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Surgical Recall > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

What is anesthesia?

A

Loss of sensation/pain

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2
Q

What is local anesthesia?

A

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

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3
Q

What is epidural anesthesia?

A

Anesthetic drugs/narcotics infused into epidural space

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4
Q

What is spinal anesthesia?

A

Anesthetic agents injected into the thecal sac

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5
Q

What is regional anesthesia?

A

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

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6
Q

What is general anesthesia?

A
  1. Unconsciousness/amnesia
  2. Analgesia
  3. Muscle relaxation
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7
Q

What is GET or GETA?

A

General EndoTrachael Anesthesia

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8
Q

What are common local anesthetics?

A

Lidocaine, bupivacaine (Marcaine)

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9
Q

What are common regional anesthetics?

A

Lidocaine, bupivacaine (Marcaine)

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10
Q

What are common general anesthetics?

A

Isoflurane, enflurane, sevoflurane, desflurane

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11
Q

What is a common dissociative agent?

A

Ketamine

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12
Q

What is cricoid pressure?

A

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.

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13
Q

What is rapid-sequence anesthesia induction?

A
  1. Oxygenation and short-acting induction agent
  2. Muscle relaxant
  3. Cricoid pressure
  4. Intubation
  5. Inhalation anesthetic
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14
Q

What are common induction agents?

A

Propofol, midazolam, sodium thiopental

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15
Q

What are contraindications of the depolarizing agent succinylcholine? Why?

A

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

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16
Q

Why doesn’t lidocaine work in an abscess?

A

Lidocaine does not work in an acidic environment

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17
Q

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

A

Lidocaine is acidic, which causes the burning.

Add sodium bicarbonate to decrease the burning sensation.

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18
Q

Why does some lidocaine come with epinephrine?

A

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.

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19
Q

In what locations is lidocaine with epinephrine contraindicated?

A

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

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20
Q

What are the contraindications to nitrous oxide?

A

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.

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21
Q

What is the feared side effect of bupivacaine?

A

Cardiac dysrhythmia after intravascular injection leading to fatal refractory dysrhythmia

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22
Q

What are the side effects of morphine?

A

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

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23
Q

What are the side effects of meperidine (Demerol)?

A

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

24
Q

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

A

Build up of the metabolites (normeperidine)

25
Q

What medication is a contraindication to meperidine (Demerol)?

A

Monoamine oxidase inhibitor

26
Q

What metabolite of Demerol breakdown causes side effects?

A

Normeperidine

27
Q

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

A

Narcan IV (naloxone)

28
Q

What are the side effects of epidural analgesia?

A

Orthostatic hypotension, decreased motor function, urinary retention

29
Q

What is the advantage of epidural analgesia?

A

Analgesia without decreased cough reflex

30
Q

What are the side effects of spinal analgesia?

A

Urinary retention, hypotension

31
Q

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

A

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

32
Q

What is malignant hyperthermia?

A

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.

33
Q

What is the incidence of malignant hyperthermia?

A

Very rare

34
Q

What are the causative agents of malignant hyperthermia?

A

General anesthesia, succinylcholine

35
Q

What are the signs and symptoms of malignant hyperthermia?

A

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

36
Q

What is the treatment for malignant hyperthermia?

A

IV dantrolene, body cooling, discontinuation of anesthesia

37
Q

What are some of the non-depolarizing muscle blockers?

A

Vecuronium, pancuronium

38
Q

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

A

Edrophonium, neostigmine, pyridostigmine

39
Q

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

A

They inhibit anticholinesterase

40
Q

Which muscle blocker is depolarizing?

A

Succinylcholine

41
Q

What is the duration of action of succinylcholine?

A

< 6 minutes

42
Q

What is the antidote to reverse succinylcholine?

A

Time.

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

43
Q

What is the maximum dose of lidocaine with epinephrine?

A

7 mg/kg

44
Q

What is the maximum dose of lidocaine without epinephrine?

A

4 mg/kg

45
Q

What is the duration of lidocaine local anesthesia?

A

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

46
Q

What are the early signs of lidocaine toxicity?

A

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

47
Q

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

A

Seizures, coma, respiratory arrest, LOC, apnea

48
Q

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

A

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

49
Q

What is a PCA pump?

A

Patient-Controlled Analgesia:

A pump delivers a set amount of pain reliever when the patient pushes a button.

50
Q

What are the advantages of a PCA pump?

A

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.

51
Q

What is a basal rate on the PCA?

A

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.

52
Q

What is used to reverse narcotics?

A

Naloxone (Narcan)

53
Q

What is used to reverse benzodiazepines?

A

Flumazenil

54
Q

What is fentanyl?

A

Very potent narcotic

55
Q

What is a common IV NSAID?

A

Ketorolac (Toradol)

Surgical Recall (68 decks)

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