Anesthesia Flashcards
4 goals of anesthesia
Analgesia
Amnesia
Paralysis
Unconsciousness/hypnosis
ASA standards
Oxygenation Ventilation Circulation Consistent presence Temperature
ASA class 1
Healthy normal
ASA class 2
Well controlled systemic dz (mild asthma) Smokers automatically at least class 2
ASA class 3
Moderately controlled systemic dz (severe asthma)
ASA class 4
Dz that is constant threat to life (organ failure)
ASA class 5
Need surgery in order to survive (ruptured AAA)
ASA class 6
Basically being sustained chemically or on vent for organ donation.
3 critical questions to ask pts before anesthesia
- Last eat or drink (must be more than 6 hrs)
- Big meal - at least 8 hrs - Allergies
- Problems w/ anesthesia in past
Drug to block sympathetic response for ET tube placement
Lidocaine
Drugs for induction
- Fentanyl
- Propofol (with lido 1 mg/kg)
- Rocuronium (takes 60 seconds)
What may help with someone who has a big fat neck?
Pillow under shoulders
Standard size ET tubes
- 5 for men
7. 0 for women
Fentanyl duration
30 - 60 mins
Propofol duration
5 - 10 mins
Rocuronium duration
45 - 60 mins
Maintenance meds
Nitrous oxide (104%)
Sevoflurane (2%)
Desflurane (65%)
Dilaudid for narcotic maintainance
Narcotic potency
Merperidine: .1 Morphine: 1 (standard) Hydromorphone: 5x Alfentinil: 10x Fent: 75 - 100x Remifentanyl: 500x Sufentanyl: 1,000x
Morphine ans hydromorphone duration
Effect around 15 mins
Peak at 60 mins
Duration of 3-4 hrs
Perioperative pain control serves what purpose?
Decreases sympathetic surge and reduces risk of:
PE, MI
Very high amounts of IV propofol maintenance is ideal for what type of surgery?
Aneurysm repair
Lowers o2 demand of brain
What reverses muscle relaxants (paralytics).
ACTH esterase inhibitors
Neostigmine
Edrophonium
ACTH esterase inhibitors are always given in conjunction with
Antocholinergics
Glocopyrolate (preferred)
Atropine
Most common antiemetic
Zofran (serotonin 5HT receptors)
Dose needed to control pain for conscious patient on floor post-op?
18 times less than loading dose needed in surgery
During surgery, vitals should be within ___% of baseline
20%
Stop taking plavix __ days before spinal block
7 days
ASA, NSAIDS and spinal blocks
Generally not a big enough concern to stop them from doing a block.
<p>INR cut off for spinal block</p>
<p>1.5 is maximum</p>
Local anesthetics 2 classes
Amides (lidocaine, bupi, ropi)
Esters (cocaine)
Amides are metabolized by?
Metabolized by liver
Esters have greater risk of?
Allergic rxn
Amides have VERY low risk
Epinephrine decreases the uptake of?
Lidocaine etc.
Steroids make the block last?
Twice as long
Lidocaine vs Bupivocaine
Lido has fast onset, short duration (1-2 hrs)
Bupi has slow onset, longer duration (4-8 hrs)
Bupivocaine w/ dex in a spinal = how long of duration?
24 hrs
Most interscalene blocks also block which nerve?
Phrenic
Causes hemodiaphragmatic paralysis
