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Hershey Manual > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Anesthesia Classifications (5)

A

Class I (Normal and Healthy): No known diseases

Class 2 Mild Systemic diseases/ Presence of essential hypertension or mild type II diabetes

Class 3 Severe Systemic disease that is not incapacitating. Severe diabetes, type I with vascular complications

Class 4 incapacitating systemic disease that is a threat to life. Advanced cardiac, renal, pulmonary, hepatic, or endocrine

Class 5: Moribund Patient who is not expected to live with or without surgery.

Emergency operation: any patient in one of the above classes who is operated on as an emergency

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2
Q

What is General Anesthesia?

A

It is a reversible state of unconsciousness produced by anesthetic agents, with loss of sensation of pain over the whole body. The order of descending depression of the CNS during anesthesia is: cortical/psychic centers, basal ganglia/cerebellum, medullary centers, and spinal cord

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3
Q

Inhalation agents (2)

A

Volatile liquids and Gaseous anesthetic agents

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4
Q

Types of volatile liquids (6)

A 
Chloroform
Diethyl ether
Halothane
Methoxyflurane
Enflurane
Isoflurane
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5
Q

Chloroform: advantages and disadvantages

A

no longer in use

advantages: rapid induction and recovery, nonflammable, good muscle relaxation

Disadvantages: myocardial depressant and hepatotoxic

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6
Q

Diethyl ether: advantages and disadvantages

A

No longer used

Advantage: reliable sign of anesthesia depth, respiration stimulated, bronchodilator, circulation not depressed, good muscle relaxation, relatively safe and nontoxic.

Disadvantages: Prolonged induction and recovery, irritating to mucous membranes of upper airway, dangerous in patients with full stomachs, flammable and explosive

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7
Q

Halothane: advantages and disadvantages

A

Advantages: rapid smooth induction and recovery, pleasant smell, nonirritating, bronchodilator, nonemetic, nonflammable

Disadvantages: myocardial depressant, may trigger malignant hyperthermia reaction, arrhythmia-producing drug, sensitizes the myocardium to catecholamines, possibly toxic to the liver, postoperative shivering

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8
Q

Methoxyflurane: advantages and disadvantages

A

No longer used

Advantage: great margin of safety, good muscle relaxant, not sensitive to cathecholamines, and nonflammable

Disadvantages: Prolonged induction of anesthesia and prolonged recovery, nephrotoxic

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9
Q

Enflurane: advantages and disadvantages

A

Advantages: Pleasant smell, rapid induction and recovery, nonirritating, bronchodilator, maintains stability of the cardiovascular system, nonemetic, compatible with epinephrine

Disadvantages: myocardial depressant, smooth muscle relaxant, increase hypertension with increase depth of anesthesia, CNS irritant, possible hepatotoxicity

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10
Q

Isoflurane advantages and disadvantages

A

Newest inhalation agent

Advantages: rapid induction and recovery, nonirritating, bronchodilator, excellent muscle relaxation, maintains stable cardiac rhythm, compatible with epinephrine, nonemetic and nonflammable

Disadvantages: depresses the cardiovascular system, shivering postoperatively, possible acute or delayed liver injury.

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11
Q

Gaseous anesthetic agents types (2)

A

nitrous oxide and cyclopropane

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12
Q

Nitrous oxide description

A

least potent of the anesthetic gases and the most frequently used inhaled anesthetic.

In the absence of hypoxia, there is little effect on the heart rate, myocardial contractility, respiration, blood pressure, liver, kidney, or metabolism.

Oxygen 100% must be givan at the termination of surgery to prevent diffusion hypoxia

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13
Q

Nitrous oxide: advantages and disadvantages

A

Advantage: rapid induction of anesthesia and emergence, does not sensitize the myocardium to epinephrine, nonirritating, intense analgesia, nonemetic

Disadvantages: no muscular relaxation, possible bone marrow depression and fatal agranulocytosis from prolonged administration or exposure, and increased risk of spontaneous abortion with prolonged use

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14
Q

Cyclopropane

A

No longer in use

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15
Q

Classes of Preanesthesia/ supplementary agents (4)

A

1) Sedatives
2) narcotic analgesics
3) tranquilizers
4) belladonna compounds

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16
Q

Types of sedative supplementary agents (6)

A 
Pentobarbital
Phenobarbital
Choralhydrate
Diazepam
Hydroxazine
Droperidol-fentanyl
Droperidol
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17
Q

Pentobarbital description

A

used before surgery to relieve anxiety and tension. Has a short hypnotic effect and pronounced sedative action. Used as an inducing agent and have no analgesic component

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18
Q

Chloral hydrate

A

one of the oldest and best hypnotics, and a very good alternative to barbituates in children and the elderly.

Excreted by the lung

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19
Q

Diazepam

A

produces a satisfactory sedative and amnesic effect. It is indicated to prevent and treat convulsions

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20
Q

Hydroxazine

A

has sedative, antihistiminic, antiemetic, and cronchodilating properties but used primarily for its sedative properties.

