Anaesthesia

Question 1

gases used for inhalational anesthesia

Answer 1

nitrous oxide

Question 2

liquids used for inhalation anesthesia

Answer 2

halothane
enflurane
isoflurane
desflurane
sevoflurane

Question 3

define conscious sedation

Answer 3

protective relfexes mantained

independent mainatinence of airways/O2/ventillation

response to physical or verbal stimuli

Question 4

deep or unconsious sedation

Answer 4

profound effects with loss of one or more of the conscious sedation criteria

Question 5

define general anesthesia

Answer 5

sensory, mental. reflex, and motor blockade

concurrent loss of all protective reflexes

Question 6

general anesthetic advantage

Answer 6

capable fo producing reversible depression of neuronal function, producing loss of abaility to precieve and other sensations

Question 7

maintainence of airway under general anesthesia

Answer 7

PEEP pressure needs to be applied

Question 8

dosing of general anesthesia

Answer 8

inhalation or intravenous

Question 9

MAC=

Answer 9

minimum alveolar concentration

concentration in the inspired gas required to render half a group of patients unconscious -unresponsive to painful stimuli

Question 10

oil gas patition coefficient

Answer 10

describes the lipid solublity of a drug

the higher the number the more lipid soluble

Question 11

MOQ for anesthetic agents

Answer 11

reinforcements of GABA and GLYCINE

resinforcement of two pore K channels

inhibition of glutamate excitatory signalling

Question 12

other than CNS, where do general anesthetics work?

Answer 12

modulate ascending pathways to CNS and descending pathways to peripheral tissues

Question 13

describe the mixture of a typical inhalation anesthetic

Answer 13

70% N2O
25% O2
5% Halothane

Question 14

REFLEX RESPONSE TO HYPERCAPNIA IS BLOCKED BY ALL EXCEPT

Answer 14

N2O

Question 15

WHEN USED ALONE DOES N2O HAVE CV EFFECTS

Answer 15

NO BUT IT IS OFTEN GIVEN IN CONJUNCTION WITH OTHERS that do

Question 16

N2O given with opioids suggests

Answer 16

a sympathomimetic action since no significant CV effects

Question 17

anesthetics that provide analgesia

Answer 17

N2O

Question 18

does not inhibit preotective reflexes if used alone

Answer 18

N2O

Question 19

pro arrythmogenic anesthetic

Answer 19

halothane-sensitizes myocardium to ciruclating cetacholamiens

Question 20

bad about liver damage

Answer 20

halothane

Question 21

proepileptic potentials

Answer 21

enflurane

Question 22

cause muscle relaxation

Answer 22

enflurane and isoflurane

Question 23

copmplications from N2o

Answer 23

second gas effect
diffusional hypoxia
N2O solubility

bowel surgery, pneumothorax, middle ear-rupture air drum

Question 24

Amide type

Answer 24

lidocaine
mepivicaine
prolicaine
bupivicaine
ropivicaine
articaine

Question 25

ester-type

Answer 25

procaine chlorprocaine tetracaine cocaine

Question 26

topical use only

Answer 26

benzocaine dyclonine dibucaine pramoxine

Question 27

EMLA,LET

Answer 27

VASOCONSTRICTORS: EPI, PHENYLEPHRINE, OXYMETAZOLE REVERSAL AGENTS: PHENTOLAMINE

Question 28

ONLY local anesthetic with vasoconstrictor effects

Answer 28

cocaine

Question 29

ideal agent for local anesthesia

Answer 29

lipophillic and hydrophobic low toxicity short onset completely reversible active by topical injection infiltration

Question 30

Local anesthetic MOA

Answer 30

inhibit voltage gated sodium channels involved in process of neuronal conduction

Question 31

ap seen in local anesthetic

Answer 31

never reaches threshold

Question 32

reason for differences in onset of action of local anesthetics in different fiber types

Answer 32

local anesthetic reaching a critical concentration along the length of the nerve more rapidly, when successive nodes are closer spaced.

