase neostigmine

Malignant hyperthermia ____ Triggered by volatile ____ and succinylcholine Does not occur with every ____ No ____ straightforward test Muscle ____, hypercapnia, hyperthermia, tachycardia, rhabdomyolosis, metabolic and respiratory ____

``` autosomal dominant anesthetics exposure simple rigidity acidosis ```

Treatment of malignant hyperthermia Discontinue ____ agent Administer ____ Supportive ____

triggering IV dantrolene therapy