Anesthesia

Question 1

what do local anesthetics work on?

Answer 1

Na channels

Question 2

two types of local anesthetics

Answer 2

esters and amides (all of the amides have i’s in them)

Question 3

aromatic ring

Answer 3

inc’s lipid solubility

Question 4

linkage

Answer 4

determines type of metabolism

amides: hepatic
esters: plasma esterases

Question 5

terminal amine

Answer 5

influences aqueous solubility

Question 6

lidocaine with epi

Answer 6

controls bleeding

Question 7

lidocaine

Answer 7

most widely used local anesthetic
all have comparable efficacy though
500 mg/10 mg/mL max lidocaine = 50 mL of 1% lidocaine

Question 8

1% solution of local anesthetic =

Answer 8

10 mg/mL

Question 9

lidoderm

Answer 9

lidocaine patch 5% topical
on 12 hrs - off 12 hrs
may be cut to size (unlike most transdermals)
max 3 patches/day

Question 10

hypersensitivity to local anesthetics

Answer 10

true allergies are rafre
more common with ester type
if allergic to one, allergic to all esters - switch to amide (or vice versa)

Question 11

what local anesthetic is in epidurals?

Answer 11

bupivacaine

Question 12

EMLA

Answer 12

used for starting IVs/, biopsies

venous, arterial, finger, heel and lumbar punctures

Question 13

general anesthetic toxicity emergencies

Answer 13

chloroform (long term liver damage and sudden death), methoxyflurane (nephrotoxic)
ether (too flammable)

Question 14

Halothane

Answer 14

hepatotoxic and arrhythmia

Question 15

Enflurane

Answer 15

hepato and renal toxicities

Question 16

general anesthesia safety

Answer 16

as long as patient is breathing satisfactory

Question 17

adv of inhalation anesthesia

Answer 17

completely painless, no IV access, rapid

Question 18

rates of PONV for inhalation anesthetics

Answer 18

all pretty similar

Question 19

differences between inhaled anesthetics

Answer 19

metabolism and effects on heart

Question 20

indications for sedatives

Answer 20

facilitate tolerance to procedures
red unnecessary recall
mandatory adjunct to neuromuscular blockade

Question 21

diazepam

Answer 21

propylene glycol vehicle

sig accumulation with repetitive dosing

Question 22

3 active metabolites in diazepam (name 1)

Answer 22

desmethyldiazepam (T1/2 = 100-200 hrs)

Question 23

lorazepam

Answer 23

continuous infusion may cause propylene glycol-induced metabolic acidosis
for anxiety/sedation in adults: preprocedural anxiety (PO) 1-2 mg 1 hr prior

Question 24

Midazolam

Answer 24

least lipid soluble
drug interactions - metabolized by CYP3A4 (hepatic)
renally eliminated
metabolized in liver to active metab

Question 25

Midazolam pre-op sedation

Answer 25

usually 5 mg

Question 26

Midazolam conscious sedation

Answer 26

usual dose: 2.5-5 mg

Question 27

Propfol

Answer 27

decreased time to weaning and extubation
rapid assessment of neurologic status
variable 1/2 lives

Question 28

dexmedetomidine

Answer 28

pt’s appear awake and alert
rescue doses required in majority of patients
multi-drug regimen
minimal amnestic properties

Question 29

Etomidate

Answer 29

rapid onset of unconsciousness (within seconds)
minimal hypotension or disruption of ventilation
depresses cortisol synthesis: use short-term

Question 30

MOA of NMBAs

Answer 30

depolarizing (noncompetitive) and non depolarizing (competitive)

Question 31

indications for use of NMBAs

Answer 31

intubation
mechanical ventilation synchrony (improves pt compliance with vent)
must have adequate sedation and analgesia at start and during therapy

Question 32

steroid based NMBAs

Answer 32

pancuronium, rocuronium and vecuronium

may cause liver/renal failure or prolonged myopathy

Question 33

benzylisoquinolonium compounds for NMBAs

Answer 33

atracurium and mivacurium (histamine release - hypotension)

Question 34

NMBA drug interactions

Answer 34

steroids, aminoglycosides, CCB, BB and furosemide

Question 35

net result of NMBAs

Answer 35

increased bolus and infusion doses to induce and maintain paralysis

Question 36

monitoring therapy

Answer 36

train of four (TOF)

Question 37

benzo’s provide the greatest what?

Answer 37

amnesia (no analgesia)

Question 38

NMBAs provide what?

Answer 38

sedation and analgesia