Anesthesia Flashcards
local anesthetics act by
blocking sodium channels of axon causing reversible blockade of neural conduction
what can decrease effectiveness of drug
weakly basic-acidic environment
local anesthetics can be either…
amides (liver) or esters (hydrolysis)
amides in local anesthetics
lidocaine, bupivicaine, ropivicaine
esters in local anesthetics
benzocaine, cocaine, chloroprocaine, procaine, tetracaine
pain pumps used for
long acting local anesthetic to minimize post-op pain and the need for narcotics
regional anesthesia includes
spinal, epidural anesthesia, and peripheral nerve block
difference between spinal vs. epidural anesthesia
spinal- CSF obtained. epidural- No CSF obtained.
Local anesthetic (lidocaine or bupivacaine) plus EPI plus Opiate. CSF obtained=
spinal anesthesia
“sympathectomy” can occur from cephalic spread in spinal anesthesia resulting in
hypotension and bradycardia
complications from spinal anesthesia
spinal headache, hypotension and bradycardia, urinary retention
where is needle placed in epidural?
between ligamentum flavum and dura
epidural complications
slower onset, hemi-block, urinary retention, CV effects, misplacement in subarachnoid space
useful for surgery on extremity
peripheral nerve block. UE- brachial plexus block. LE- Lumbar plexus block
moderate vs. deep conscious sedation
moderate- patient opens eyes to voice or pain. deep- patient does not respond to voice or open but maintains their own airway
anesthetic agents
IV anesthetics, inhalation anesthetics, amnestics, narcotic
what is good for inducing children?
inhalation anesthetics
use inhalation anesthetics if preggo?
NO- TERATOGENIC
inhalation anesthetics examples
“fluranes”- isoflurane, sevoflurane, nitrous oxide, halothane
IV anesthetic agents
ketamine, propofol, etomidate, barbiturates
phecycyclidine derivative, diisopropylphenol, and carboxylated imidazole
ketamine, propofol, etomidate
IV anesthetic used a lot in kids and burn patients. causes dissociative amnesia, hallucinations, emergence delerium
ketamine
IV anesthetic that has rapid onset and rapid awakening. Lipid soluble, looks like mild. Side effects are resp and CV depression, seizures
propofol
IV anesthetic that has short half life (acts for about 30 seconds). MINIMAL CV effects. causes involuntary muscle movement, seizures (SE)
etomidate
barbiturates MOA
suppresses reticular activating system
amnestics
diazepam (valium), midazolam (versed), lorazepam (ativan)
reversal agent for benzos
flumazenil 0.2-0.4 mg
sedation accomplished by
benzo plus narcotic, nitrous oxide, or propofol
reversal agent of narcotics
narcan 2 mg every 3 minutes (max of 10 mg)
depolarizing muscle relaxant/paralytic
succinylcholine
non depolarizing muscle relaxants/paralytics
“curonium” or “curium” (mivacurium, pancuronium)
CI to paralytics
history of malignant hyperthermia, NM problems, allergy, lack of sedation
succinylcholine can cause…
malignant hyperthermia
twitches check in paralytics
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
if patient is going for urgent/emergent surgery, and last po was less than 4 hours ago…
need NG tube to empty stomach
airway managed by
oral airway, nasal trumpet, LMA, endotracheal tube
post op pain control
oral analgesics (codeine), pain patches, IV narcotics, PCA pumps, epidural catheter
vicodin vs narco in oral analgesic for pain
norco- tylenol stays constant. Vicodin- tylenol dose escalates with each dose (toxic to kidneys)
tylenol in pain preparation
no more than 4 g for first few days, then no more than 2 g/day
pain patches are NOT indicated for post-op pain. for Long-term management of pain. apply every..
72 hours
IV narcotics
morphine, dilaudid, fentanyl, demerol
morphine dose per hour
0.5-1 mg/hour
lockout morphine
6-10 minutes
morphine one hour max dose
5 mg
morphine basal dose/continuous
0-1 mg
morphine breakthrough dose
1-3 mg q 2 hours prn
If using IV morphine BASAL dose
always place pulse ox if ordering basal dose
