Anesthesia

Question 1

Four components of the anesthetic state

Answer 1

analgesia, amnesia, muscle relaxation, unconsciousness

Question 2

Refers to the suppression of activity in the CNS resulting in unconsciousness and total lack of sensation

Answer 2

general anesthesia

Question 3

Uses agents that inhibit transmission of nerve impulses between higher and lower centers of the brain inhibiting anxiety and the creation of long-term memories

Answer 3

sedation (dissociative amnesia)

Question 4

Renders large area of the body insensate by blocking transmission of nerve impulses between part of the body and spinal cord. Divided into peripheral and central blockades

Answer 4

regional anesthesia

Question 5

Inhibits sensory perception within a specific location on the body

Answer 5

peripheral blockade

Question 6

Local anesthetic is placed around the spinal cord (spinal or epidural anesthesia) removing sensation to any area below the level of the block

Answer 6

central blockade

Question 7

Factor that has the greatest bearing on the probability of a complication occurring from anesthesia

Answer 7

patient’s health prior to surgery

Question 8

Potential complication of anesthesia characterized by persistent confusion lasting weeks to months. More common in patients undergoing cardiac surgery and the elderly.

Answer 8

long-term post-operative cognitive dysfunction

Question 9

Describe the 6 tiers of the ASA physical status classification system which is used to stratify the pre-operative physical state of the patient

Answer 9

1-healthy. 2-mild systemic dz. 3-severe systemic dz. 4- severe systemic dz that is a threat to life. 5- person who is not expected to survive w/out operation. 6- brain dead organ donor

Question 10

Three main goals of general anesthesia

Answer 10

paralysis, unconsciousness, blunting of stress response

Question 11

What is the most common approach to reach the goals of general anesthesia?

Answer 11

use of inhaled general anesthetics

Question 12

Quantifies the potency of an inhalational anesthetic. It’s the percentage dose of anesthetic that will prevent a response to painful stimuli in 50% of subjects.

Answer 12

minimum alveolar concentration (MAC)

Question 13

What are the minimum physiologic monitoring guidelines for patients undergoing any type of anesthesia?

Answer 13

ECG, HR, BP, inspired and expired gases, pulse ox, and temp

Question 14

What are sedatives such as benzos usually given with for sedation anesthesia?

Answer 14

pain relievers

Question 15

Type of regional anesthesia where dilute local anesthetic is infused to a limb through a vein with a tourniquet placed to prevent the drug from diffusing out of the limb

Answer 15

Bier block

Question 16

Where is the anesthetic for a spinal block delivered?

Answer 16

injected into the subarachnoid space

Question 17

Where is the anesthetic for an epidural block delivered?

Answer 17

injected into the epidural space

Question 18

What are the main difference between the effects of spinal and epidural blocks?

Answer 18

spinal- rapid onset, sensory anesthesia w/low doses, loss of muscle control. epidural-larger doses thru indwelling catheter and doesn’t effect muscle control

Question 19

Contraindications to regional anesthesia

Answer 19

pt refusal, coagulopathy, infection at site, nerve deficit

Question 20

Major advantage of using amide local anesthetics vs esters

Answer 20

low chance of allergic rxn

Question 21

Why is epi useful for the administration of local anesthetic?

Answer 21

you can use 50% more of the drug w/epi (toxic dose is increased)

Question 22

Name the amides

Answer 22

lidocaine, bupivicaine (Marcaine), Ropivicaine

Question 23

Name the esters

Answer 23

cocaine, chloroprocaine, tetracaine

Question 24

Important to prevent desaturation during apnea (induction/intubation)

Answer 24

preoxygenation

Question 25

Name the depolarizing neuromuscular blocker

Answer 25

succinylcholine

Question 26

Name the non-depolarizing neuromuscular blockers

Answer 26

rocuronium, vecuronium, pancuronium

Question 27

Name the volitile (inhaled) anesthetics

Answer 27

iso-, sevo-, and des- FLURANE

Question 28

Agents that can be used to reverse the neuromuscular blockers. Are acetylcholinesterase inhibitors (ACh I’s)

Answer 28

Neostigmine and Edrophonium

Question 29

Name the anticholinergics given with ACh I’s to prevent asystole

Answer 29

glycopyrolate, atropine, scopolamine

Question 30

What is your anesthetic choice for a patient who is having a total knee replacement?

Answer 30

spinal + nerve block (saphenous or femoral)

Question 31

What are the next steps in management of a patient who has vomited and has an LMA?

Answer 31

take out LMA and replace with oral airway and mask ventilate. place in Trendelenberg

Question 32

Bronchospasm is a complication that frequently occurs in asthmatics. During surgery it’s noted by low tidal volumes with increased airway pressures. What is the treatment?

Answer 32

lidocaine bolus, albuterol, increased sevo, and epi to relax smooth muscle