Anesthesia

Question 1

general anesthesia

Answer 1

State that produces amnesia and analgesia with or without reversible muscle paralysis

Controlled, reversible state of unconsciousness

Involves a combination of inhaled and intravenous medications

Question 2

general anesthesia benefits

Answer 2

Good control and adaptation
Allows use of muscle relaxants
Rapid administration
Can be reversed
Decreases patient recall

Question 3

general anesthesia disadvantages

Answer 3

Pre op prep
Physiological fluctuations
Costly
Nausea, vomiting, sore throat, shivering, emergence delirium
Malignant hyperthermia

Question 4

Mallampati Score
class 1-5

Answer 4

Class I-see everything

Class II-lose pillars and lose tip of uvula

Class III- only see base of uvula

Class IV- only hard palate

Question 5

what thyromental distance suggests difficult intubation

Answer 5

less than 6.5

Question 6

Sedation/Monitored Anesthesia Care (MAC)

Answer 6

Patient responsive and maintains airway

Continuum of sedation- from light to moderate to deep

Prepare for general anesthesia

Used with local or regional as sedation

Question 7

benefits of MAC

Answer 7

Awake patient
Avoids hemodynamical instability
No risks inherent to ET intubation

Question 8

risks of MAC

Answer 8

Over sedation/hypercarbia
Patient movement/discomfort
Conversion to General Anesthesia

Question 9

Regional/Local Anesthesia

Answer 9

Reversible loss of sensation over a specific body area

Doesn’t produce unconsciousness

Question 10

examples of regional/local anesthetics

Answer 10

Spinal Anesthesia
Epidural anesthesia
Peripheral nerve blocks
Local/field anesthesia
Topical anesthesia

Question 11

benefits of regional/local anesthetics

Answer 11

Preservation of cerebral function
In general Hemodynamic stability
Avoidance of general anesthesia in high risk patients
Pain control
Improved early mobilization

Question 12

disadvantages of regional/local anesthetics

Answer 12

Patient movement/discomfort
Time consuming
Requires regional anesthesia skill
Nerve injury
Infection
Bleeding

Question 13

spinal vs epidural

Answer 13

Spinal
Inject anesthetic drug into subarachnoid space (where CSF lives!) below L1/L2  spinal cord ends and cauda equina starts
Rapid acting
Needle injection, no catheter
Single dosing
Lower limb and pelvic surgeries
Complications: hypotension and headache

                                          Epidural  Inject anesthetic drug into epidural space at any level Slower acting Medication through an indwelling catheter Multiple dosing Lower limb, pelvic, and child delivery

Question 14

what is Malignant Hyperthermia

Answer 14

Life-threatening clinical syndrome of hypermetabolism involving the skeletal muscle

Question 15

what is malignant hyperthermia caused by

Answer 15

inhaled anesthetic agents and the paralytic agent succinylcholine

Question 16

what inheritance pattern is malignant hyperthermia

Answer 16

Autosomal dominate trait with reduced penetrance

Question 17

is malignant hyperthermia an allergy

Answer 17

NO

Question 18

MOA for malignant hyperthermia

Answer 18

Altered Ca channels that leads to sustained elevation of calcium

Elevated Ca causes excessive stimulation of aerobic and anaerobic metabolism

Question 19

early s/sx of malignant hyperthermia

Answer 19

Arterial carbon dioxide (PaCo2) increased
Tachypnea
Tachycardia/Arrhythmias
Flushing
Rigidity/Masseter spasm 
Electrolyte disturbances

Question 20

late s/sx of malignant hyperthermia

Answer 20

Pyrexia
Mottled skin/cyanosis
Rhabdomyolysis
Renal failure
DIC
Compartment syndrome
Cerebral edema
Death

Question 21

malignant hyperthermia tx

Answer 21

Dantrolene 2.5 mg/kg Q 5minutes prn