Anesthesia

Question 1

General anesthesia

Answer 1

Suppression of activity in the CNS

Unconciousness and total lack of sensation

Question 2

Sedation anesthesia

Answer 2

Inhibition of transmission of nerve impulses between higher and lower centers of the brain inhibition of anxiety and memory

Question 3

Regional anesthesia

Answer 3

Regional : use of local anesthetics to make a use of local anesthetics to make a portion of the body insensate by blocking transmission of nerve impulses between a part of the body and the spinal cord
Peripheral: Inhibits sensory perception within a specific location, Nerve blocks
Central: Local anesthetic delivered around the spinal cord and removes sensation of the body below the level of the block (spinal and epidural)

Question 4

Types of regional anesthesia

Answer 4

Infiltrative: Local anesthetic injected in a small area to stop sensation
Peripheral nerve block: Local anesthetic injected near a nerve that provides sensation to a portion of the body
IV regional anesthesia (aka Bier block): Dilute local anesthetic infused to a limb through a vein with a tourniquet placed to prevent the drug from diffusing out of the limb
Central nerve blockade: Infusion or injection of local anesthetic in or around portion of CNS
Topical anesthesia: Special formulation that diffuses through the skin or mucous membranes (EMLA patches)
Tumescent anesthesia: Large amount of dilute local anesthesia infilatrated into the subcutaneous tissue used in liposuction

Question 5

When not to add epinephrine

Answer 5

When the vasoconstrictive properties of epinephrine may compromise tissue perfusion 
(e.g. “end” arteries): 
	Fingers/toes
	Penis
	Ear/nose
	Skin flaps

Question 6

Propofol (Diprivan)

Answer 6

Non-barbiturate hypnotic agent
Used for general surgery, cardiac surgery, neurosurgery, and pediatric surgery
Rapid onset of action, rapid clearance, and reversibility
Some anti-emetic effect so less nausea and vomiting associated with use
No analgesic effect

Question 7

Ketamine (Ketalar)

Answer 7

Affects the senses, and produces a dissociative anesthesia, patient may appear awake and reactive, but cannot respond to sensory stimuli
Frequently used in pediatric patients
Rapid onset (30 sec)
Short duration (5-10 minutes)

Question 8

Anesthestic Gases

Answer 8

Isoflurane (Forane)
Desfluorane (Suprane) 
Sevofluorane (Ultane)
Nitrous oxide
Nitrous oxide and desflurane are the shortest-acting anesthetic gases because they are the least soluble in blood

Question 9

2 Types of NMBDs

Answer 9

Depolarizing:
Succinylcholine (Anectine)
Nondepolarizing:
Rocuronium (Zemuron)
Vecuronium (Norcuron)
Pancuronium (Pavulon)
Cisatracurium (Nimbex)

Question 10

Succinylcholine (“Anectine”)

Answer 10

Causes depolarization at the motor endplate
In contrast to ACh, succinylcholine slowly dissociates from the ACh receptors, resulting in an inactive state
Broken down by butyrylcholinesterase to choline and succinylmonocholine
Rapid onset (

Question 11

Nondepolarizing agents Duration of Action

Answer 11

Long-acting: Pancurounium
Intermediate-acting:
Vecuronium
Rocuronium, 
Cisatracurium
Short-acting: Mivacurium

Question 12

“Train of Four”

Answer 12

4 twitches: 0-75% of the receptors are blocked.
3 twitches: at least 75% of the receptors are blocked.
2 twitches: 80% of the receptors are blocked.
1 twitch: 90% of the receptors are blocked.
When no twitches are seen, 100% of receptors are blocked.

Question 13

Reversal of NMBDs

Answer 13

Acetylcholine esterase inhibitors:
Neostigmine, edrophonium result in accumulation of Ach at the neuromuscular junction
Sugammadex: No anticholinergic effects like those above