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Pharm 3 > Anesthesia > Flashcards

Anesthesia Flashcards

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1
Q

Stage 1 Anesthesia

A

decreased awareness of pain and consciousness, sometimes w/ amnesia

consciousness may be impaired but its not lost

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2
Q

Stage 2 Anesthesia

A

Disinhibition –> pt is delirious and excited; amnesia
Reflexes are enhanced and respiration is typically irregular
Possible retching and incontinence

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3
Q

Stage 3 Anesthesia

A

surgical anesthesia:
regular respiration, skeletal muscle relaxation, decrease in eye reflexes and movements, fixed pupils
Loss of motor and autonomic responses to pain; BP is maintained

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4
Q

Stage 4 Anesthesia

A

Medullary paralysis: depression of respiratory and vasomotor centers
*requires mechanical and pharmacologic support to prevent death

Anesthesiologist job for sure!

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5
Q

Types of General Inhaled Anesthesia

A

Nitrous oxide, halothane, isoflurane, sevoflurane

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6
Q

Types of General IV Anesthesia

A

Propofol, etomidate, ketamine, barbiturates

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7
Q

Types of Local Ester Anesthesia

A

Procaine, Tetracaine

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8
Q

Types of Local Amide Anesthesia

A

Lidocaine, Bupivacaine

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9
Q

Goals of General Anesthesia

A

analgesia, unconsciousness/hypnosis, amnesia
Muscle relaxation or immobility (PRN for procedure)
Autonomic and sensory blockade of responses to noxious surgical stimulation

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10
Q

Phases of Anesthesia

A

Induction
Maintenance
Emergence

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11
Q

General Anesthetic Mechanisms and Effects

A

Neuronal depression in many regions
Decrease in BP
Respiratory depression
Bronchodilation
Impaired mucociliary clearance
decreased hepatorenal perfusion

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12
Q

Types of Anesthesia

A

General, Neuraxial (spinal or epidural), peripheral nerve blocks, intravenous regional anesthesia, monitored anesthesia care (MAC), conscious sedation w/out anesthesia personnel

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13
Q

Conscious sedation: how it is administered, pt state

A

Through IV to make pt sleepy/calm for procedure
**NOT expected to induce impairment of pt respiratory function or ability to maintain their own airway

Pt technically awake but groggy/unable to follow instructions

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14
Q

Conscious sedation Drugs used

A

periprocedural anesthesia assessment of the patient’s coexisting med conditions and management of actual or anticipated physiological derangements during procedure

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15
Q

MAC: what does it include

A

administration of sedatives and/or analgesics for conscious sedation (usually)

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16
Q

What is provider focused on during MAC

A

exclusive and continuously on pt for attendant airway, hemodynamic and physiologic derangements

**must be ready/prepped to covert to general anesthesia AND intervene to rescue pt airway

17
Q

What is nitrous oxide?

A

laughing gas; weak anesthesia but good analgesic

**Used a lot as adjuvant

18
Q

What to give after NO tx

A

Oxygen

19
Q

what does pt population does NO not work well in

A

pt taking opiates

20
Q

Laughing gas SE

A

N/V, headache, increased sleepiness, diaphoresis BUT no resp depression

21
Q

Laughing Gas Contraindications

A

Respiratory Compromise (ie COPD)

22
Q

What causes malignant hyperthermia?

A

Inhaled anesthesia and succinylcholine

Genetic disorder –> caused by mutations of muscle ryanodine receptor leading to uncontrolled release of Ca from the sarcoplasmic reticulum

23
Q

symptoms of malignant hyperthermia

A

tachycardia, HTN, severe muscle rigidity, hyperthermia, hyperkalemia, acidosis

CAN BE FATAL!

24
Q

Tx of malignant hyperthermia

A

Dantrolene (block Ca release via ryanodine receptor)

Plus cooling, correction of acid-base disturbances

25
Q

IV Barbiturates Use and Names

A

Thiopental v. methohexital - redistribution, induction; significant respiratory depression à induction of anesthesia

26
Q

IV Benzos use and names

A

*midazolam (Versed®), lorazepam (Ativan®)
*Can be given intranasally; perioperative amnesia, pre-procedure use; amnestic effects

27
Q

IV Propofol Use and SE

A

(This slide was not well described)
Induction and maintenance; GABA- A; day surgery (rapid onset and recovery); potent respiratory depression, decreased inotropism, decreased PR, decreased cerebral BP

28
Q

IV fentanyl Use and SE

A

Induction and maintenance, conscious and deep sedation; respiratory depression

29
Q

Ketamine: what is it, Use, who is it used for

A

NMDA blocker

Use: Dissociative anesthesia (catatonia, amnesia and analgesia without loss of consciousness)

Used in children for short procedure

30
Q

Ketamine SE

A

increased HR and CO, increased ICP leading to hallucinations

*not a significant resp depressant

31
Q

Short Acting Esters for Local anesthesia*

A

Procaine (Novocaine)

32
Q

Medium Acting Esters for Local anesthesia*

A

Cocaine

33
Q

Long Acting Esters for Local anesthesia*

A

Tetracaine (more lipophilic)

34
Q

Medium Acting Amides for Local anesthesia*

A

Lidocaine (xylocaine)

35
Q

Long Acting Amides for Local anesthesia*

A

Bupivacaine (Marcaine)

36
Q

All local anesthetics do what?*

A

block Na channels- failure of nerve conduction

37
Q

Why use adjuvant local anesthetics*

A

Decrease onset time, Increase duration, increase block intensity, or decrease toxicity

38
Q

options for adjuvant local anesthetics*

A

1) Epinephrine (Vasoconstrictor) –> hemostasis
*However, cannot use on certain organs that can easily become ischemic
(Fingers, toes, penis, and nose)
2) Sodium bicarbonate
3) Dexamethasone

Pharm 3 (10 decks)

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