Ancillary Anesthesia Drugs

Question 1

What’s important to consider for pre anesthesia?

Answer 1

Relieve anxiety, sedate, cause amenisa, dry secretions, reduce autonomic response, decrease gastric fluid volume, decrease gastric pH, antiemesis, reduce anesthetic requirement, induce, and prophylaxis of allergic rxn/Infxn.

Question 2

What’s most important to consider regarding timing?

Answer 2

No best combination/drug. But, onset of action is important (when is the pt going to the OR). Differ b/w adults and kids.

Question 3

What can be used for sedation?

Answer 3

Benzodiazepines and 1st gen. anti-histamines

Question 4

What sedation effects do the benzo’s have?

Answer 4

Diazepam and Lorazepam have amnesic and calming effect, used night before to anxiolysis

Question 5

What sedation effects do the 1st gen. histamines have?

Answer 5

Hydroxyzine, diphenhydramine and promethazine are useful for sedation, anxiolysis, bronchodilation, anti-­emesis, and analgesia. These are anti cholinergic dry secretions too

Question 6

What classes of drugs can be used for analgesia?

Answer 6

Opiates and NSAIDs

Question 7

What ADEs are associated with opiates?

Answer 7

Morphine, Codeine, Fentanyl have ortho hypotension, constipation, N/V, respiratory depression and coma.

Question 8

What ADEs are associated with NSAIDs?

Answer 8

Ketorolac and Ibuprofen can cause bleeding and fracture healing

Question 9

What’s aspiration pneumonitis?

Answer 9

Reflux of gastric content into lung is a big problem in surgery

Question 10

What can you give to neutralize the acid assoc. with aspiration pneumonitis?

Answer 10

H2 blockers: Cimetdine and

Ranitidine=prevent new acid, but you still have the old contents in there

Question 11

What can you give to increase the pH to Tx aspiration pneumonitis?

Answer 11

Antacids like Bicitra and Polycitra

Question 12

What will accelerate gastric emptying?

Answer 12

Metoclopromide (dopa blocker). Give 150mL of water which will cause emptying by stretch reflex.

Question 13

What can you give for prophylaxis of allergic rxns?

Answer 13

Cimetidine and Diphenhydramine

Question 14

What Rx are always given before surgery to prevent infection?

Answer 14

Cefazolin (staph/strep), cefotetan/cefoxitin (GI anaerobes) and vanc (MRSA).

Question 15

What Rx could you give to prevent reflex bradycardia?

Answer 15

Atropine

Question 16

What else can atropine be given for?

Answer 16

Amnesia and to sedate

Question 17

What anticholinergic would you give to decrease secretions?

Answer 17

Glycopyrrolate

Question 18

What anticholinergic has the greatest sedation/amnesia effect?

Answer 18

Scopolamine

Question 19

What Rx’s do you give immediately before intubating?

Answer 19

First oxygenate the pt so you have more time. Then, Lidocaine, vecuronium, fentanyl
and atropine. After you give them that you push sedatives and succinylcholine.

Question 20

Why do you give lidocaine before intubating?

Answer 20

For increasing ICP and bronchospasm

Question 21

Why do you give vecuronium before intubating?

Answer 21

To decrease the ICP increase caused by succinylcholine

Question 22

Why do you give fentanyl before intubating?

Answer 22

For increased ICP, CV dz and bleeding

Question 23

Why do you give atropine before intubating?

Answer 23

To decrease bradycardia caused by succinylcholine

Question 24

What problems are seen with post-­‐anesthesia?

Answer 24

Big problems w/ N/V, can’t extubate, and CV problems like hyper/hypotension and arrhythmia’s

Question 25

What’s a big problem that can be seen with any anesthetic?

Answer 25

Central respiratory depression. Give antagonist to reverse

Question 26

Failure to reverse drugs like succinylcholine may produce inadequate resp. muscle fnc. What are some reasons that succinylcholine wouldn’t reverse?

Answer 26

Renal failure, antibiotic use, diuretics, increased Mg levels and decreased temp.

Question 27

What Rx’s should you give for hypotension?

Answer 27

Give fluids, dopamine, phenylephrine, or ephedrine.

Question 28

What Rx’s should you give for hypertension?

Answer 28

Nitroprusside (rapid vasodilator) or Trimethaphan (heart ganglionic blocker)

Question 29

When are you particularly concerned about drug drug interactions from polypharmacy?

Answer 29

When 10 or more drugs are given

Question 30

What things are particularly big problems after surgery?

Answer 30

Delirium and post op N/V (esp with N20)

Question 31

Can some pts have withdrawal symptoms after surgery?

Answer 31

Yes

Question 32

How can anaphylaxis occur?

Answer 32

From bone cement or radio contrast (renal failure)

Question 33

How should you Rx anaphylaxis if it occurs?

Answer 33

Give Epi +O2+ IV volume, and stop offending drug.