Anesthesia Flashcards
What is anesthesia?
Elimination of sensation
What is analgesia
Elimination of pain
What is sedation?
Is a decrease in activity, alertness, arousal and/or vigilance
What is general anesthesia?
Drug-induced, reversible depression of the CNS that results in the loss of physiologic response and perception to all external stimuli
What are the general actions of inhalation anesthetic agents?
CV Resp Brain Renal Hepatic Malignant hyperthermia
How do inhalation anesthetic agents affect CV?
Decreased MAP
Depression of myocardial function
How do inhalation anesthetic agents affect respiratory?
Depress mucocilliary function
How do inhalation anesthetic agents affect brain?
Decrease metabolic rate of the brain
Increase cerebral blood flow
How do inhalation anesthetic agents affect renal?
Decrease renal blood flow and GFR
How do inhalation anesthetic agents affect hepatic?
Decrease hepatic blood flow
Rarely causes permanent changes in liver enzymes
What are the drugs that require special ventilation?
NO Halothan Isoflurane Enflurane Desflurane Sevoflurane
What is malignant hyperthermia?
Autosomal dominant genetic disorder
What are the sx of MH?
Tachy HTN Muscle rigidity Hyperthermia Hyperkalemia Acidosis
What is the treatment of MH?
Dantrolene
Supportive treatment
What are the IV agents for anesthesia?
Barbiturates Benzos Opioids Propofol Etomidate Ketamine Dexmedetomidine
What are commonly used for IV induction of anesthesia?
Barbiturates
What barbiturates are used for anesthesia?
Thiopental
Why are benzos not used for anesthesia?
Inadequate depth of sedation for surgical anesthesia
Why are benzos used for anesthesia?
Premedicate because of the sedative, anxiolytic and amnestic properties
What is the most commonly used opioid for anesthetia?
Fentanyl
What can the emulsion formulation of propofol cause?
Hypertriglyceridemia
What do HD of propofol cause?
Propofol Infusion Related Syndrome can result in death
What is etomidate used for?
Induction of anesthesia
What are the AEs of etomidate?
Injection site pain
Myoclonic activity
Post-op n/v
Decreases plasma cortisol
How does ketamine work?
Produces dissociative anesthetic state characterized by catatonia, amnesia, and analgesia e/ or e/o loss of consciousness
What are the AEs of ketamine?
Produces CV stmiulation
Increases cerebral blood flow, oxygen consumption and intracranial pressure
Associated with post-op disorientation, illusions and vivid dreams
Where is dexmedetomidine used?
ICU
What are the indications of NMBAs?
Facilitate short procedures under general anesthesia Facilitate mechanical ventilation ARDS Manage increased ICP Treat muscle spasms Decrease oxygen consumption Surgery
What are NMBAs?
Succinylcholine Pancuronium Vecuronium Rocuronium Atracurium Cisatracurium
How does succinylcholine work?
Mimics acetylcholine at the NMJ and prolongs the repolarization phase
How is pancuronium eliminated?
Renal
What are the AEs of pancuronium?
Tachy
HTN
Increased CO
Which NMBA is the fastest onset?
Rocuronium
What drugs interact with NMBAs?
Diuretics Antiarrhythmics AG Mg Li
What is the reversal agent for rocuronium and vecuronium?
Sugammadex
What is the reversal agent for non-depolarizing agents?
Neostigmine
Pyridostigmine
Where is sugammadex used?
In the OR only
What is procedural sedation?
Creates a decreased level of awareness for a patient while maintaining protective airway reflexes and adequate spontaneous ventilation
What medications are used for procedural sedation?
Ketamine and benzo
Benzo and analgesic
Propofol or etomidate and analgesic
What type of patient can procedural sedation be used in?
Healthy
How do we monitor sedation in OR?
BIS monitor - mini EEG
BIS < 60 = no recall
How do we monitor sedation in ICU?
RASS
RAMSEY
CAM
What are the 7 steps of rapid sequence intubation?
Preparation Pretreatment Premedication (induction) Paralyze after sedation Protection/positioning Post-intubation management
What drugs are used for pretreatment?
Fentanyl IV*
Lidocaine IV
Atropine IV
Esmolol IV
What drugs do we use for premedication?
Midazolam, etomidate, propofol, ketamine
What drug is the gold standard for paralyzation?
Succinylcholine
What drugs are used to paralyze?
Succinylcholine
NMBAS (rocuronium, vecuronium)
What is done in protection/placement step?
Trach placement
