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OMC V, Module II > 6. Deep Sedation and General Anesthesia > Flashcards

6. Deep Sedation and General Anesthesia Flashcards

1
Q

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

A

reversible

sensation

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2
Q 
Effects
  ■ ■ ■ ■ ■ ■
Loss of \_\_\_\_
Loss of protective laryngeal reflexes 
Loss of \_\_\_\_ tone 
Analgesia
\_\_\_\_
Cardiovascular depression
A

consciousness
skeletal muscle
amnesia

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3
Q 
Advantages
  ■ ■ ■ ■
Patient \_\_\_\_ is not essential 
The patient is \_\_\_\_
\_\_\_\_ of action is rapid
\_\_\_\_ is possible
A

cooperation
unconscious
onset
titration

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4
Q

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

A

unconscious
depressed
team
recovery

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5
Q

Indications

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

A

anxious
young
behaviorally
invasive

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6
Q

Contraindications

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

A

IV

III

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7
Q

Routes of Administration
■ ■
____
____

A

inhalation

intravenous

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8
Q 
Armamentarium
  ■ ■ ■ ■ ■
Anesthesia machine
\_\_\_\_ equipment
Ancillary anesthesia equipment \_\_\_\_ equipment Emergency equipment and drugs
A

intravenous

monitoring

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9
Q

Anesthesia Machine

Delivers ____ and inhaled anesthetics to the patient

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

Attached to the unit is a ____

A

oxygen
monitors
ventilator

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10
Q

Ancillary Equipment

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

face-masks
oropharyngeal
suction
stethoscope

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11
Q

Face Masks

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

A

rubber
nose
O2

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12
Q

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 \_\_\_\_
A 
trachea
handle
light bulb
macintosh
hand
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13
Q

Endotracheal tubes

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

rubber tubes
disposable
inflatable cuff
connectors

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14
Q

Oropharyngeal and nasopharyngeal airways

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

A

maintaining
tongue
nasopharyngeal

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15
Q

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 ____.

A

gaseous
pulmonary tree
pulmonary bed

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16
Q

Composition of Respiratory Gases

O2
% in inspired: ____

CO2
% in inspired: ____

N2
% in inspired: ____

A
  1. 94
  2. 04
  3. 3
17
Q

Inhalation anesthetics

Most frequently used to produce ____
Uptake an elimination by ____

A

general anesthesia

ventilation

18
Q

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
A

action
muscle
bronchodilation
inflammable

19
Q

Inhaled anesthetics

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

halothane
isoflurance
sevoflurane
chloroform

20
Q

Halothane

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

depression
catecholamines
hepatotoxicity

21
Q

Desflurane

____ induction and emergence Less ____
____ irritant

A

fastest
potent
airway

22
Q

Sevoflurane

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

A

second
sweet
renal

23
Q

Solubility (Partition Coefficients)

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

A

phases
low
rapid

24
Q 
\_\_\_\_ blood gas coefficient
>
\_\_\_\_ solubility
>
\_\_\_\_ onset of action and rapid elimination
A

low
low
fast

25
Q

Comparison of Blood: gas partition coefficients

____ > desflurane > sevoflurane > isoflurane > enflurane > ____

A

N2O

halothane

26
Q

Concentration Effect

Occurs when ____ concentrations of a gas are administered

The higher the ____ the more rapidly the arterial tension of the gas increases

A

high

inspired partial pressure (Pi)

27
Q

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

A

N2O

nitrous oxide

28
Q

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

A 
alveolar
50
1
effect
stimulus-induced
additive
1.0
29
Q

MAC for inhaled anesthetics

____ > desflurane > ____ > isoflurane > ____ > halothane

A

N2O
sevoflurane
enflurane

30
Q

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

A

10

  1. 2
  2. 3
31
Q 
Factors that decrease MAC or decrease anesthetic requirement
■ \_\_\_\_
Hypothermia
\_\_\_\_
Other CNS depressants 
\_\_\_\_
 Pregnancy
A

elderly
hypoxia
antihypertensives

32
Q

Factors that increase MAC or increase anesthetic requirement

____
Infant
Chronic ____ abuse

A

hyperthermia

EtOH

33
Q 
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
A 
white
cardiorespiratory
rapidly
quick
nausea
34
Q

Neuromuscular blocking agents

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

A

paralysis
tracheal
surgical
sedative-hypnotic

35
Q

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
A

succinylcholine
acetylcholine
rapid

36
Q

Non-depolarizing muscle relaxants

  • competitive antagonists at the ACh receptor
  • short-acting
    • ____
    • ____
  • intermediate-acting
    • ____
    • ____
  • long-acting
    • ____
A

mivacuronium
rocuronium

vecuronium
atracurium

pancuronium

37
Q

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

A

non-depolarizing
acetylcholinesterase
neostigmine

38
Q

Malignant hyperthermia

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

A 
autosomal dominant
anesthetics
exposure
simple
rigidity
acidosis
39
Q

Treatment of malignant hyperthermia
Discontinue ____ agent Administer ____
Supportive ____

A

triggering
IV dantrolene
therapy

OMC V, Module II (9 decks)

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