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Anesthesia, C31 P190-195 Flashcards

1
Q

Define the following terms:
Anesthesia
P190

A

Loss of sensation/pain

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2
Q

Define the following terms:
Local anesthesia
P190

A

Anesthesia of a small confined area of
the body (e.g., lidocaine for an elbow
laceration)

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3
Q

Define the following terms:
Epidural anesthesia
P190

A

Anesthetic drugs/narcotics infused into

epidural space

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4
Q

Define the following terms:
Spinal anesthesia
P190

A

Anesthetic agents injected into the thecal

sac

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5
Q

Define the following terms:
Regional anesthesia
P190

A

Blocking of the sensory afferent nerve
fibers from a region of the body
(e.g., radial nerve block)

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6
Q

Define the following terms:
General anesthesia
P191

A

Triad:

  1. Unconsciousness/amnesia
  2. Analgesia
  3. Muscle relaxation
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7
Q

Define the following terms:
GET or GETA
P191

A

General EndoTracheal Anesthesia

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8
Q

Give examples of the following terms:
Local anesthetic
P191

A

Lidocaine, bupivacaine (Marcaine®)

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9
Q

Give examples of the following terms:
Regional anesthetic
P191

A

Lidocaine, bupivacaine (Marcaine®)

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10
Q

Give examples of the following terms:
General anesthesia
P191

A

Isoflurane, enflurane, sevoflurane,

desflurane

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11
Q

Give examples of the following terms:
Dissociative agent
P191

A

Ketamine

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12
Q

What is cricoid pressure?

P191

A 
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)
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13
Q

What is “rapid-sequence”
anesthesia induction?
P191

A 
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)
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14
Q

Give examples of induction
agents.
P191

A

Propofol, midazolam, sodium thiopental

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15
Q

What are contraindications
of the depolarizing agent
succinylcholine?
P191

A

Patients with burns, neuromuscular
diseases/paraplegia, eye trauma, or
increased ICP

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16
Q

Why is succinylcholine
contraindicated in these
patients?
P191

A

Depolarization can result in life-threatening
hyperkalemia; succinylcholine also
increases intraocular pressure

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17
Q

Why doesn’t lidocaine work
in an abscess?
P191

A

Lidocaine does not work in an acidic

environment

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18
Q 
Why does lidocaine burn
on injection and what can
be done to decrease the
burning sensation?
P192
A

Lidocaine is acidic, which causes the
burning; add sodium bicarbonate to
decrease the burning sensation

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19
Q

Why does some lidocaine
come with epinephrine?
P192

A

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

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20
Q

In what locations is lidocaine
with epinephrine contraindicated?
P192

A

Fingers, toes, penis, etc., because of the
possibility of ischemic injury/necrosis
resulting from vasoconstriction

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21
Q

What are the contraindications
to nitrous oxide?
P192

A

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.

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22
Q

What is the feared side effect
of bupivacaine (Marcaine®)?
P192

A

Cardiac dysrhythmia after intravascular
injection leading to fatal refractory
dysrhythmia

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23
Q

What are the side effects of
morphine?
P192

A 
Constipation, respiratory failure,
hypotension (from histamine release),
spasm of sphincter of Oddi (use
Demerol® in pancreatitis and biliary
surgery), decreased cough reflex
24
Q

What are the side effects of
meperidine?
P192

A

Similar to those of morphine but causes
less sphincteric spasm and can cause
tachycardia and seizures

25
Limit to the duration of Demerol® postoperatively? P192
Build up of the metabolites | normeperidine
26
What medication is a contraindication to Demerol®? P192
Monoamine oxidase inhibitor
27
What metabolite of Demerol® breakdown causes side effects (e.g., seizures)? P192
Normeperidine
28
What is the treatment of life-threatening respiratory depression with narcotics? P193
Narcan® IV (naloxone)
29
What are the side effects of epidural analgesia? P193
Orthostatic hypotension, decreased | motor function, urinary retention
30
What is the advantage of epidural analgesia? P193
Analgesia without decreased cough reflex
31
What are the side effects of spinal anesthesia? P193
Urinary retention | Hypotension (neurogenic shock)
32
What is the side effect of inhalational (volatile) anesthesia? P193
Halothane—hypotension (cardiac depression, decreased baroreceptor response to hypotension, and peripheral vasodilation), malignant hyperthermia
33
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
34
MALIGNANT HYPERTHERMIA What is the incidence? P193
Very rare
35
MALIGNANT HYPERTHERMIA What are the causative agents? P193
General anesthesia, succinylcholine
36
MALIGNANT HYPERTHERMIA What are the signs/symptoms? P193
Increased body temperature; hypoxia; acidosis; tachycardia, ↑ PCO(2) (↑ end tidal CO(2))
37
MALIGNANT HYPERTHERMIA What is the treatment? P193
IV dantrolene, body cooling, discontinuation | of anesthesia
38
``` MISCELLANEOUS What are some of the nondepolarizing muscle blockers? P193 ```
Vecuronium | Pancuronium
39
``` MISCELLANEOUS What are the antidotes to the nondepolarizing neuromuscular blocking agents? P194 ```
Edrophonium Neostigmine Pyridostigmine
40
MISCELLANEOUS How do these agents work? P194
They inhibit anticholinesterase
41
MISCELLANEOUS Which muscle blocker is depolarizing? P194
Succinylcholine
42
MISCELLANEOUS What is the duration of action of succinylcholine? P194
43
MISCELLANEOUS What is the antidote to reverse succinylcholine? P194
Time; endogenous blood pseudocholinesterase (patients deficient in this enzyme may be paralyzed for hours!)
44
MISCELLANEOUS What is the maximum dose of lidocaine: With epinephrine? P194
7 mg/kg
45
MISCELLANEOUS What is the maximum dose of lidocaine: Without epinephrine? P194
4 mg/kg
46
MISCELLANEOUS What is the duration of lidocaine local anesthesia? P194
30 to 60 minutes (up to 4 hours with | epinephrine)
47
MISCELLANEOUS What are the early signs of lidocaine toxicity? P194
Tinnitus, perioral/tongue numbness, metallic taste, blurred vision, muscle twitches, drowsiness
48
``` MISCELLANEOUS What are the signs of lidocaine toxicity with large overdose ( > 10 mcg/mL)? P194 ```
Seizures, coma, respiratory arrest Loss of consciousness Apnea
49
``` 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) ```
50
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)
51
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!)
52
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 ```
53
MISCELLANEOUS What is used to reverse narcotics? P195
Naloxone (Narcan®)
54
MISCELLANEOUS What is used to reverse benzodiazepines? P195
Flumazenil
55
MISCELLANEOUS What is fentanyl? P195
Very potent narcotic (#1 drug of abuse by | anesthesiologists)
56
MISCELLANEOUS Name an IV NSAID. P195
Ketorolac (has classic side effects of | NSAIDs: PUD, renal insufficiency)

Surgery 🤓 (29 decks)

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