Anesthesia

Question 1

What is anesthesia?

Answer 1

Loss of sensation/pain

Question 2

What is local anesthesia?

Answer 2

Anesthesia of a small confined area of the body (e.g. lidocaine for an elbow laceration)

Question 3

What is epidural anesthesia?

Answer 3

Anesthetic drugs/narcotics infused into epidural space

Question 4

What is spinal anesthesia?

Answer 4

Anesthetic agents injected into the thecal sac

Question 5

What is regional anesthesia?

Answer 5

Blocking of the sensory afferent nerve fibers from a region of the body (e.g. radial nerve block)

Question 6

What is general anesthesia?

Answer 6

1. Unconsciousness/amnesia
2. Analgesia
3. Muscle relaxation

Question 7

What is GET or GETA?

Answer 7

General EndoTrachael Anesthesia

Question 8

What are common local anesthetics?

Answer 8

Lidocaine, bupivacaine (Marcaine)

Question 9

What are common regional anesthetics?

Answer 9

Lidocaine, bupivacaine (Marcaine)

Question 10

What are common general anesthetics?

Answer 10

Isoflurane, enflurane, sevoflurane, desflurane

Question 11

What is a common dissociative agent?

Answer 11

Ketamine

Question 12

What is cricoid pressure?

Answer 12

Manual pressure on cricoid cartilage occluding the esophagus and thus decreasing the chance of aspiration of gastric contents during intubation.
Also called Sellick’s maneuver.

Question 13

What is rapid-sequence anesthesia induction?

Answer 13

1. Oxygenation and short-acting induction agent
2. Muscle relaxant
3. Cricoid pressure
4. Intubation
5. Inhalation anesthetic

Question 14

What are common induction agents?

Answer 14

Propofol, midazolam, sodium thiopental

Question 15

What are contraindications of the depolarizing agent succinylcholine? Why?

Answer 15

Patients with burns, neuromuscular diseases/paraplegia, eye trauma, increased ICP.
Depolarization can result in life-threatening hyperkalemia and also increases intra-ocular pressure.

Question 16

Why doesn’t lidocaine work in an abscess?

Answer 16

Lidocaine does not work in an acidic environment

Question 17

Why does lidocaine burn on injection and what can be done to decrease the burning sensation?

Answer 17

Lidocaine is acidic, which causes the burning.

Add sodium bicarbonate to decrease the burning sensation.

Question 18

Why does some lidocaine come with epinephrine?

Answer 18

Epinephrine vasoconstricts the small vessels, resulting in a decrease in bleeding and blood flow in the area.
This prolongs retention of lidocaine and its effects.

Question 19

In what locations is lidocaine with epinephrine contraindicated?

Answer 19

Fingers, toes, penis because of the possibility of ischemic injury or necrosis resulting from vasoconstriction

Question 20

What are the contraindications to nitrous oxide?

Answer 20

Nitrous oxide is poorly soluble in serum and thus expands into any air-filled body pockets.
Avoid in patients with middle ear occlusions, PTX, SBO, etc.

Question 21

What is the feared side effect of bupivacaine?

Answer 21

Cardiac dysrhythmia after intravascular injection leading to fatal refractory dysrhythmia

Question 22

What are the side effects of morphine?

Answer 22

Constipation, respiratory failure, hypotension (from histamine release), spasm of sphincter of Oddi (use Demerol in pancreatitis and biliary surgery), decreased cough reflex

Question 23

What are the side effects of meperidine (Demerol)?

Answer 23

Similar to those of morphine but causes less sphincteric spasm and can cause tachycardia and seizures

Question 24

What is the limit to the duration of meperidine (Demerol) postoperatively?

Answer 24

Build up of the metabolites (normeperidine)

Question 25

What medication is a contraindication to meperidine (Demerol)?

Answer 25

Monoamine oxidase inhibitor

Question 26

What metabolite of Demerol breakdown causes side effects?

