Anesthesia Flashcards
What level of anesthesia is considered surgical anesthesia?
Level 3
There are 4 reflexes progressively lost in level 3 surgical anesthesia. The third reflex lost in the progression is?
thoracic muscular
Anesthesiologist mentions that he is administering Reglan. What is this for?
Reglan (Metoclopramide) - reduce gastric motility
Pediatric hypoglycemia is very dangerous. Pediatric patients have limited amount of glycogen stores and therefore what fluid should always be running in their IV?
D5W
What are the effects of low serum Ca2+ on the EKG?
wide QRS complex
What effect does Ketamine have on a patient?
amnesia only
Fentanyl is used as what?
narcotic analgesic
What is the first symptom of malignant hyperthermia?
tachycardia
what drug has largely replaced sodium pentothal?
propofol (Dipriva)
what is the mechanism of breakdown of amides and esters?
esters are hydrolyzed by pseudocholinesterase in the blood; amides are metabolized in the liver
what is the treatment for convulsions?
valium
describe a Mayo block.
local “ring” block of the 1st MPJ
describe MAC anesthesia.
IV sedation with a local anesthesia block
what is the mechanism for local anesthesia in how it provides pain relief?
blocks Na+ conduction across the mb, which prevents depolarization and causes inhibition of nerve conduction
what is the treatment for shock?
fluids
ABC’s
monitor vitals
What is the ASA classification for a healthy patient?
ASA class 1
what complications are associated with tourniquet use?
tissue necrosis inflammation paralysis thrombosis circulatory volume overload
what are some complications of endotracheal intubation?
sore throat tracheal edema croup laceration pneumothorax
what is a contraindication to tourniquet use?
- previous popliteal- dorsalis pedis bypass grafting
2. sickle cell dz- bc tourniquet causes low O2 tension which would cause cells to sickle
when positioning a patient in the prone position during general anesthesia, what is the most common complication?
pressure on the orbit as well as teh dorsum of the foot
when positioning a patient in the SUPINE position during general anesthesia, what is the most common complication?
ulnar nerve neuropathy
during spinal anesthesia, where is the anesthetic placed in the lumbar area of the spine?
subarachnoid space, deep to the dura
complications of spinal anesthesia?
headache
hypotension
cauda equina syndrome
infection
what is the most common cause of elevated temperature intraoperatively?
malignant hyperthermia
what medication is used to treat malignant hyperthermia?
dantrolene- IV
what type of allergic reaction is anaphylaxis?
type I- antibody mediated hypersensitivity rxn, seen immediately
what are early signs of anaphylaxis?
flush, difficulty breathing, wheezing, stridor, laryngeal edema
what is the treatment for anaphylaxis?
Epi 0.3-0.5mL SC of a 1,1000 solution; along with antihistamines
List some common examples of Amide based local anesthetics.
Lidocaine
Bupivicaine (Marcaine)
Mepivicaine
List common examples of Ester based local anesthetics.
procaine
tetracaine
chloroprocaine
when performing tendon transfer type procedures, list the type of potential anesthesia used.
general, spinal, and epidural (bc each of those modalities will temporarily eliminate LE muscular activity)
what type of local block is most widely accepted when performing HAV surgery in a healthy patient?
MAC with a local Mayo block
what nerve lies within the first IM space?
deep peroneal n.
cervical spine radiographs should be obtained on a patient with a history of what?
RA- in case we need to intubate them
what is the recommended pressure for a high thigh tourniquet?
200mmHg over systolic pressure due to the large soft tissue mass on the thigh
when using a high thigh tourniquet, which types of anesthesia would be unwise?
MAC and local types bc the high thigh tourniquet causes too much discomfort and generally requires a general anesthetic
during which stage of anesthesia would it be appropriate to elevate an extremity tourniquet?
stage 2
when comparing a spinal block to a epidural block, which will allow greater control?
epidural block
when a patient has completed general anesthesia and is violently shaking as if cold, what medication will relieve these symptoms?
Demerol (Meperidine)
the morning of surgery, a patient with non-insulin dependent diabetes, hypothyroidism, and hypertension should be told to take all of their medications except?
oral diabetic med bc they have been NPO and could become severely hypoglycemia and go into insulin shock
factors that affect concentration of a drug at a site of action as a function of time is referred to as?
pharmacokinetics
succinylcholine is used to achieve?
muscle relaxation thru depolarization
succinylcholine has what AE?
fasiculations as well as hyperkalemia
list a potential AE caused by Toradol?
peptic ulcer
do esters or amides anesthetics have a higher allergic potential?
esters
the protein binding characteristics of a drug will afffec what?
duration of action
is eating within 6 hrs prior to a general anesthetic a cause to cancel the surgery? why or why not?
yes- due to the risk of regurgitation and aspiration
during a local field block, what sensation is lost first?
pain and temp first, second is touch and motor
a local field block injected into an infected area is less because because of what action?
the acidic area of the infection converts the anesthetic chemically thus decreasing penetration in to the cell
when performing an ankle block, what nerves are bloked?
saphenous tibial n. sural n. superficial peroneal deep peroneal
what are the initial steps to perform once it is determine the patient is having a syncope reaction?
oxygen
Trendelenberg positioning
monitor vitals
when performing various types of anesthesia on pediatric patients, what is the most common concern during anesthesia?
hypothermia (temp fluctuations)
What is Wydase (hyaluronidase) and how does it work?
is a medical preparation of highly purified bovine testicular enzyme. The enzyme hydrolyzes hyaluronic acid, which usually limits diffusion by binding cells together. Thus, it is believed that hyaluronidase increases permeability and promotes the spread of local anesthetic
when using halothane, what vasoconstrictive drug is contraindicated?
epi
what AE of narcotics?
resp depression
emesis
dependence
what inhalation agent is non-flammable?
halothane
which has greater DOA- lidocaine or marcaine?
marcaine
if a patient becomes hyperkalemic during surgery, what may you observe?
muscle weakness, cardiac changes on EKG
what type of anesthesia causes the least interference with preexisting diseases?
regional nerve block
what are the various etiologies of syncope?
vasovagal postural hypotension orthostatic hypotension cardiac carotid sinus secondary to CVD
what is the toxic dose of Lidocaine plain 1%?
300mg (30mL) 4.5mg/kg
what is the toxic dose of Lidocaine 1% with epi?
500mg (50mL) 7mg/kg
what is the toxic dose of Bupivicaine 0.5% plain?
175mmg (35mL) 2.5mg/kg
what is the toxic dose of Bupividaine 0.25% with e[o
225mg (45mL) 3.2mg/kg
what nerve lies anterior to the medial mallleolus?
saphenous
a local field block injected into an infected area becomes less active because of what?
the acidic area of the infection converts the anesthetic chemically thus decreasing pemetration into a cell mb
what nerves are blocked when performing an ankle block?
- posterior tibial
- saphenous
- superficial peroneal
- deep peroneal
- sural nerve
which local anesthetic has a higher allergic potential?
esters
which has a greater duration of action: lidocaine or marcaine?
marcaine
