Anesthesia, C31 P190-195 Flashcards
Define the following terms:
Anesthesia
P190
Loss of sensation/pain
Define the following terms:
Local anesthesia
P190
Anesthesia of a small confined area of
the body (e.g., lidocaine for an elbow
laceration)
Define the following terms:
Epidural anesthesia
P190
Anesthetic drugs/narcotics infused into
epidural space
Define the following terms:
Spinal anesthesia
P190
Anesthetic agents injected into the thecal
sac
Define the following terms:
Regional anesthesia
P190
Blocking of the sensory afferent nerve
fibers from a region of the body
(e.g., radial nerve block)
Define the following terms:
General anesthesia
P191
Triad:
- Unconsciousness/amnesia
- Analgesia
- Muscle relaxation
Define the following terms:
GET or GETA
P191
General EndoTracheal Anesthesia
Give examples of the following terms:
Local anesthetic
P191
Lidocaine, bupivacaine (Marcaine®)
Give examples of the following terms:
Regional anesthetic
P191
Lidocaine, bupivacaine (Marcaine®)
Give examples of the following terms:
General anesthesia
P191
Isoflurane, enflurane, sevoflurane,
desflurane
Give examples of the following terms:
Dissociative agent
P191
Ketamine
What is cricoid pressure?
P191
Manual pressure on cricoid cartilage occluding the esophagus and thus decreasing the chance of aspiration of gastric contents during intubation (a.k.a. Sellick’s maneuver)
What is “rapid-sequence”
anesthesia induction?
P191
1. Oxygenation and short-acting
induction agent
2. Muscle relaxant
3. Cricoid pressure
4. Intubation
5. Inhalation anesthetic (rapid: boom,
boom, boom S to lower the risk of
aspiration during intubation)Give examples of induction
agents.
P191
Propofol, midazolam, sodium thiopental
What are contraindications
of the depolarizing agent
succinylcholine?
P191
Patients with burns, neuromuscular
diseases/paraplegia, eye trauma, or
increased ICP
Why is succinylcholine
contraindicated in these
patients?
P191
Depolarization can result in life-threatening
hyperkalemia; succinylcholine also
increases intraocular pressure
Why doesn’t lidocaine work
in an abscess?
P191
Lidocaine does not work in an acidic
environment
Why does lidocaine burn on injection and what can be done to decrease the burning sensation? P192
Lidocaine is acidic, which causes the
burning; add sodium bicarbonate to
decrease the burning sensation
Why does some lidocaine
come with epinephrine?
P192
Epinephrine vasoconstricts the small
vessels, resulting in a decrease in bleeding
and blood flow in the area; this prolongs
retention of lidocaine and its effects
In what locations is lidocaine
with epinephrine contraindicated?
P192
Fingers, toes, penis, etc., because of the
possibility of ischemic injury/necrosis
resulting from vasoconstriction
What are the contraindications
to nitrous oxide?
P192
Nitrous oxide is poorly soluble in serum
and thus expands into any air-filled body
pockets; avoid in patients with middle ear
occlusions, pneumothorax, small bowel
obstruction, etc.
What is the feared side effect
of bupivacaine (Marcaine®)?
P192
Cardiac dysrhythmia after intravascular
injection leading to fatal refractory
dysrhythmia
What are the side effects of
morphine?
P192
Constipation, respiratory failure, hypotension (from histamine release), spasm of sphincter of Oddi (use Demerol® in pancreatitis and biliary surgery), decreased cough reflex
What are the side effects of
meperidine?
P192
Similar to those of morphine but causes
less sphincteric spasm and can cause
tachycardia and seizures
Limit to the duration of
Demerol® postoperatively?
P192
Build up of the metabolites
normeperidine
What medication is a
contraindication to
Demerol®?
P192
Monoamine oxidase inhibitor
What metabolite of Demerol®
breakdown causes side effects
(e.g., seizures)?
P192
Normeperidine
What is the treatment of
life-threatening respiratory
depression with narcotics?
P193
Narcan® IV (naloxone)
What are the side effects of
epidural analgesia?
P193
Orthostatic hypotension, decreased
motor function, urinary retention
What is the advantage of
epidural analgesia?
