Anesthesia Principles Lecture Powerpoint

Question 1

Anethesia definition

Answer 1

State of controlled temporary loss of sensation or awareness that is induced for medical purposes, can include analgesia, paralysis, amnesia, and unconsciousness

Question 2

General anesthesia

Answer 2

State that produces amnesia and analgesia with or without reversible muscle paralysis, controlled reversible state of unconsciousness involving combo of inhaled and IV medications, some benefits include good control and adaption, rapid administration, and can be reversed, but some disadvantages include the pre-op prep, cost, nausea, malignant hyperthermia, and emergence delirium as side effects

Question 3

Physical exam findings a anesthesiologist focuses on during assessment

Answer 3

-head and neck findings such as poor dentition, large tongue, immobile neck, difficulty obtaining IV access

Question 4

Mallampati scoring (I-IV)

Answer 4

A scoring system assessing how visible anatomic structures are in the back of the throat to determine the ease or difficutly of intubation, class I sees everything, class II loses pillars and tips of uvula but still has soft and hard palate, class III can only see base of uvula and hard and soft palate and have lost pillars, class IV has lost everything, class III and IV will see difficulty intubating

Question 5

Thyromental distance

Answer 5

Measured from thyroid notch to tip of jaw with head extended to determine if less than 6.5cm, if it is less then suggests difficult intubation will be present

Question 6

NPO rules pre op (4)

Answer 6

• No solid food 6 hours prior
• no clear fluids 2-4 hours prior
• don’t take any anticoagulants, ACEs, herbs and vitamins
• B blockers the morning of surgery is recommended and protective

Question 7

Essentials to monitor under general anesthesia intraop

Answer 7

• Have IV access peripheral or central
• heart monitor
• noninvasive BP
• temp
• pulse ox
• end tidal CO2

Question 8

General anesthesia induction steps (6)

Answer 8

1) preoxygenation either by mask or nasal canula
2) sedative drug via IV access (propolol, ketamine, thiopental, or midezelam)
3) analgesic drug administered (morphine, fentanyl, dilaudid)
4) paralytic drugs (succinylcholine, rocuronium)
5) establish endotrachial tube placement
6) anesthesiologist begins maintenance anesthesia (nitrous oxide, isoflurane)

Question 9

Sedative and analgesic used in intubated patients post op that will go to ICU

Answer 9

Propophol and fentanyl

Question 10

Sedation/monitored anesthesia care (MAC)

Answer 10

Type of anesthesia technique where patient is responsive and maintains airway, continuum either light to moderate to deep sedation, used with local or regional anesthesia, benefits include keeping patients awake and avoiding hemodynamic instability, risks include over sedation or patient discomfort

Question 11

Regional/local anesthesia

Answer 11

Reversible loss of sensation over a specific body area without producing unconsciusness, includes spinal, epidural, peripheral nerve blocks, local/field, and topical anesthesias, benefits include preservation of cerebral function, general less hemodynamic effect, improved early mobilization, but disadvantage is time consumption, patient discomfort, risk of nerve injury

Question 12

Spinal vs epidural anesthesia

Answer 12

A spinal sees injection of anesthetic drug into subarachnoid space below L1-2, rapid acting and good for lower limb or pelvic surgeries vs injection of anesthetic drug into epidural space at any level, is slower acting, uses medication thru an indwelling catheter and requires multiple dosing and is most often used in lower limb, pelvic surgery, and child delivery

Question 13

Peripheral nerve blocks

Answer 13

Injection of anesthetic around peripheral nerve or plexus, single injection typically, used for intra op anesthesia or post op pain relief, not associated with nausea/vomiting, headaches, or hypotension

Question 14

Malignant hyperthermia

Answer 14

Life threatening clinical syndrome of hypermetabolism involving the skeletal muscle triggered by inhaled certain anesthetic agents and paralytic agent succinylcholine***, autosomal dominant inherited with reduced penetrance (not always received but is dominant) - not an allergy! Sees large quantities of calcium released from SR of skeletal muscle causing hypermetabolic state and aerobic and anaeroic metabolism producing heat, acidosis, and rigidity

Question 15

Malignant hyperthermia signs and symptoms (5 early and 6 late)

Answer 15

• arterial CO2
• tachypnea
• flushing
• rigidity or masseter spasm
• pyrexia
• mottled skin and cyanosis
• rhabdo
• DIC
• cerebral edema
• death

Question 16

Malignant hyperthermia treatment** (6)

Answer 16

• stop surgery
• discontinue inhalation agents and succicholine
• hyperventilate 100% O2
• dantrolene 2.5mg/kg Q 5 min PRN*****
• monitor and treat temp, urine output, hyperkalemia, ABGs, etc
• ICU admission

Question 17

Malignant hyperthermia diagnosis (3)

Answer 17

• clinical diagnosis in the surgical setting
• caffeine halothane contracture test (muscle biopsy)
• molecular genetic testing (these last 2 are for future cases)