Anesthesia

Question 1

What is anesthesia

Answer 1

sedation of a patient for the purposes of a medical procedure

Question 2

what are four types of anesthesia

Answer 2

local, regional, general, and monitored anesthesia care (MAC)

Question 3

what is the difference between local and regional anesthesia?

Answer 3

loss of sensation in a focused body area

loss of sensation in a region of a body

Question 4

what kind of anesthesia is used for minor procedures?

Answer 4

local anesthesia (sutures)

Question 5

what kind of anesthesia is used for major procedures

Answer 5

general anesthesia (abdominal surgery)

Question 6

how is general anesthesia different from other anesthesia

Answer 6

total loss of consciousness

Question 7

what is the similarity between general anesthesia and monitored anesthesia care

Answer 7

both affect systemically

Question 8

how is monitored anesthesia care special?

Answer 8

conscious sedation (sedation at low levels to maintain vital signs without intubation)

• able to awake
• able to respond
• maintain vital signs without assistance

Question 9

pathophysiology of local anesthesia

Answer 9

Na influx into neurons is blocked, efferent and afferent are both affected

Question 10

kinetics of local anesthesia

Answer 10

lipophilic, metabolized via hepatic

Question 11

Does local anesthesia cross BBB?

Answer 11

no

Question 12

suffix for local anesthesia

Answer 12

• caine

Question 13

onset and duration for local anesthesia

Answer 13

onset: less than 2 min
duration: drug dependent

Question 14

three routes for local anesthesia are

Answer 14

topical, infiltration, nerve block

Question 15

infiltration is SC injection into the _____

Answer 15

tissue

Question 16

nerve block is SC injection near a ________

Answer 16

large nerve bundle

Question 17

three adjunct medications for local anesthesia

Answer 17

1. epinephrine (vasoconstriction)
2. sodium bicarbonate (for bacterial acidify environment)
3. opioids

Question 18

What do we need to make sure if inject anesthesia into the epidural space?

Answer 18

no CSF return in needle

Question 19

onset for epidural local anesthesia

Answer 19

20-30 minutes

Question 20

the epidural route requires _____ drug dosage than for spinal route

Answer 20

higher

Question 21

can epidural block all levels of the spinal column

Answer 21

yes; cervical, thoracic, lumbar

Question 22

which level of spinal column should be injected with epidural local anesthesia for any thoracic surgery

Answer 22

cervical

Question 23

which level of spinal column should be injected with epidural local anesthesia for any upper abdominal surgery

Answer 23

thoracic

Question 24

which level of spinal column should be injected with epidural local anesthesia for any lower abdominal surgery

Answer 24

lumbar

Question 25

which level of spinal cord should be delivered for a subarachnoid route to avoid spinal injury?

Answer 25

below L2

Question 26

onset for intrathecal route

Answer 26

quick onset

Question 27

how many doses are needed for the intrathecal route

Answer 27

one dose into CSF

Question 28

how to verify needle position for intrathecal route

Answer 28

whether CSF is present in the needle

Question 29

what are the common procedures for intrathecal route

Answer 29

abdominal and pelvic

Question 30

what is a risk for the intrathecal route if the diaphragm is affected

Answer 30

respiratory depression

Question 31

side effects of anesthesia

Answer 31

hypotension, respiratory depression, loss of sensation and motor function post-op, site of hematoma and infection, catheter migration, backache, urinary retention, spinal cord injury, CSF infiltration

Question 32

what is the treatment goals for general anesthesia

Answer 32

1. analgesia 2. relaxation/amnesia/hypnosis 3. loss of reflexes (neuromuscular blockers)

Question 33

opioid such as fentanyl and morphine are used in anesthesia for ____

Answer 33

analgesia

Question 34

what are the two drug classes for general anesthesia

Answer 34

inhaled general anesthetics and intravenous anesthetics

Question 35

nitrous oxide, halothane, and isoflurane are _____ general anesthetics used for _____________.

Answer 35

inhaled; decrease action potentials, increase GABA

Question 36

ketamine and barbiturate like drugs like propofol are _____ anesthetics

Answer 36

intravenous; increase GABA

Question 37

IV anesthetics have _____ onset and ____t1/2; _____ is necessary and vital sign should be supported to prevent _____.

Answer 37

rapid; short; intubation; hypotension

Question 38

what are three types of general anesthetic medication

Answer 38

analgesia, unconsciousness, neuromuscular blocking agents

Question 39

neuromuscular blocking agents is also known as

Answer 39

anticholinergics or paralytics

Question 40

why both IV and inhaled general anesthetics are sometimes needed?

Answer 40

induction and maintenance

Question 41

how does neuromuscular blocking agents work

Answer 41

block Ach binding at nicotinic receptors

Question 42

is there BBB penetration for neuromuscular blocking agents

Answer 42

no

Question 43

why is intubation needed for neuromuscular blocking agents?

Answer 43

it causes muscle paralysis including the diaphragm

Question 44

``` vecuronium rocuronium pancuronium succinylcholine (short t1/2) botox ``` are meds for?

Answer 44

neuromuscular blocking agents

Question 45

neuromuscular blocking agents is ideal for ____, ____, and ____.

Answer 45

complex procedures, ICU recovery, and mechanical ventilation

Question 46

neuromuscular blocking agents is _____ onset.

Answer 46

rapid

Question 47

botox is _____ injection and ____ paralysis.

Answer 47

intradermal; superficial

Question 48

ketamine, benzodiazepines, opioids are used in

Answer 48

conscious sedation

Question 49

midazolam (versed) is used for

Answer 49

MAC