Continuum of Anesthesia

Question 1

What is Anesthesia?

Answer 1

Loss of consciousness
Loss of memory
Loss of all senses
Immobility
Abolition of reflexes-somatic and automatic

Question 2

What is the triad of Anesthesia?

Answer 2

Analgesia, Hypnosis, Muscle Relaxation

Question 3

What is the Dyad of Regional Anesthesia?

Answer 3

Analgesia

Muscle Relaxation

Question 4

What are medications used to accomplish Anesthesia?

Answer 4

Sedative-hypnotics: 
  Propofol
  Etomidate
  Ketamine
  Benzodiazepines
  Barbiturates
Anesthetic Gases:
  Ensoflurane, Isoflurane, Halothane, Sevoflurane, 
  Desflurane

Question 5

Do sedative-hypnotics have analgesic effects?

Answer 5

No, most do not

Question 6

How do we accomplish pt immobility?

Answer 6

Muscle Relaxants (paralytics: depolarizers and non-depolarizers)

Question 7

What are prerequisites to an anesthesia case?

Answer 7

ANESTHESIA PROVIDER, machines, monitors, suction, drugs (for case and resuscitation), A/W equipment

Question 8

What are the steps for anesthesia recovery?

Answer 8

1. Turn off agents
2. Reverse relaxants
3. Ensure return of motor and sensory blockade
4. Remove airway (ETT, LMA, etc.)
5. Monitor in recovery area (e.g. ICU or PACU)

Question 9

What are disadvantages of anesthesia?

Answer 9

Various systems effected (CV, Respiratory, etc.)
Allergic reactions
PONV
Pain and Awareness
Recovery varies for individuals

Question 10

What is the Continuum of Anesthetic State?

Answer 10

Local Anesthesia
Regional Anesthesia
Minimal Sedation  "Anxiolysis"
Moderate Sedation "Conscious Sedation"
Deep Sedation
General Anesthesia

Question 11

Local Anesthesia

Answer 11

Anesthetic drug that can be injected into the tissue to numb a specific area

Question 12

Regional Anesthesia

Answer 12

Anesthetic drug injection near a cluster of nerves that will numb an specific area
e.g. Epidurals, spinal, and peripheral nerve blocks

Question 13

Minimal Sedation “Anxiolysis’’

Answer 13

Drug that can help pt feel relaxed

Response: responds normally to verbal commands
Effects: Cognition and Coordination may be impaired

Question 14

Moderate Sedation “Conscious Sedation”

Answer 14

Drug that helps pt to feel drowsy & pt may sleep through procedure w/ minimal memory of procedure

Response: responds purposefully to verbal commands either alone or by light tactile stimulation

Question 15

Deep Sedation

Answer 15

Drug that causes pt to sleep through procedure w/ little memory of procedure

Response: Not easily aroused but may respond to repeated painful stimuli
*Independent ventilatory function and ability to maintain a patent airway may be impaired so supplemental O2 is given

Question 16

General Anesthesia

Answer 16

Gases & vapors inhaled through breathing device or drugs given intravenously that render the patient unconscious

Response: unarousable
Effects: Requires assistance maintaining a patent airaway, PPV may be required, CV may be impaired

Question 17

What is MAC?

Answer 17

Monitored Anesthesia Care (for simple procedures and minor surgeries)

sedative and other agents; dosage low enough that pt remains responsive and breathes without assistance

Question 18

What is a combination technique?

Answer 18

MAC/sedation and local/regional anesthesia, regional and general anesthesia, etc.

Question 19

What is general anesthesia w/ an ETT template?

Answer 19

1. Pre-op meds (Benzodiazepines, ABX)
2. Induction Drug (to induce)
3. Neuromuscular blockade (to facilitate intubation)
4. Inhalational Drugs (to maintain general anesthesia)
5. Opiods/local anesthetics (to minimize physiological
   effects of pain and promote comfort at emergence)
6. Antiemetic (to prevent nausea which can be caused by opiods or inhalational agents)
7. Neuromuscular blockade reversal (reverse paralytic)