Anesthesia study guide Flashcards
What are the different types of sedation?
- General anesthesia
- Local anesthesia
- Regional anesthesia
- Moderate sedation
- Adjunct medications (benzodiazepines, opioids, and NMBA)
What is balanced anesthesia?
The combined use of medication in general anesthesia
Purpose of balanced anesthesia?
Analgesia, anti-anxiety, amnesia, block reflexes, depress consciousness
What combinations of medications are used for balanced anesthesia?
- NMBA (paralyzes muscles) *NOT AN ANALGESIA
- Benzodiazepines (Enhances GABA, results in sedative, hypnotic, muscle relaxant *Too much can lead to respiratory depression, lactic acidosis, coma
- Opioids (Analgesia)
- General anesthetics (LOC)
Effects of drug combinations:
- Rapid induction
- Reduced dosages
Stage 1 of anesthesia
- From the start of anesthesia up to LOC
- Analgesia
Stage 2 of anesthesia
- LOC to automatic breathing
- Excitement
- Loss of eyelash reflex
Stage 3 of anesthesia
- From onset of automatic breathing to respiratory paralysis (need ventilator, tube)
- Surgical anesthesia
Stage 4 of anesthesia
-From respiratory cessation to death
What is malignant hyperthermia?
- Disease that causes a fast rise in body temperature and severe muscle contractions
- Rare adverse effects of isoflurane (Forane)
- Breaks down protein/muscles
- Passed down through families
- Triggered by a drug (NMBA or inhaled ethers)
- Occurs during or after general anesthesia
- Tachypnea, tachycardia, muscle rigidity
- Life-threatening emergency
Antidote for malignant hyperthermia
Dantrolene
*can use a cooling blanket also
MOA for Nitrous Oxide (NO)
Not completely known
MOA for Isoflurane (Forane)
- Unknown
- GABA, glycine, and glutamate receptor agonist
- Reduces pain and relaxes muscles
MOA for Propofol (Diprivan)
- Unclear
- Binds to GABA receptor
MOA for Midazolam (versed)
GABA receptor agonist
MOA for fentanyl (Sublimaze)
Mu and Kappa receptor agonist
MOA for NMBAs
Prevents nerve transmission in certain muscles, resulting in paralysis
MOA for Procaine and Lidocaine
Blocks Na+ channels
SE of Nitrous Oxide
- Low potency
- Analgesia
- Anxiolytic
- No LOC and little muscle relaxation
- Usually dose related anxiety
- Difficulty breathing, nausea,dizziness, lethargy
SE of Isoflurane (Forane)
- Nausea, vomiting, tremors
- Dose dependent: decrease in respirations, blood pressure
- RARE: Malignant Hyperthermia
SE of Propofol (Diprivan)
- Pain at injection site
- Respiratory depression
- Hypotension
- Hyperlipidemia
- PIF (metabolic acidosis, rhabdomyolysis, hepatomegaly, hypertriglyceridemia, hyperkalemia, cardiac and renal failure, often fatal)
SE of Midazolam (versed)
- CNS depression
- Drowsiness, fatigue
- Hypotension
- Cardiovascular collapse
- Respiratory depression
SE of Fentanyl (Sublimaze)
- Respiratory depression
- Skeletal muscle rigidity
- Bradycardia
- Nausea, vomiting, constipation
SE of NMBAs
- Respiratory depression
- Hypotension
- Tachycardia (blockade of muscarinic receptors)
- Malignant hyperthermia
- Myalgia, muscle weakness
SE of Procaine (Novocaine)
- Rare with local use
- Anaphylaxis
- Respiratory depression
- Arrhythmias
- Nervousness, dizziness, confusion
SE of Lidocaine (Xylocaine)
- Injection site reactions
- Hypersensitivity
- Anxiety, tremors
- Arrhythmias
Antidote for Midazolam (versed)
Flumazenil (Romazicon)
Antidote for Fentanyl (Sublimaze)
Naloxone (Narcan)
