Anesthesia and Moderate Sedation

Question 1

Anesthesia

Answer 1

A state of depressed central nervous system (CNS) activity, with depression of consciousness, loss of responsiveness to stimulation and muscle relaxation.

Question 2

What are the 3 types of Anesthesia?

Answer 2

General
Regional
Local

Question 3

General Anesthesia

Answer 3

Cause loss of sensation, consciousness, reflexes, and memory of the surgery. It is used for major surgery or one that requires complete muscle relaxation.

Question 4

Regional Anesthesia

Answer 4

Causes reduction of sensation in selected parts of the body due to blockage of peripheral nerves, or the spinal cord.
Ex: local conduction or field block, epidural, spinal or nerve block

Question 5

Local Anesthesia

Answer 5

Involves topical application of an anesthetic agent to the skin or mucous membranes. The term can be used to refer to any anesthesia that is not general (monitored).

Question 6

Opioids

Answer 6

Fentanyl
Sufentanil
Alfentanil

Question 7

Opioids Uses

Answer 7

Sedation
Analgescices to relieve preoperative and postoperative pain

Question 8

Opioids Adverse effects

Answer 8

Depress the CNS, resulting in respiratory depression
Delays awakening following surgery or a procedure
Can result in postoperative constipation and urinary retention
Can trigger nausea and vomiting

Question 9

Benzodiazepines

Answer 9

Diazepam
Midazolam

Question 10

Benzodiazepines Uses

Answer 10

Reduce anxiety
Promote amnesia
Produce mild sedation (unconsciousness) with little to moderate respiratory depression with careful titration

Question 11

Benzodiazepines Adverse Effects

Answer 11

Can result in cardiac and respiratory arrest with rapid administration or without waiting for the full effect to develop

Question 12

Antiemetics

Answer 12

Ondansetron
Metoclopramide
Promethazine

Question 13

Antiemetics Uses

Answer 13

Decrease post-anesthesia nausea and vomiting
Enhances gastric emptying (metoclopramide)
Induces sedation (promethazine)
Decrease the risk for aspiration

Question 14

Antiemetics Adverse Effects

Answer 14

Dry Mouth
Dizziness
Extrapyramidal manifestations and tardive dyskinesia (metoclopramide)
Respiratory depression and apnea (promethazine)

Question 15

Anticholinergics

Answer 15

Atropine
Glycopyrrolate

Question 16

Anticholinergics Uses

Answer 16

Decreases the risk of bradycardia during surgery due to the parasympathetic response to surgical manipulation
Block the muscarinic response to acetycholine by decreasing salivation, perspiration, bowel motility and GI secretions
Decrease the risk for aspiration

Question 17

Anticholinergics Adverse Effects

Answer 17

Urinary retention, difficulty starting urination
Tachycardia
Dry mouth

Question 18

Anticholinergics Contraindication

Answer 18

Glaucoma

Question 19

Sedative

Answer 19

Pentobarbital
Secobarbital

Question 20

Sedative Uses

Answer 20

Sedative effect for preanesthesia sedation or amnesia
Induction of general anesthesia

Question 21

Sedatives Adverse Effects

Answer 21

Avoid giving within 14 days of starting or stopping MAOI

Question 22

Neuromuscular blocking agents

Answer 22

Succinycholine
Vecuronium

Question 23

Neuromuscular Blocking Agents Uses

Answer 23

Skeletal muscle relaxation for surgery
Airway placement
In conjunction with IV anesthetic agents (propofol, opioids, benzodiazepines)

Question 24

Neuromuscular Blocking Agents Adverse Effects

Answer 24

Total flaccid paralysis
Requires mechanical ventilation because it blocks contraction of all muscles, including the diaphragm and respiratory system