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Surgery > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Types of anesthesia

A
  1. General
  2. Sedation
  3. Regional
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2
Q

General anesthesia:

  1. Suppression of what activity?
  2. How does it affect the patient? 2
A
  1. Suppression of activity in the CNS
    • Unconsciousness and
    • total lack of sensation
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3
Q

Sedation anesthesia

What is it?

A

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

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4
Q

What is regional anesthesia?

A

Regional : 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

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5
Q

Peripheral regional anesthesia

  1. Inhibits what?
  2. What are a type of this?
  3. Central regional anesthesia is what?
A

Peripheral
1. Inhibits sensory perception within a specific location
2 .Nerve blocks

Central
3. Local anesthetic delivered around the spinal cord and removes sensation of the body below the level of the block (spinal and epidural)

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6
Q

Endpoints of Anesthesia? 5

A
  1. Analgesia
  2. Hypnosis
  3. Amnesia
  4. Hemodynamic Stability
  5. Immobility
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7
Q

What helps us accomplish the following anesthesia endpoints:

  1. Analgesia? 4
  2. Hypnosis? 3
  3. Amnesia? 1
  4. Hemodynamic Stability? 2
  5. Immobility? 1
A
    • Opiates
    • Local anesthetics
    • Ketamine
    • NSAIDs
    • Barbiturates
    • Propofol
    • Etomidate
  3. Benzodiazepines
    • Beta-blockers
    • Sympathomimetics
  5. Muscle relaxants
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8
Q

Risks of anesthesia

4

A
  1. Death
  2. Myocardial infarction
  3. Pulmonary embolism
  4. Post operative nausea and vomiting
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9
Q

ASA Classification

The higher the ASA class = what?

A

increased likelihood of surgical or anesthetic complications

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10
Q

Regional anesthesia/Local anesthesia

is what?

A

Pain blocked from a part of the body using local anesthetics

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11
Q

Types of regional anesthesia

6

A
  1. Infiltrative
  2. Peripheral nerve block
  3. IV regional anesthesia
  4. Central nerve blockade
  5. Topical anesthesia
  6. Tumescent anesthesia
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12
Q

Describe the Types of regional anesthesia:

  1. Infiltrative?
  2. Peripheral nerve block?
  3. IV regional anesthesia (aka Bier block)?
A
  1. Infiltrative
    - Local anesthetic injected in a small area to stop sensation
  2. Peripheral nerve block
    - Local anesthetic injected near a nerve that provides sensation to a portion of the body
  3. 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
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13
Q

Describe the Types of regional anesthesia:

  1. Central nerve block? (two kinds?)
  2. Topical Anesthesia?
  3. Tumescent anestheisa?
A
  1. Central nerve blockade
    -Infusion or injection of local anesthetic in or around a portion of the CNS
    (Spinal (intrathecal) and epidural)
  2. Topical anesthesia
    - Special formulation that diffuses through the skin or mucous membranes (EMLA patches)
  3. Tumescent anesthesia
    - Large amount of dilute local anesthesia infilatrated into the subcutaneous tissue used in liposuction
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14
Q

Neuroaxial anesthesia

  1. Indications?2
  2. Contraindications? 3
A
  1. Indications:
    - Surgery or pain
    - Appropriate distribution
  2. Contraindications:
    - Patient refusal
    - Infection
    - Coagulopathy
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15
Q

Benefits of spinal anesthesia

4

A
  1. Decreased surgical time by 12%
  2. 25% less blood loss
  3. 50% less intraoperative transfusion requirements
  4. May decrease the incidence of DVT or PE
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16
Q

Benefits of epidural anesthesia and analgesia

6

A
  1. Less blood loss
  2. Reduced platelet aggregation
  3. Reduced stress response to surgery
  4. Decreased incidence of DVT
  5. Improved graft patency after LE revascularization
  6. Patients with combined (general and epidural) for aortic surgery had lower incidence of death and major perioperative complications
17
Q

Neuroaxial anesthesia compications? 2

-most common?

A
  1. Most common is a post procedural headache

2. Spinal hematoma or abscess

18
Q

Compare the following with Spinal and Epidural Anesthesia:

  1. Location of injection?
  2. Specific levels?
  3. Injection vs. catheter?
A 
Spinal
1.  Lumbar region only
(below L2)
2. No
3. Many times just a one time dose

Epidural

  1. Anywhere along the spine
  2. Chest, abdomen, pelvis, legs
  3. Often a catheter is left in place for multiple injections
19
Q

How would you accomplish nerve localization for a regional block? 3

A
  1. Paresthesia
  2. Nerve stimulation
  3. US
20
Q

Common brachial plexus blocks? 3

A
  1. Interscalene
  2. Supraclavicular
  3. Axillary
21
Q

Digital block

  1. What needle?
  2. What should you use?
A
  1. 1.5 inch 25ga needle
  2. 1-2ml local anesthetic/side
    No epinephrine!**
22
Q

List the following meds in order of short duration to long duration (and fast onset to slow)? 7

A
  1. Procaine
  2. Chloroprocaine
  3. Lidocaine
  4. Mepivacaine
  5. Ropivicaine
  6. Bupivacaine
  7. Tretracaine
23
Q
  1. What are the short acting esters? 2
  2. What are the long actin esters?
  3. What are the intermediate amides? 2
  4. What are the long acting amides? 2
A
    • Procaine (Novacaine)
    • 2-Chloroprocaine
  2. Tetracaine
    • Lidocaine (Xylocaine)
    • Mepivacaine
  4. -Bupivacaine
    (Sensorcaine, Marcaine)
    -Ropivacaine (Naropin)
24
Q

Differential blocks? 2

A
  1. Bupivacaine

2. Lidocaine

25
Q

Why Add Epinephrine to LAs?

4

A
  1. Prolong surgical anesthesia time
  2. Decrease peak serum levels
  3. Intravascular marker
  4. Decrease surgical site bleeding
26
Q
  1. When not to add epinephrine?

2. Four areas?

A
  1. When the vasoconstrictive properties of epinephrine may compromise tissue perfusion
    (e. g. “end” arteries):Fingers/toes
    Penis
    Ear/nose
    Skin flaps
27
Q

Treatment of local anesthetic toxicity

5

A
  1. Stop injection
  2. Call for help
  3. Supportive care (ABCs)
  4. 20% Intralipid
    1.5ml/kg IV bolus
    0.25ml/kg/min
    May repeat bolus (1-2X)
  5. Cardiopulmonary bypass

Surgery (20 decks)

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