Question 33

list the onset of actions in the different fiber types based on myelination

Answer 33

``` Aalpha Abeta Agamma Adelta B fibers C fibers-postganglionic C fibers-sensory ```

Question 34

order of onset of block

Answer 34

B fibers c fibers postgang, C fibers sensory, Adelta Agamma a beta a alpha

Question 35

do local anesthetics work on ascending or descending fibers

Answer 35

no, only at the axon segments

Question 36

pH of most local anesthetics

Answer 36

weak bases wit a pKa of 8

Question 37

thiopene ring rather than benzene ring for lipophillicity

Answer 37

articaine

Question 38

amide metabolism may be affected by

Answer 38

cardiovascular status, liver disease, toxemia of pregnancy, cimetidine, volatile anesthetics, beta blockers

Question 39

ester metabolism by esterases may be affected by

Answer 39

liver disease, pregnancy, chemo, atypical enzyme activity

Question 40

vasoconstrictors used in conjunciton with local anesthetics

Answer 40

epinephrine levonordefin

Question 41

complications of vasoconstrcitors coadministered

Answer 41

pallor, undrest, sweating, fatigue, palpitations, N/V

Question 42

epinephrine interactions with

Answer 42

``` beta blockers tcas halothane HTN heart block cerbral vascular insufficency ```

Question 43

highest chance of allergic reactions

Answer 43

procaine-conversion to paraaminobenzoic acid also some sulphites may produce an allergy thus in asthamtics use preservitive free

Question 44

short acting local anesthetics <1 hour

Answer 44

procaine-slow onset-1 | chlorprocaine-rapid onset-4

Question 45

intermediate acting local anesthetics 2-3 hours

Answer 45

articaine-rapid lidocaine-rapid pilocaine-rapid mepivicaine

Question 46

long acting local anesthetics *potency of 16 2 hours-8 hours

Answer 46

bupivicaine-slow ropivicaine-slow tetracaine-slow

Question 47

procaine has the same potency as

Answer 47

mepivicaine

Question 48

protein binging determines

Answer 48

duration of effect for local anesth

Question 49

chemical linkages determine

Answer 49

metabolism for local anesth

Question 50

dissociation constant determines

Answer 50

time of onset

Question 51

lipid solubility

Answer 51

potency

Question 52

toxic metab of these drugs cause methemogolinemia

Answer 52

prilocaine benxocaine

Question 53

bupivicaine is special in that is has a certain toxicity

Answer 53

longer duration potent cardio toxic than lidocaine/mepivicaine prolonged activity >24 hours useful for postoperative analgesis but cauting wiht lip trauma=no solid foods

Question 54

local anesthetic with reduced cardiotoxicity a greater safety margin

Answer 54

ropivicaine

Question 55

topical local anesthetics for mouth, pharynx, larynx, trachea, esophagus

Answer 55

benzocaine dyclonine

Question 56

topical local anesthetics for SKIN AND NOT MUCOUS MEMBRANES

Answer 56

dibucaine pramoxine

Question 57

EMLA=

Answer 57

eutectic mixture of local anesthetics

Question 58

LET=

Answer 58

lidocaine-epinephrine-tetracaine or tetracaine-phelynephrine

Question 59

widely widely used in pediatric

Answer 59

LET

Question 60

EMLA made of

Answer 60

2. 5% lidocaine | 2. 5% prilocaine

Question 61

Lidocaine-oxymetazoline

Answer 61

(alpha 1/2 adrenergic agonist)*

Question 62

method of EMLA delivery

Answer 62

applied to the skin and covered with an occlusive dressing for an hour to permit anesthesia of surface tissues before grafting

Question 63

used by ENTs to see engorged nasal passages

Answer 63

lidocaine-oxymetazoline

Question 64

nerve block occurs

Answer 64

not in the spinal cord itself but in the fibers exiting the cord at that anatomical level

Question 65

baricity

Answer 65

density compared to csf