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Surgery > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Diff types of anesthesia?

A
  • general: suppression of activity in CNS, unconsciousness and total lack of sensation
  • sedation: inhibition of transmission of nerve impulses b/t higher and lower centers of the brain inhibition of anxiety and memory
  • regional: use of local anesthetics to make a portion of body insensate by blocking transmission of nerve impulses b/t a part of body and spinal cord -
    peripheral: inhibits sensory perception w/in a specific location, nerve blocks.
    central: local anesthetic delivered around spinal cord and removes sensation of body below level of bloc (spinal and epidural)
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2
Q

Endpts of anesthesia? Agents used?

A
  • analgesia: opiates, local anesthetics, ketamine, NSAIDs
  • amnesia: benzos
  • hypnosis: barbiturates, propofol, etomidate
  • immobility: muscle relaxants
  • hemodynamic stability: BBs, sympathomimetics
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3
Q

Risks of anesthesia?

A
  • death
  • MI
  • PE
  • post-op N/V
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4
Q

What is the ASA classification?

A
  • American society of anesthesiologists - classification of pt’s physicla status
  • the greatest predictor of the probability of a complication occuring
  • higher the ASA class = increased likelihood of surgical or anesthetic complications
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5
Q

ASA classes?

A
  • ASA I: a normal healthy pt (no smoking, no or very minimal drinking)
  • ASA II: pt w/ mild systemic disease, (smoker, more than min. drinking, pregnancy, obesity, well controlled diabetes, well controlled HTN, mild lung disease)
  • ASA III: pt w/ severe systemic disease, not incapacitating (diabetets, poorly controlled HTN, distant hx of MI, CVA, TIA, cardiac stent, COPD, ESRD, dialysis, hepatitis, pacemaker, EF below 40%)
  • ASA IV: pt w/ severe systemic disease that is a constant threat to life ( recent hx of MI, CVA, TIA, cardiac stent, ongoing cardiac ischemia or severe valve dysfxn, implanted ICD, EF below 25%)
  • ASA V: moribund pt who isn’t expected to survive w/o the operation (ruptured abominal or thoracic aneurysm, intracranial bleed w/ mass effect, ischemic bowel in face of sig cardiac pathology)
  • ASA VI: a pt who has already been declared brain dead and whose organs are being removed for transplant
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6
Q

What is regional/local anesthesia?

A
  • pain blocked from a part of the body using local anesthetics
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7
Q

Types of regional anesthesia?

A
  • infitrative
  • peripheral nerve block
  • IV regional anesthesia
  • central nerve blockade
  • topical anesthesia
  • tumescent anesthesia
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8
Q

What is infiltrative anesthesia?

A
  • local anesthetic injected into small area to stop sensation
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9
Q

What is a peripheral nerve block?

A
  • local anesthetic injected near a nerve that provides sensation to portion of the body
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10
Q

What is IV regional anesethesia (aka Bier block)?

A
  • dilute local anesthetic infused to a limb through a vein w/ a tourniquet placed to prevent the drug from diffusing out of the limb
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11
Q

What is a central nerve blockade?

A
  • infusion or injection of local anesthetic in or around a portion of the CNS
  • spinal (intrathecal) and epidural
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12
Q

What is topical anesthesia?

A
  • special formulation that diffuses through the skin or mucous membranes (EMLA patcthes)
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13
Q

What is Tumescent anesthesia?

A
  • large amts of dilute local anesthesia infiltrated into subq tissue used in liposuction (puff up surrounding tissue w/ anesthesia)
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14
Q

Indications and CIs for Neuroaxial anesthesia?

A

Indications:
surgery or pain
appropriate distribution

CIs:
pt refusal
infection
coagulopathy

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15
Q

Benefits of spinal anesthesia?

A
  • decreased surgical time by 12%
  • 25% less blood loss
  • 50% less intraop transfusion requirements
  • may decrease the incidence of DVT or PE
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16
Q

Benefits of epidural anesthesia and analgesia? Complications?

A
  • less blood loss
  • reduced platelet aggregation
  • reduced stress response to surgery
  • decreased incidence of DVT
  • improved graft patency after LE revascularization
  • pts w/ combined (general and epidural) for aortic surgery had lower incidence of death and major periop complications
  • complications:
    MC: post procedural HA
    spinal hematoma or abscess
17
Q

Comparison of spinal and epidural anesthesia?

A 
Spinal:
- location of injection:
lumbar region only (below L2)
- no specific levels affected
- many times just a 1 time dose

Epidural:

  • injection: anywhere along the spine
  • specific levels: chest, abdomen, pelvis and legs
  • often a catheter is left in place for multiple injections
18
Q

Diff nerve blocks? How do you localize?

A
  • brachial plexus: interscalene, supraclavicular, axillary
  • digital block (no Epi!!)
  • use paresthesias, US, and nerve stimulation for nerve localization
19
Q

How does a nerve block work?

A
  • blocks Na channels
20
Q

Diff types of local anesthetics?

A
  • Esters:
    short infiltration: 45-60:
    procaine (novocaine), 2-chloroprocaine
    long infitration 180-360 - tetracaine
  • Amides:
    intermediate: lidocaine, mepivacaine
    long: bupivacaine, Ropivacaine
21
Q

Differential block - concentration and block produced?

A
  • low concentration = sympathetic block
  • intermediate = sensory
  • high = motor
  • anesthetic effect: dose dependent
22
Q

Diff blocks dependent on diff agents?

A
  • Bupivacaine:
    sympathetic: 0.125% and below
    motor: 0.5% and greater
  • lidocaine:
    sympathetic: below 0.5%
    motor: 2% and greater
23
Q

Why do we add Epi to LAs?

A 
- prolong surgical anesthesia time: 
procaine from 45-60 to 60-90min
lidocaine from 75-90 to 90-180 min 
bupivacaine from 180-360 to 200-400 
- decrease peak serum levels
- intravascular marker 
- decrease surgical site bleeding
24
Q

When should you not add epi?

A
  • when vasoconstrictive properties of Epi may compromise tissue perfusion (end arteries)
  • fingers/toes
  • penis
  • ear/nose
  • skin flaps
25
Q

Local anesthetic toxicty of lidocaine?

A

low plasma levels to high levels of lidocaine:

  • dizziness
  • tinnitus
  • shivering, dysphoria, nystagmus
  • somnolence, muscle twitching
  • seizures
  • cardiac arrhythmias
  • **CV instability and collapse
26
Q

Tx for local anesthetic toxicity?

A
  1. stop injection
  2. call for help
  3. supportive care (ABCs)
  4. 20% intralipid 1.5ml/kg/min, may repeat bolus (1-2x)
  5. cardiopulmonary bypass

Surgery (19 decks)

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