6. Deep Sedation and General Anesthesia Flashcards
General Anesthesia
■
A ____ state of unconsciousness produced by anesthetic agents with loss of the ____ of pain over the entire body.
reversible
sensation
Effects ■ ■ ■ ■ ■ ■ Loss of \_\_\_\_ Loss of protective laryngeal reflexes Loss of \_\_\_\_ tone Analgesia \_\_\_\_ Cardiovascular depression
consciousness
skeletal muscle
amnesia
Advantages ■ ■ ■ ■ Patient \_\_\_\_ is not essential The patient is \_\_\_\_ \_\_\_\_ of action is rapid \_\_\_\_ is possible
cooperation
unconscious
onset
titration
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
Indications
Extremely ____ or fearful
____ children
____ challenged
Those undergoing an ____ or extensive procedure
anxious
young
behaviorally
invasive
Contraindications
Lack of adequate training, personnel, equipment, or facilities
ASA ____ and certain ASA ____ patients
IV
III
Routes of Administration
■ ■
____
____
inhalation
intravenous
Armamentarium ■ ■ ■ ■ ■ Anesthesia machine \_\_\_\_ equipment Ancillary anesthesia equipment \_\_\_\_ equipment Emergency equipment and drugs
intravenous
monitoring
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
Ancillary Equipment
Full \_\_\_\_ Laryngoscopes \_\_\_\_ and nasopharyngeal airways \_\_\_\_ Intubation forceps \_\_\_\_
face-masks
oropharyngeal
suction
stethoscope
Face Masks
____ or silicone
Cover ____ and mouth
Use to deliver ____
and inhaled anesthetics
rubber
nose
O2
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
Endotracheal tubes
\_\_\_\_ Orotracheal or nasotracheal Mostly \_\_\_\_ Variety of diameters Contain an \_\_\_\_ that seals the trachea from the pharynx \_\_\_\_
rubber tubes
disposable
inflatable cuff
connectors
Oropharyngeal and nasopharyngeal airways
Assist in ____ a patent airway
Displace the ____ from the pharynx
____ airway is better tolerated
maintaining
tongue
nasopharyngeal
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
Composition of Respiratory Gases
O2
% in inspired: ____
CO2
% in inspired: ____
N2
% in inspired: ____
- 94
- 04
- 3
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
- 2
- 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
