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Medicine II: Surgery > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

What is the definition of anesthesia?

A

is the process of blocking the perception of pain and other sensations. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience.

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2
Q

What is the definition of general anesthesia?

A

with reversible loss of consciousness

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3
Q

What is the definition of local anesthesia?

A

with reversible loss of sensation in a (small) part of the body by localized administration of anesthetic drugs at the affected site.

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4
Q

What is the definition of regional anesthesia?

A

with reversible loss of sensation and possibly movement in a region of the body by selective blockade of sections of the spinal cord or nerves supplying the region.

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5
Q

What are the goals of anesthesia?

A 
Analgesia
Sedation
Reversible loss of consciousness
Amnesia
Muscle relaxation
Hemodynamic stability
Fast recovery
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6
Q

What happens if you do not have muscle relaxation?

A

will never get the fascia back together

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7
Q

What are the principles of anesthesia?

A 
analgesia (local, regional, central)
NSAIDS
Local Anesthetics
Acupuncture 
Opiates
Hypnosis
General Anesthesia
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8
Q

What is significant with opiods?

A

want to augment with another type to avoid dependency

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9
Q

What is minimal sedation?

A

anxiolysis
Normal response to verbal commands
Normal cardiovascular and respiratory status

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10
Q

What is moderate sedation?

A

(conscious sedation)
Purposeful response to verbal commands
Maintained airway, ventilation, cv-status

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11
Q

What is deep sedation?

A

Pt cannot be easily aroused
Purposeful response to repeat or painful stimulation
Airway and ventilation may be impaired
Cv-status maintained

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12
Q

What is sedation with general anesthesia?

A

Loss of consciousness
Airway and ventilation may need to be secured and maintained
Cv-status may be impaired

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13
Q

What happens at anxiolysis?

A

Patient can not consent to procedure at this point, patient is under baseline

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14
Q

What sedation is most oftenly used in the elderly and why?

A

conscious sedation; it reduces CV compromise

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15
Q

What are types of sedatives?

A 
Benzodiazepines
Barbiturates
Ketamine
Etomidate
Propofol
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16
Q

What are the types of general anesthetics?

A

Gases

Sedatives

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17
Q

Why use analgesia with anesthesia?

A

Anesthesia w/ analgesia: Coming out of surgery is interesting (pt wakes up and looks at you, airway intact, pt goes home faster and needs less meds)

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18
Q

What do we use for amnesia?

A

Midazolam
Scopolamine
Anesthesia Gases

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19
Q

Why have amnestics became an important part of surgery?

A

dont want patient to remember surgery

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20
Q

What are the types of muscle relaxants?

A

Neuromuscular endplate
Nerve conduction
Nerve transmission

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21
Q

What are the types of neuromuscular endplates relaxants?

A

Nondepolarizing neuromuscular blocking agent

Depolarizing neuromuscular blocking agent

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22
Q

What are the types of nerve conduction relaxants?

A

Peripheral nerve blocks

Epidural anesthesia

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23
Q

What are the types of nerve transmission relaxants?

A

Spinal anesthesia

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24
Q

What is a specific case where we use non-depolarizing muscular blocking agents?

A

crush injuries

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25
Q

What is the goal of using muscle relaxants?

A

Goal is to get away from narcotics (since they have a lot of side effects: addiction, bowel problems)

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26
Q

What do we have to look at for hemodynamic stability?

A 
Patient requirements
Coronary and cerebral perfusion
Preload
Contractility
Afterload
Heart rate/rhythm
Intentional hypo/hypertension:
--Hypo- in cases of bleeding (to slow it down)
--Hyper- cases of low perfusion; concern ischemia
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27
Q

What is a caution that we need to be aware of with a patient?

A

Preload; pts who are in house are NPO and you are giving them fluids so you have more CV stability
If pt has COPD or CHF you can give too much.. Delicate balance

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28
Q

Do you give a muscle relaxant to a pt with a B-blocker?

A

If pt is not on bblocker and you give right before surgery you can cause a stroke or MI

If pt is on bblocker you def give before surgery because it has been proven to improve outcomes (oral is better)

29
Q

What is a specific medication you do not give before surgery?

A

ACE inhibitor

30
Q

What is a type of local anesthesia?

A

lidocaine

31
Q

What are the types of anesthesia?

A

local
general
regional

32
Q

Why would you give epidural instead of lidocaine?

A

Epi causes it to stay longer so you can give more: ear tips, nose, lips do not give epi because low vascular areas

33
Q

What are types of regional anesthetics?

A

Epidural Anesthesia
Spinal Anesthesia
Regional Block
Bier Block

34
Q

When do you give a bier block?

A

when working on an extremity

35
Q

What is a key factor you have to consider when using a spinal anesthetic?

A

Spinal is one shot one deal (good because if you give to pt it can go away by the time they wake up, but you can’t undo what you give.. Can give too much, have high spinal and cause resp depression)

36
Q

What is a wet tap?

A

Wet tap means you’ve gone to far and drawn spinal fluid. You’ve gone through ligamentum flavum

37
Q

What are epidural anesthetic effects?

A 
Block of sensation of affected dermatomes
Motor block of affected dermatomes
Block of pain
Block of sympathetic response
Block of vagal response
38
Q

What can the patient not do if you give them an epidural?

