Anesthesia

Question 1

• Used in general anesthesia
• mechanism of action not completely understood
• delivered to the patient using vaporizer and a carrier gas

Answer 1

Inhaled agents

Question 2

physiologic effects of inhaled agents?

Answer 2

• cardiac (decreased contractility, decreased systemic vascular resistance, decreased mean arterial pressure)
• pulmonary
• CNS

Question 3

CNS effects of anesthesia?

Answer 3

1. Anesthetic Effects: Analgesia, amnesia, muscle relaxation , hypnosis
2. increased cerebral blood flow
3. decreased cerebral metabolic demand
4. increased ICP

Question 4

why would someone have a prolong reaction to medications?

Answer 4

• it is indicative of pseudocholinesterase deficiency

Question 5

• Autosomal dominant inherited defect in the ryanodine receptor
• uncontrolled release of calcium causes- increased energy production, uncontrolled muscle contraction (heat, increased lactic acid)
• as progresses- acidosis, hyperkalemia, arrhythmia

Answer 5

Malignant hyperthermia

Question 6

what do you see with MH?

Answer 6

• increased respiratory rate
• increased CO2
• increased HR
• increased temp
• rigidity
• acidosis
• hyperkalemia

Question 7

how do you manage malignant hyperthermia?

Answer 7

• mix and give dantrolene (this prevents the release of calcium from the SR and stops the cascade of events that lead to the symptoms of MH
• Supportive care decrease temperature (ice bags, gastric lavage)

Question 8

types of anesthesia?

Answer 8

General

• endotracheal
• laryngeal mask airway

Regional

• peripheral regional
• neuraxial

Sedation, or M.A.C (monitored anesthesia care)

Question 9

• defined as the complete loss of consciousness
• patient is rendered insensate to surgical stimulus
• practical versus semantic defintion

Answer 9

General anesthesia

Question 10

Components of general anesthesia?

Answer 10

Analgesia

• lack of pain

Hypnosis

• loss of consciousness
• amnesia

Muscle relaxant (in some cases)

Question 11

what can be used to achieve GA?

Answer 11

• inhaled gases
• intravenous hypnotics
• intravenous analgesics
• muscle relaxants (paralytics)

Question 12

ex. of inhaled anesthetic gasses?

Answer 12

• Sevoflurane
• isoflurane
• desflurane

Question 13

ex. of intravenous hypnotics

Answer 13

propfol

Question 14

ex. intravenous analgesics?

Answer 14

• narcotics
• NSAIDs

Question 15

ex. of muscle relaxants (paralytics)

Answer 15

Succinylcholine, NDMR

Question 16

Why is NPO necessary with GA? what are the guidelines for NPO?

Answer 16

NPO necessary to decrease risk for aspiration pneumonia

• 2 hours- clear liquid
• 4 hours- breast milk
• 6 hours- milk, “light” meal (toast and clear liquids), formula
• 8-12 hours- large meal, fried or fatty foods, meats

Question 17

Common pretreatment medications

Answer 17

• Anxiolytics
• antiemetcs
• aspiration risk reduction- sodium bicarb, famotidine
• prokinetics
• bronchodilators
• antihypertensive
• topical anesthetics

Question 18

what medications are commonly used as induction medications for GA?

Answer 18

Commonly used IV agents: propofol, etomidate
commonly used gas agent: Sevoflurane

Question 19

what are some endotracheal tube advantages and disadvantages?

Answer 19

advantages

• secure airway
• if patient laryngospasms, you can still move air
• cuffed tubes can help prevent aspiration of gastric contents from reaching below

Disadvantages

• can cause hypertension and tachycardia on placement and removal
• can be technically difficult to place
• ETT is irritating to the trachea causing coughing, bronchospasm