Anesthesia

Question 1

What does succinylcholine cause?

Answer 1

Initial *muscle fasciculations followed by paralysis

• it binds to the motor end plate
• “activates” or “stimulates the muscle to initially cause a muscle contraction
• followed by paralysis of that muscle

(Anesthesia-Paralytics)

Question 2

What type of neuromuscular blocker is succinylcholine?

Answer 2

Depolarizing

Anesthesia-Paralytics

Question 3

Which is the only neuromuscular blocker that can be given by IM injection?

Answer 3

Succinylcholine

Anesthesia-Paralytics

Question 4

Describe succinylcholine muscular fasciculations.

Answer 4

Upon administration, the body:

• starts to demonstrate rapid small *muscle contractions
• stop within 30 seconds

(Anesthesia-Paralytics)

Question 5

Describe the half life and duration of pancuronium (Pavulon).

Answer 5

Half life: 110 minutes
Duration: up to 100 minutes

(Anesthesia-Paralytics)

Question 6

What is another name for neuromuscular blockers?

Answer 6

Paralytics

Anesthesia-Paralytics

Question 7

Describe the onset of action and duration of action of succinylcholine.

Answer 7

*Short

Onset: less than 1 minute
Duration: 4-6 minutes

(Anesthesia-Paralytics)

Question 8

What should be given to a patient before giving a neuromuscular blocker and why?

Answer 8

*Sedative hypnotic

• patient can hear, see, and experience everything going on around them (if awake)
• also cannot breathe on their own
• can be a terrifying experience

(Anesthesia-Paralytics)

Question 9

Which electrolyte disorder can succinylcholine cause?

Answer 9

• Hyperkalemia
• potassium can be released from inside the cell and into the blood
• thereby raises the blood levels of potassium
• occurs during the phase of fasciculations
• could increase the risk of *cardiac dysrhythmias if the patient already has a baseline elevation in potassium

(Anesthesia-Paralytics)

Question 10

What are general contraindications or concerns about the use of succinylcholine?

Answer 10

• *hyperkalemia
• *rhabdomyolysis
• significant *3rd degree burns
• high *intracranial pressures (ICPs)
• high *intraocular pressures affecting vision

(Anesthesia-Paralytics)

Question 11

What type of procedures is succinylcholine ideal for?

Answer 11

• Short procedures; not long surgeries
• short onset of action
• shortest duration of action

(Anesthesia-Paralytics)

Question 12

What is the MOA of ketamine (Ketalar)?

Answer 12

Non-competitive *NMDA receptor antagonist

• causes a *dissociative anesthesia
• also provides *analgesia

(Anesthesia-Anesthesia)

Question 13

In what patient populations does ketamine show a potential advantage in?

Answer 13

• Asthmatics or those with *reactive airway disease
• has *bronchodilatory effects
• does not impair respiratory drive

Patients needing *blood pressure support or maintenance of *hemodynamic support
-has positive inotropic effects

(Anesthesia-Anesthesia)

Question 14

What is the MOA of etomidate (Amidate)?

Answer 14

Non-barbiturate sedative / hypnotic

Anesthesia-Anesthesia

Question 15

What is the effect of etomidate on the heart at normal doses?

Answer 15

Neutral on its effects

Anesthesia-Anesthesia

Question 16

What is the MOA of lorazepam (Ativan) and midazolam (Versed)?

Answer 16

*Benzodiazepine
-augments the activity of *GABA
—causes hyperpolarization of the neurons

Associated with amnesia

(Anesthesia-Anesthesia)

Question 17

What is the MOA of propofol (Diprivan)?

Answer 17

• General anesthetic
• potentiates the activity of *GABA

(Anesthesia-Anesthesia)

Question 18

What is the effect of propofol on the heart?

Answer 18

Associated with a reduction in *inotropy

Anesthesia-Anesthesia

Question 19

In what patient population may ketamine’s increase in cardiac output or blood pressure theoretically be a harmful effect?

Answer 19

Patients with:
-increased *intracranial pressure from *traumatic brain injury

(Anesthesia-Anesthesia)

Question 20

What effect does etomidate have on the adrenal glands?

Answer 20

Has been shown to impart *cortisol production in the adrenal glands
-potentially increases the risk of *adrenal insufficiency

(Anesthesia-Anesthesia)

Question 21

What is the MOA of dexmedetomidine (Precedex)?

Answer 21

Highly selective centrally acting *alpha-2 agonist sedative / hypnotic

• does not normally suppress the *respiratory drive
• known to lower *blood pressure

(Anesthesia-Anesthesia)

Question 22

By what routes can ketamine be given?

Answer 22

IM or IV

Anesthesia-Anesthesia

Question 23

What patients are at risk when receiving propofol, and which side effect would these patients be at a higher risk to experience?

Answer 23

*Hypotension

Patients with:
-known *heart failure
—especially *systolic HF that is associated with poor cardiac output

-hypovolemia
—IV fluids should be available before or during use (assuming the patient can tolerate the extra fluid)

(Anesthesia-Anesthesia)

Question 24

What kind of dosage form is propofol available as?

Answer 24

• Lipid based emulsion for IV injection
• may need to have *triglycerides checked on a prolonged infusion

(Anesthesia-Anesthesia)

Question 25

When is dexmedetomidine used?

Answer 25

Commonly used to:
-provide *sedation while on *mechanical ventilation in the *ICU
—while still needing to maintain the *respiratory drive

Sometimes used:
-help wean patients from *ventilator
—these patients need the strength of their *respiratory system to aid in the process

(Anesthesia-Anesthesia)

Question 26

What can benzodiazepines affect and when?

Answer 26

• Respiratory drive
• at high doses

(Anesthesia-Anesthesia)

Question 27

Describe the MOA of clonidine and guanfacine.

Answer 27

Centrally acting alpha-2 agonists
-orally administered

Used in the management of:

• *hypertension
• *ADHD

(Anesthesia-Anesthesia)