CCP 213 - Anesthesia

Question 1

The five types of anesthesia are:

Answer 1

1) General
2) Local
3) Nerve blocks
4) Procedural
5) Pain control

Question 2

The three stages of anesthesia are:

Answer 2

1) Induction
2) Maintenance
3) Reemergence

Question 3

The five approaches to intubation include:

Answer 3

1) RSI
2) SFI
3) DSI
4) PAI
5) Awake

Question 4

PAI entails:

Answer 4

Sedating, visualizing, then paralyzing & passing the ETT.

Question 5

SFI entails:

Answer 5

Sedation to ETI, without use of a paralytic.

Question 6

DSI entails:

Answer 6

Sedation, followed by a delay to utilize pre-oxygenation, then paralysis with ETI.

Question 7

Indications for intubation:

Answer 7

1) Protection
2) Progression
3) Oxygenation
4) Ventilation
5) Refractory shock (ie. relief/maximization)

Question 8

Explain the MOA of succinylcholine:

Answer 8

Produces depolarization of skeletal tissue by stimulating nicotinic receptors allowing cation influx. Short-lived depolarization because of acetylcholinesterase cleavage from the nicotine receptor, allowing repolarization.

Question 9

Explain the MOA of rocuronium:

Answer 9

Blocks the nicotine receptor, preventing stimulation by ACh or nicotine, preventing depolarization altogether.

Question 10

Explain the effects of rocuronium if used on a patient with myasthenia gravis:

Answer 10

Rocuronium will have a lasting effect, as there are fewer ACh receptors to bind to, meaning rocuronium will stay in the serum longer than usual.

Question 11

Explain the effects of succinylcholine if used on a patient with myasthenia gravis:

Answer 11

Succinylcholine may be ineffective and require larger doses (ie. 3x normal) in order to produce depolarization, due to lack of available ACh receptors (as they are already occupied by ACh).

Question 12

Explain the effects of rocuronium if used on a patient with muscular dystrophy:

Answer 12

Rocuronium may have a prolonged course of action, due to abundance of receptors that are bound to in MD.

Question 13

Explain why succinylcholine is contraindicated in muscular dystrophy:

Answer 13

Succinylcholine has an unacceptable risk of producing hyperkalemia from rhabdomyolysis, due to significant binding of the excess of ACh on post-synaptic neurons, in which AChE is unable to cleave effectively.

Question 14

What is the reversal agent for non-depolarizing neuromuscular blocking agents?

Answer 14

Sugammadex.

Question 15

The PACE acronym for intubation stands for:

Answer 15

1. Primary
2. Alternate
3. Contingency
4. Emergency