P193
Analgesia without decreased cough reflex
What are the side effects of
spinal anesthesia?
P193
Urinary retention
Hypotension (neurogenic shock)
What is the side effect of
inhalational (volatile)
anesthesia?
P193
Halothane—hypotension (cardiac
depression, decreased baroreceptor
response to hypotension, and peripheral
vasodilation), malignant hyperthermia
MALIGNANT HYPERTHERMIA
What is it?
P193
Inherited predisposition to an anesthetic
reaction, causing uncoupling of the
excitation–contraction system in skeletal
muscle, which in turn causes malignant
hyperthermia; hypermetabolism is fatal
if untreated
MALIGNANT HYPERTHERMIA
What is the incidence?
P193
Very rare
MALIGNANT HYPERTHERMIA
What are the causative agents?
P193
General anesthesia, succinylcholine
MALIGNANT HYPERTHERMIA
What are the signs/symptoms?
P193
Increased body temperature; hypoxia;
acidosis; tachycardia, ↑ PCO(2) (↑ end tidal
CO(2))
MALIGNANT HYPERTHERMIA
What is the treatment?
P193
IV dantrolene, body cooling, discontinuation
of anesthesia
MISCELLANEOUS What are some of the nondepolarizing muscle blockers? P193
Vecuronium
Pancuronium
MISCELLANEOUS What are the antidotes to the nondepolarizing neuromuscular blocking agents? P194
Edrophonium
Neostigmine
Pyridostigmine
MISCELLANEOUS
How do these agents work?
P194
They inhibit anticholinesterase
MISCELLANEOUS
Which muscle blocker is
depolarizing?
P194
Succinylcholine
MISCELLANEOUS
What is the duration of
action of succinylcholine?
P194
< 6 minutes
MISCELLANEOUS
What is the antidote to
reverse succinylcholine?
P194
Time; endogenous blood pseudocholinesterase
(patients deficient in this enzyme
may be paralyzed for hours!)
MISCELLANEOUS
What is the maximum dose of lidocaine:
With epinephrine?
P194
7 mg/kg
MISCELLANEOUS
What is the maximum dose of lidocaine:
Without epinephrine?
P194
4 mg/kg
MISCELLANEOUS
What is the duration of
lidocaine local anesthesia?
P194
30 to 60 minutes (up to 4 hours with
epinephrine)
MISCELLANEOUS
What are the early signs of
lidocaine toxicity?
P194
Tinnitus, perioral/tongue numbness,
metallic taste, blurred vision, muscle
twitches, drowsiness
MISCELLANEOUS What are the signs of lidocaine toxicity with large overdose ( > 10 mcg/mL)? P194
Seizures, coma, respiratory arrest
Loss of consciousness
Apnea
MISCELLANEOUS When should the Foley catheter be removed in a patient with an epidural catheter? P194
Several hours after the epidural catheter is removed (to prevent urinary retention)
MISCELLANEOUS
What is a PCA pump?
P194
Patient-Controlled Analgesia; a pump
delivers a set amount of pain reliever
when the patient pushes a button
(e.g., 1 mg of morphine every 6 minutes)
MISCELLANEOUS
What are the advantages of
a PCA pump?
P195
Better pain control
Patients actually use less pain medication
with a PCA!
If given a moderate dose without a basal
rate, patients should not be able to
overdose (They will fall asleep and not
be able to push the button!)
MISCELLANEOUS
What is a “basal rate” on the PCA?
P195
Steady continuous infusion rate of the narcotic (e.g., 1–2 mg of morphine) continuously infused per hour; patient can supplement with additional doses as needed
MISCELLANEOUS
What is used to reverse
narcotics?
P195
Naloxone (Narcan®)
MISCELLANEOUS
What is used to reverse
benzodiazepines?
P195
Flumazenil
MISCELLANEOUS
What is fentanyl?
P195
Very potent narcotic (#1 drug of abuse by
anesthesiologists)
MISCELLANEOUS
Name an IV NSAID.
P195
Ketorolac (has classic side effects of
NSAIDs: PUD, renal insufficiency)
