Anesthesia II Flashcards
What is the triad of anesthesia?
Sedation
Loss of Pain
Muscle weakness
Class 1 ASA?
Normal healthy
Class 2 ASA
Mild systemic disease
Class 3 ASA
Severe systemic disease
(Uncontrolled diabetes, etc)
Not incaacitating
Class 4 ASA
incapacatating systemic disease threatening life
Stage 1 of anesthesia is known as?
This is known as the amnesia stage! Three planes: 1:Preanalgesia, memory and sensation intact 2: Partial amnesia and analgesia 3: Total amnesia and analgesia
What is stage 2 of anesthesia?
Stage 2 is delerium
Unconsciousness, mydriasis, irregular breathing, involuntary movements
What is stage 3 of anesthesia known as?
Known as surgical anesthesia!
Broken into 3 planes
1: Sleeping with faint lid reflex and eye focused centrally/ regular breathing.
2: Partial intercostal paralysis, tachycardia, hypotension, hypotonia
3: Complete intercostal paralysis and respiratory arrest
What is stage 4 of anesthesia known as?
This is the medullary paralysis and is not good!
Plane 1: Reversible
Plane 2: irreversable
Causes respiratory and cardiac failure
What are the major first signs of malignant hyperthermia?
TACHYCARDIA
Sweating, muscle rigidity etc.
What is the treatment for malignant hyperthermia?
Sodium Dantrolene 2.5 mg/kg
Which two medications can put a patient at risk for malignant hyperthermia?
Halothane
Succinylcholine
Inhalated agents with increased risk of spontaneous abortion?
Diethyl Ether
Chloroform
Does halothane effect the liver or the kidneys?
LIVER
H FOR HEPATIC
Also may trigger malignant hyperthermia, myocardial depression, and arythmias.
What is good about halothane?
Most potent inhalation Lowest MAC Rapid smooth induction and recovery Pleasant smell Non-irritating/emetic/and safe in asthmatics.
What are the pros and cons of Isoflurane?
Rapid induction, good muscle relaxant, heart rhythm safe, and compatible with epinephrine.
Cons: post op shivering, possible delayed hepatic damage.
Which inhalation agent is known to cause seizures?
Enflurane!!
It is also nephrotoxic and hepatotoxic
Which inhalation agents are nephrotoxic?
Enflurane (hepato and nephro)
and
Methoxyflurane.
The higher the MAC for an agent the …
The least potent the agent.
MAC = The lowest possible dose to limit movement in 50% of patients.
What is the dose per kg for lidocaine?
4.5 mg/kg
What is the dose per kg for lidocaine with epi?
7 mg/kg
What is the dose per kg for marcaine?
2 mg/kg
How many mg/mL of epinephrine is in 1:1000?
In a solution of 1:1000 there is 1 mg/mL of epinephrine.
What type of local is contraindicated with the use of halothane?
Should not use epinephrine halothane sensitizes the heart
What is clark’s rule?
Pediatric local dosing.
weight of child in lbs / 150 x ( adult dose)
Why are intravenous anesthetics used before inhalation agents?
Intravenous agents do not cause as much muscle relaxation/breathing supression.
Its best to initiate with IV and then follow up with inhalation products.
Why is ketamine so nephrotoxic?
It is one of the few intravenous agents that is not bound to albumin.
Thus it is cleared by the kidneys instead of the liver!
Why is the recovery from diprivan (propofol) quicker than any other induction agent?
Because propofol is quickly cleared by the liver at a rapid rate.
What is the moa of ketamine?
NMDA antagonist
What trifecta does ketamine provide patients?
Hypnotic
Analgesia
Amnesia
Also hallucinogenic with dissociative amnesia.
Why is ketamine useful in trauma cases?
Has no effect on the heart!
Prevents any drops in blood pressure!
Safest anesthetic for people with cardiac issues and asthma?
Etomidate
Antidote for benzodiazepines?
Flumazenil 0.2 mg/kg
Another name for versed?
Midazolam
Sedative, hypnotic, amnesia.
Whats the differnce between versed and valium?
Both are benzos but…
Versed (midazolam) allows hypnotic effects.
Valium allows for anti anxiety effects!
What drug can reverse narcotic overdose?
Naloxone!
What drug can reverse opiod antagonists?
Narcan