A

Pts w/ epi can not walk after

39
Q

How can the patient present after getting an epidural?

A

Lots of pts w/ epis get hypotensive

40
Q

What are relative contraindications to epidural anesthetics?

A

Patient unable to comprehend procedure
Prior back surgery or back pain
Fixed cardiac output states (AS)

41
Q

What are absolute contraindications to epidural anesthetics?

A 
Patient refusal
Infection of skin
Sepsis
Patient anticoagulated
Increased intracranial pressure
42
Q

What is important to do before giving an epidural?

A

Sterilize the skin, Infection of skin can bring infx into spinal fluid

43
Q

What are positives of epidurals?

A 
Patient awake
No depression of baby
Postoperative analgesia
Postoperative breathing
Less risk of thrombosis
Earlier intestinal motility
No intubation
44
Q

What are negatives to epidurals?

A 
Failure of block
Bleeding
Infection
Wet tap
Bradycardia
Hypotension
Breathing difficulty
45
Q

What do you do if you get a wet tap?

A

Can pull back, Put something in to stop bleed

Patient can get spinal h/a

46
Q

What is a problem with a paravertebral epidural?

A

pneumothorax

47
Q

What are the features of spinal anesthetics?

A 
One shot
Continuous spinal anesthesia
Bilateral block
Unilateral block
Speed of onset
Possibility of high spinal
48
Q

When are spinal anesthetics most oftenly used?

A

More often used w/ obstretrics

49
Q

What are contraindications for spinal anesthetics?

A

Same as for epidural anesthesia
Additional risk for heart failure patients due to increase in preload as block weans
Additional risk of sympathetic activation when block wears off
Risk if muscle relaxation is needed

50
Q

What are the features of a regional block?

A 
Peripheral nerve blocks
Brachial plexus block
--Interscalene
--Infraclavicular
Lumbar plexus block
Continuous Nerve Sheath catheter
51
Q

What are the choices of drugs for general anesthesia?

A

Total IV anesthesia

Balanced anesthetic

52
Q

How do we do air way control for general anesthesia?

A

Oral and nasal airways
Mask anesthesia
LMA
Endotracheal intubation

53
Q

What are air way issues?

A

The difficult airway
Gastroesophageal Reflux
Full stomach
Unstable neck

54
Q

What about the spine can make the airway difficult?

A

if its fused

55
Q

How do you control the air way in a trauma patient with an unstable neck?

A

have someone hold the c spine while you intubate

56
Q

What is the number one cause of problems with the airway?

A

big tongue

57
Q

What are possible problems the patient can present with that give them a difficult airyway?

A 
Mallampati classification
Mentomhyoid distance
Mouth opening
Neck mobility
Buck Teeth
Big tongue
58
Q

What can someone have/get that increases the incidence of GERD/full stomach that would make it difficult to assess their airway?

A 
History of GERD
History of ESLD and Ascites
Any Trauma
Pregnancy
Diabetes of long duration with supposed gastro paresis
Rapid sequence induction
Cricoid pressure
Awake fiber optic intubation
59
Q

What can give someone an unstable neck making it difficult to assess the air way?

A 
Trauma 
Cervical Spine Fracture
Atlanto-occipital Instability
Spinal cord stenosis
Awake fiberoptic intubation
Awake positioning
Inline stabilization
60
Q

How do we secure the airway?

A 
Mask ventilation
Direct Laryngoscopy
LMA/intubating LMA/combitube
Fiberoptic Methods
--Bronchoscope (flexible)
--Bronchoscope (rigid)
--Bullard
Transtracheal Jet ventilation
Tracheotomy
61
Q

What is significant about the mask in securing the airway?

A

Mask: easiest to do but least security (less security that airway is maintained, and more risk of air going into stomach)

62
Q

What are major clinical predictors?

A

Unstable coronary symptoms
Recent MI and risk of ischemia by clinical symptoms or noninvasive testing
Unstable angina

Severe valvular disease

Decompensated heart failure

Significant arrhythmias
High degree AV-block
Supraventricular arrhythmia with uncontrolled HR
Symptomatic ventricular arrhythmia with underlying heart disease

63
Q

What are minor clinical predictors?

A 
Advanced age 
Abnormal ECG (left ventricular hypertrophy, left bundle-branch block, ST-T abnormalities) 
Rhythm other than sinus 
Low functional capacity 
History of stroke 
Uncontrolled systemic hypertension
64
Q

What are intermediate clinical predictors?

A

Mild angina pectoris
Previous MI by history or pathological Q waves Compensated or prior heart failure
Diabetes mellitus
Renal insufficiency

65
Q

What would require further preop testing?

A

2 out of 3 positive:

Intermediate clinical predictors
Low functional capacity 
High surgical risk
--Aortic surgery
--Peripheral vascular procedures
--Long procedures with fluid shifts and blood loss
66
Q

If the patient can do _____________, they are probably ok for surgery.

A

walk up 2 flights of stairs

67
Q

What are examples of non-invasive testing?

A 
Stress test
Thallium stress
Dobutamine stress echocardiography
Dipyridamole or adenosine perfusion
Holter recording
68
Q

If the non invasive testing is positive what is next?

A

coronary angiography

Medicine II: Surgery (14 decks)

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