Anesthesia and Anesthetics

Question 1

Definition of anesthesia vs analgesia

Answer 1

Anesthesia: make one insensible to pain
Analgesia: relieve pain

Question 2

Routes of general anesthesia

Answer 2

Inhalation

IV

Question 3

Stages of Anesthesia

Answer 3

I: induction to LOC
II: excitement; uncontrolled movements, vomit risk, high BP, fast irregular pulse
III: operative; absence of movement, regular respiration and BP
IV: overdosage; hypotension, very weak respiration

Question 4

Disadvantage of ether and its relatives

Answer 4

Decrease CO, BP, and SVR
Respiratory depression
Longer stage II

Question 5

Inhalation that is “incomplete anesthetic”

Answer 5

Nitrous oxide

Question 6

Advantages of ether inhalation

Answer 6

Rapid in and out
Good analgesic
Don’t need IV access

Question 7

Types of IV anesthesias

Answer 7

Barbiturates
Propofol
Ketamine

Question 8

Advantages of Propofol

Answer 8

Rapid onset
Rapid metabolism– quick recovery, awake in 5 min
Easily used for induction, maintenance of GA, or sedation (OR / ICU)
Minimal “excitation” (stage II)
Antiemetic properties

Question 9

Which IV anesthetic is very helpful for extremely uncooperative patients?

Answer 9

Ketamine

Question 10

MOA of narcotics is inhibition of nociceptive impulses in the _________.

Answer 10

substantia gelatinosa

Question 11

Adjunct to general anesthesia and when used?

Answer 11

Muscle relaxants and opioids

Muscle relaxants: used for ETT, absolute patient immobility (ex. eye, neuro, bowel resection surgery)

Opioids: can lower inhaled anesthetic ADRs, pre-op anxiolytic, post-op pain control

Question 12

2 classes of local anesthetics

Answer 12

Esters

Amides

Question 13

First sign of local anesthetic (Lidocaine) toxicity? Which anesthetic is exception?

Answer 13

CNS side effects, especially seizures

Bupivacaine toxicity first sign is irreversible V-fib

Question 14

1% solution = _____ mg/cc

Answer 14

10

Question 15

Reasons to use epinephrine with Licodaine as local anesthetic

Answer 15

vasoconstriction
prolong length of action
slow absorption of Lidocaine

Question 16

What locations should you not use epinephrine as local anesthetic?

Answer 16

Nose, ears, digits, penis

Question 17

What are major risks of anesthetics?

Answer 17

CV: perioperative MI or CHF
Pulm (common): aspiration, pneumonia, acute bronchospasm, PE
Neuro: perioperative CVA, post-op blindness
Renal: worsening CKD, ATN

Question 18

What can primary providers do the help their patient’s perioperatively?

Answer 18

o Identify health problems
o Delineate, treat, and manage these health problems before operation
o Educate patient
• Importance of NPO status
• Development of URI or other changes in health status
• Continue chronic important medication (ex. poorly controlled blood pressure is a anesthetic and surgical risk)
• Stop medication which interfere with clotting mechanism (ASA, Fish oil etc)