Answer 26

Normeperidine

Question 27

What is the treatment of life-threatening respiratory depression with narcotics?

Answer 27

Narcan IV (naloxone)

Question 28

What are the side effects of epidural analgesia?

Answer 28

Orthostatic hypotension, decreased motor function, urinary retention

Question 29

What is the advantage of epidural analgesia?

Answer 29

Analgesia without decreased cough reflex

Question 30

What are the side effects of spinal analgesia?

Answer 30

Urinary retention, hypotension

Question 31

What is the side effect of inhalational (volatile) anesthesia?

Answer 31

Halothane: hypotension (cardiac depression, decreased baroreceptor response to hypotension, peripheral vasodilation), malignant hyperthermia

Question 32

What is malignant hyperthermia?

Answer 32

Inherited predisposition to an anesthetic reaction, causing uncoupling of the excitation-contraction system in skeletal muscle, which in turn causes malignant hyperthermia. Hypermetabolism is fatal if untreated.

Question 33

What is the incidence of malignant hyperthermia?

Answer 33

Very rare

Question 34

What are the causative agents of malignant hyperthermia?

Answer 34

General anesthesia, succinylcholine

Question 35

What are the signs and symptoms of malignant hyperthermia?

Answer 35

Increased body temperature; hypoxia; acidosis; tachycardia; increased PCO2

Question 36

What is the treatment for malignant hyperthermia?

Answer 36

IV dantrolene, body cooling, discontinuation of anesthesia

Question 37

What are some of the non-depolarizing muscle blockers?

Answer 37

Vecuronium, pancuronium

Question 38

What are the antidotes to the non-depolarizing neuromuscular blocking agents?

Answer 38

Edrophonium, neostigmine, pyridostigmine

Question 39

How do antidotes to the non-depolarizing neuromuscular blocking agents work?

Answer 39

They inhibit anticholinesterase

Question 40

Which muscle blocker is depolarizing?

Answer 40

Succinylcholine

Question 41

What is the duration of action of succinylcholine?

Answer 41

< 6 minutes

Question 42

What is the antidote to reverse succinylcholine?

Answer 42

Time. | Endogenous blood pseudocholinesterase (patients deficient in this enzyme may be paralyzed for hours).

Question 43

What is the maximum dose of lidocaine with epinephrine?

Answer 43

7 mg/kg

Question 44

What is the maximum dose of lidocaine without epinephrine?

Answer 44

4 mg/kg

Question 45

What is the duration of lidocaine local anesthesia?

Answer 45

30-60 minutes (up to 4 hours with epinephrine)

Question 46

What are the early signs of lidocaine toxicity?

Answer 46

Tinnitus, perioral/tongue numbness, metallic taste, blurred vision, muscle twitches, drowsiness

Question 47

What are the signs of lidocaine toxicity with large overdose (> 10 ug/mL)?

Answer 47

Seizures, coma, respiratory arrest, LOC, apnea

Question 48

When should the Foley catheter be removed in a patient with an epidural catheter?

Answer 48

Several hours after the epidural catheter is removed (to prevent urinary retention)

Question 49

What is a PCA pump?

Answer 49

Patient-Controlled Analgesia: | A pump delivers a set amount of pain reliever when the patient pushes a button.

Question 50

What are the advantages of a PCA pump?

Answer 50

Better pain control; patients actually use less pain medication with a PCA. If given a moderate dose without a basal rate, patients should not be able to overdose.

Question 51

What is a basal rate on the PCA?

Answer 51

Steady continuous infusion rate of the narcotic (e.g. 1-2 mg of morphine) continuously infused per hour. Patient can supplement with additional doses as needed.

Question 52

What is used to reverse narcotics?

Answer 52

Naloxone (Narcan)

Question 53

What is used to reverse benzodiazepines?

Answer 53

Flumazenil

Question 54

What is fentanyl?

Answer 54

Very potent narcotic

Question 55

What is a common IV NSAID?

Answer 55

Ketorolac (Toradol)