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Surgery/ER Fall 2013 > Anesthesia > Flashcards

Anesthesia Flashcards

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1
Q

local anesthetics act by

A

blocking sodium channels of axon causing reversible blockade of neural conduction

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2
Q

what can decrease effectiveness of drug

A

weakly basic-acidic environment

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3
Q

local anesthetics can be either…

A

amides (liver) or esters (hydrolysis)

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4
Q

amides in local anesthetics

A

lidocaine, bupivicaine, ropivicaine

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5
Q

esters in local anesthetics

A

benzocaine, cocaine, chloroprocaine, procaine, tetracaine

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6
Q

pain pumps used for

A

long acting local anesthetic to minimize post-op pain and the need for narcotics

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7
Q

regional anesthesia includes

A

spinal, epidural anesthesia, and peripheral nerve block

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8
Q

difference between spinal vs. epidural anesthesia

A

spinal- CSF obtained. epidural- No CSF obtained.

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9
Q

Local anesthetic (lidocaine or bupivacaine) plus EPI plus Opiate. CSF obtained=

A

spinal anesthesia

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10
Q

“sympathectomy” can occur from cephalic spread in spinal anesthesia resulting in

A

hypotension and bradycardia

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11
Q

complications from spinal anesthesia

A

spinal headache, hypotension and bradycardia, urinary retention

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12
Q

where is needle placed in epidural?

A

between ligamentum flavum and dura

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13
Q

epidural complications

A

slower onset, hemi-block, urinary retention, CV effects, misplacement in subarachnoid space

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14
Q

useful for surgery on extremity

A

peripheral nerve block. UE- brachial plexus block. LE- Lumbar plexus block

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15
Q

moderate vs. deep conscious sedation

A

moderate- patient opens eyes to voice or pain. deep- patient does not respond to voice or open but maintains their own airway

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16
Q

anesthetic agents

A

IV anesthetics, inhalation anesthetics, amnestics, narcotic

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17
Q

what is good for inducing children?

A

inhalation anesthetics

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18
Q

use inhalation anesthetics if preggo?

A

NO- TERATOGENIC

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19
Q

inhalation anesthetics examples

A

“fluranes”- isoflurane, sevoflurane, nitrous oxide, halothane

20
Q

IV anesthetic agents

A

ketamine, propofol, etomidate, barbiturates

21
Q

phecycyclidine derivative, diisopropylphenol, and carboxylated imidazole

A

ketamine, propofol, etomidate

22
Q

IV anesthetic used a lot in kids and burn patients. causes dissociative amnesia, hallucinations, emergence delerium

A

ketamine

23
Q

IV anesthetic that has rapid onset and rapid awakening. Lipid soluble, looks like mild. Side effects are resp and CV depression, seizures

A

propofol

24
Q

IV anesthetic that has short half life (acts for about 30 seconds). MINIMAL CV effects. causes involuntary muscle movement, seizures (SE)

A

etomidate

25
Q

barbiturates MOA

A

suppresses reticular activating system

26
Q

amnestics

A

diazepam (valium), midazolam (versed), lorazepam (ativan)

27
Q

reversal agent for benzos

A

flumazenil 0.2-0.4 mg

28
Q

sedation accomplished by

A

benzo plus narcotic, nitrous oxide, or propofol

29
Q

reversal agent of narcotics

A

narcan 2 mg every 3 minutes (max of 10 mg)

30
Q

depolarizing muscle relaxant/paralytic

A

succinylcholine

31
Q

non depolarizing muscle relaxants/paralytics

A

“curonium” or “curium” (mivacurium, pancuronium)

32
Q

CI to paralytics

A

history of malignant hyperthermia, NM problems, allergy, lack of sedation

33
Q

succinylcholine can cause…

A

malignant hyperthermia

34
Q

twitches check in paralytics

A

if 4 twitches seen, 0-75% of receptors blocked, 3 twitches seen-75% of receptores blocked, 2 twitches seen, 80% of receptors blocked, 1 twitch- 90% of receptors blocked. no twitches- all receptors blocked

35
Q

if patient is going for urgent/emergent surgery, and last po was less than 4 hours ago…

A

need NG tube to empty stomach

36
Q

airway managed by

A

oral airway, nasal trumpet, LMA, endotracheal tube

37
Q

post op pain control

A

oral analgesics (codeine), pain patches, IV narcotics, PCA pumps, epidural catheter

38
Q

vicodin vs narco in oral analgesic for pain

A

norco- tylenol stays constant. Vicodin- tylenol dose escalates with each dose (toxic to kidneys)

39
Q

tylenol in pain preparation

A

no more than 4 g for first few days, then no more than 2 g/day

40
Q

pain patches are NOT indicated for post-op pain. for Long-term management of pain. apply every..

A

72 hours

41
Q

IV narcotics

A

morphine, dilaudid, fentanyl, demerol

42
Q

morphine dose per hour

A

0.5-1 mg/hour

43
Q

lockout morphine

A

6-10 minutes

44
Q

morphine one hour max dose

A

5 mg

45
Q

morphine basal dose/continuous

A

0-1 mg

46
Q

morphine breakthrough dose

A

1-3 mg q 2 hours prn

47
Q

If using IV morphine BASAL dose

A

always place pulse ox if ordering basal dose

Surgery/ER Fall 2013 (11 decks)

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