Anesthesia meds

Question 1

pre-anesthetic meds (for anxiety, amnesia, drowsiness)

Answer 1

Benzodiazepines

Barbituates

Question 2

Benzo agents and advantages

Answer 2

Agents :
Diazepam (little use)
Lorazepam
Midazolam

Raise threshold for CNS toxicity of local anesthetics

Rapid onset and short duration of action

Varying ability to cause amnesia

Question 3

Barbiturate agents and advantages

Answer 3

Agents:
Pentobarbital
Thiopental

May yield disorientation if pain is present

Tolerance observed in patients with chronic use of alcohol

Onset: less than 1 minute / Duration: 5 – 10 minutes

Avoid in: porphyria
Limited availability in US

Question 4

Potent ultra-short acting hypnotic without analgesic properties - conscious sedation - Must follow with analgesic and muscle relaxant drugs

Answer 4

Etomidate

Question 5

Etomidate side effects

Answer 5

hypotension
carbon dioxide retention
suppresses corticosteroid synthesis at adrenal cortex

Question 6

Selectively inhibit nociceptive reflexes and induce analgesia through action at mu receptors

Inhibit release of neurotransmitters including substance P
Antagonize effect of exogenous substance P

Answer 6

Opioids

Morphine
Fentanyl
Sufentanyl
Hydromorphone

Question 7

Opioid equipotent dosing

Answer 7

Morphine
1 -2 mg

Fentanyl
0.05 – 0.1 mg

Sufentanyl
0.005-0.01 mg

Hydromorphone
0.1 – 0.2 mg

Question 8

Used for induction of dissociative anesthesia

Often used for emergency surgical procedures

Answer 8

Ketamine

Question 9

Chemically unrelated to other IV anesthetics

Oil emulsion at room temperature (1% solution)

Answer 9

Propofol

Question 10

Inhaled anesthetic agents

Answer 10

Nitrous oxide (no muscle relaxant activity)
Sevoflurane
Isoflurane
Desflurane

Question 11

Infiltration local anesthetics preferred for

Answer 11

Infiltrative anesthesia may be preferred for surgical or dental procedures.

• • subcutaneously for IV start, shave biopsy or sutures
• • submucosal for dental or laceration repair situations
• • wound infiltration for post-operative pain control
• • intra-articular injections
• • infiltrative nerve blocks

Question 12

Nerve block local anesthetics preferred for

Answer 12

Surgical or diagnostic procedures

Pain management

Question 13

Local anesthetics - Amino Amides

Answer 13

Lidocaine
Bupivacaine
Prilocaine
Dibucaine

Question 14

Local anesthetics - Amino Esters

Answer 14

Benzocaine
Cocaine
Procaine
Tetracaine

Question 15

Amino esters - benzocaine, cocaine, tetracaine - have a higher incidence of

Answer 15

allergic reaction

Question 16

Lidocaine: concentration, dose, onset/duration action

Answer 16

1-2%

4.5-5mg/kg (max 300mg)

Onset < 2 min
Duration 0.5 - 1 hr

Question 17

Lidocaine w Epinephrine: concentration, dose, onset/duration action

Answer 17

1-2% Lido
1:100,000 or 1:200,000 Epi

7mg/kg (max 500mg)

Onset < 2min
Duration 4-6 hours

Question 18

Bupivicaine: concentration, dose, onset/duration

Answer 18

0. 25%
1. 5mg/kg (max 175mg)

Onset 5 min
Duration 2-4 hours

often used as epidural for labor delivery

Question 19

Bupivicaine w Epinephrine: concentration, dose, onset/duration

Answer 19

0. 25% Bupi
   1: 100,000 or 1:200,000 Epi

Max 225mg

Onset 5 mins
Duration 3-7hrs

Question 20

Procaine: concentration, dose, onset/duration

Answer 20

0.25-0.5%

350-600mg

Onset 2-5 min
Duration 0.25-1hr