Excellent premedication in patients with a history of bronchial asthma

21
Q

Droperidol-fentanyl

A

a 50-1 mixture of droperidol and fentanyl

22
Q

droperidol

A

main effect is tranquility and peripheral vasodilation, can cause dysphoria, good antiemetic, and when infused IV produces sleepiness and mental detachment

23
Q

Types of Narcotic analgesics (3)

A

Fentanyl

Morphine

Meperedine

24
Q

Fentanyl description

A

Produces depression of ventilation which is short in duration. Reversed by Naloxone. Can also produce muscle rigidity in large doses.

25
Q

Morphine description

A

Standard analgesic narcotic drug for relief of severe pain. It depresses CNS, reduces GI motility, constricts the bronchi, and lowers the metabolic rate. Has strong sedative and analgesic properties

26
Q

Meperedine description

A

has analgesic, sedative, and spasmolytic properties, and in conjunction with barbiturates induces amnesia. It can cause tachycardia and is contraindicated in patients with atrial flutter.

27
Q

Types of tranquilizers

A

Phenothiazines
Horazine
Ompazine
Henergan

28
Q

Phenothiazines

A

used for a preanesthetic medication because of the sedative, antiemetic , antihistaminic, and temperature regulating effects. May produce postoperative hypertension and lethargy. When given with narcotic analgesics, increases respiratory depression.

29
Q

Horazine

A

15-25mg

30
Q

ompazine

A

5-10mg

31
Q

Henergan

A

25-50mg

32
Q

Belladonna compounds (3)

A

atropine
scopolamine
glycopyrrolate

33
Q

Atropine

A

Decreases secretions and is the drug of choice to reduce bronchial and cardiac effects of parasympathetic origin.

It increases the heart rate by blocking the vagus nerve and stimulates cerebral cortex.

Superior to scopolamine so can prevent severe bradycardia and asystole in the presence of vagotonic agents.

Atropine and scopolamine are potent bronchodilators.

34
Q

Scopolamine

A

An effective drugs for psychic sedation and amnesia. Drying effect is better than atropine

35
Q

Glycopyrrolate

A

also known as Robinol

36
Q

Types of Intravenous anesthesia (4)

A

1) ultrashort-acting barbiturates: in sufficient amounts these can provide all the anesthetic stages
2) Neuroleptoanalgesia : a neuroleptic drug plus a narcotic analgesic. Will produce somnolence without total unconsciousness, psychological indifference, no voluntary movements, analgesia and satisfactory amnesia.
3) Neuroleptoanesthesia: combination of nitrous oxide, droperidol, fentanyl and muscle relaxants
4) Dissociative anesthesia: produces a state where the patient becomes mentally dissociated from the environment

37
Q

Local anesthetics: how they function

A

function in such a way as to prevent sodium migration through the nerve membrane which, therefore prevents depolarization of the nerve with inhibition of nerve conduction.

38
Q

Classifications of local anesthetics

A
  • esters of para-aminobenzoic acid
  • esters of benzoic acid
  • amides
39
Q

esters of para-aminobenzoic acids: 2 different types and descritpions

A
  • procaine: most toxic, and is considered the standard in comparing the potency and toxicity of other local anesthetics used for injections
  • chlorprocaine: least toxic, and rapid plasma hydrolysis by pseudocholinesterase
40
Q

Esters of benzoic acid (2)

A
  • hexylcaine

- tetracaine: longest duration

41
Q

Amide: 4 types and description

A
  • Lidocaine: shortest duration and fastest actions

Mepivicaine: do not use in presence of renal disease

Bupivicaine: longest duration, least placental transfer, should not be used in children under the age of 12 years old, and greatest cardiac toxicity if given IV

Etidocaine: four times more potent than lidocaine, but only twice as toxic

42
Q

Where are amides hydrolyzed

A

in the liver

43
Q

What is the cross sensitivity between amides and esters

A

there is no cross sensitivity between amides and esters

44
Q

Order of sensation loss with locals

A

Pain and temperature are lost first. Touch and motor function come after.

45
Q

What happens to local when injected into an acidic area (infection)

A

converts the anesthetic chemically and does not allow for penetration into the cell membrane, which lessens its effectiveness

46
Q

Advantages (4) and disadvantages(4) of using vasoconstrictors with local

A

Advantages:

  • reduces vascularity locally at site of injection
  • reduces absorption rate of local anesthetic
  • permits a higher allowable single dose of local anesthetic
  • increases duration of action of the block

Disadvantages:

  • Use cautiously in patients with hyperparathyroidism, arteriosclerotic cardiovascular disease, hypertension, and peripheral vascular disease
  • Creates vasospasm in the end arterioles which could lead to tissue necrosis
  • Can create reactive hyperthermic reaction
  • should be acoided in patients receiving halothane
47
Q

nerves that are targeted in an ankle block(5)

A
  • saphenous nerve
  • sural nerve
  • deep peroneal
  • superficial peroneal
  • tibial nerve
48
Q

Lidocaine toxicity dose: with or without epinephrine

A

300mg plain

500mg with epinephrine

49
Q

Marcaine toxicity dose: with or without epinephrine

A

175mg plain 225 mg with epinephrine

Hershey Manual (2 decks)

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