Anesthesia Flashcards
Four components of the anesthetic state
analgesia, amnesia, muscle relaxation, unconsciousness
Refers to the suppression of activity in the CNS resulting in unconsciousness and total lack of sensation
general anesthesia
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
sedation (dissociative amnesia)
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
regional anesthesia
Inhibits sensory perception within a specific location on the body
peripheral blockade
Local anesthetic is placed around the spinal cord (spinal or epidural anesthesia) removing sensation to any area below the level of the block
central blockade
Factor that has the greatest bearing on the probability of a complication occurring from anesthesia
patient’s health prior to surgery
Potential complication of anesthesia characterized by persistent confusion lasting weeks to months. More common in patients undergoing cardiac surgery and the elderly.
long-term post-operative cognitive dysfunction
Describe the 6 tiers of the ASA physical status classification system which is used to stratify the pre-operative physical state of the patient
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
Three main goals of general anesthesia
paralysis, unconsciousness, blunting of stress response
What is the most common approach to reach the goals of general anesthesia?
use of inhaled general anesthetics
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.
minimum alveolar concentration (MAC)
What are the minimum physiologic monitoring guidelines for patients undergoing any type of anesthesia?
ECG, HR, BP, inspired and expired gases, pulse ox, and temp
What are sedatives such as benzos usually given with for sedation anesthesia?
pain relievers
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
Bier block
Where is the anesthetic for a spinal block delivered?
injected into the subarachnoid space
Where is the anesthetic for an epidural block delivered?
injected into the epidural space
What are the main difference between the effects of spinal and epidural blocks?
spinal- rapid onset, sensory anesthesia w/low doses, loss of muscle control. epidural-larger doses thru indwelling catheter and doesn’t effect muscle control
Contraindications to regional anesthesia
pt refusal, coagulopathy, infection at site, nerve deficit
Major advantage of using amide local anesthetics vs esters
low chance of allergic rxn
Why is epi useful for the administration of local anesthetic?
you can use 50% more of the drug w/epi (toxic dose is increased)
Name the amides
lidocaine, bupivicaine (Marcaine), Ropivicaine
Name the esters
cocaine, chloroprocaine, tetracaine
Important to prevent desaturation during apnea (induction/intubation)
preoxygenation
Name the depolarizing neuromuscular blocker
succinylcholine
Name the non-depolarizing neuromuscular blockers
rocuronium, vecuronium, pancuronium
Name the volitile (inhaled) anesthetics
iso-, sevo-, and des- FLURANE
Agents that can be used to reverse the neuromuscular blockers. Are acetylcholinesterase inhibitors (ACh I’s)
Neostigmine and Edrophonium
Name the anticholinergics given with ACh I’s to prevent asystole
glycopyrolate, atropine, scopolamine
What is your anesthetic choice for a patient who is having a total knee replacement?
spinal + nerve block (saphenous or femoral)
What are the next steps in management of a patient who has vomited and has an LMA?
take out LMA and replace with oral airway and mask ventilate. place in Trendelenberg
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?
lidocaine bolus, albuterol, increased sevo, and epi to relax smooth muscle
