General And Local Anthesthetics Flashcards
What is neuraxial anesthesia?
Spinal, epidural and spinal-epidural anesthesia
What is a Bier block?
Local anesthesia via IV
What is MAC? What does it stand for?
Injected anesthesia without volatile liquids
Monitored Anesthetic Care
What is induction?
Going from consciousness to stage 3
What is PSA?
Procedural sedation w/ analgesia
What are the effects of a pt enters stage 4?
Loses vasomotor, cardioregulatory and respiratory center
What occurs after a pt after induction?
Maintenance
What is monitored by CRNA when pt is in stage 3?
ABC
Airways breathing and circulation
What is PONv stand forever
Post operative Nausea and Vomitting
What is balance anesthesia?
Low doses of many different anesthesia’s meds
What is desflurane(Suprane)? What effect does it have on the body? How pungent is it?
Volatile liquid
Causes bronchodilation
Increases SM tone
Very pungent
What is sevoflurane(Ultane)? What does it cause and how pungent is it?
Volatile liquid
Causes bronchodilation and SM tone
Not very pungent
What effects do inhaled anesthetics have on memory and pain?
Analgesic and amnesia effect
What do General anesthetics and inhaled anesthetics cause in the body?
Vessels, BP, and respiration
Vasodilator
Decrease BP
Respiratory depression
What does PONV stand for?
Post operative nausea and vomitting
What is the number 1 inhaled anesthetic?
Sevoflurane
What do volatile liquids end in?
-flurane
What is the MOA if inhaled anesthetics?
Activates GABA-A receptors to increase Cl- permeability
How are inhaled anesthetics administered?
Via mask
How are inhaled drugs supplied as and then what happens to them during surgery?
Start as liquid then are vaporized to be breathed in
What is the route of elimination for inhaled anesthetics?
Respirating
True or false: many volatile anesthetics are ethers?
True
A drug that has a high blood:gas partition coefficient is considered? How fast can it get to the brain?
More soluble in the blood (more hydrophilic)
Takes longer to get to the brain
A low blood:gas partition coefficient is?
Hydrophobic. Quicker to get to the brain
Out of desflurane, sevoflurane and halothane, which has the quickest onset or lowest blood:gas partition coefficient?
Desflurane
What does MAC stand for? What does it measure?
Minimum alveolar concentration
Potency of a drug
A low MAC means?
A high potency
What is a common ADR of volatile liquids and NMBD?
Malignant hyperthermia
How can malignant hyperthermia occur?
Taking volatile liquids or succlynate NMBD
What are the 5 common symptoms of malignant hyperthermia?
Tachypnea Tachycardia Muscle rigidity Acidosis Increased body temp
True of false: is malignant hyperthermia life threatening?
True
What is the antidote or used to Tx malignant hyperthermia?
Dantrolene(dantrium)
What does PSA stand for?
Procedural sedation w/ analgesia
What is 4 stages are considered PSA? Which has the greatest CNS depression?
Analgesia
Minimal sedation
Moderate sedation
Deep sedation
Deep sedation
Which form of anesthesia uses volatile liquids?
General anesthesia
What are the indications for PSA?(5)
Dislocated joint (reduction) Electrical cardio version Severe laceration Abscess incision Lumbar puncture
What is propofol(Diprivan)? How is it given? How quick does it onset and last? PONV? Analgesia or amnesia effect? Pain w/ injection?
General anesthetic
IV
Quick onset and recovery
No PONV
No analgesic effect, only amnesia
Pain with injection
What drug is considered the milk of amnesia?
Propofol(diprivan)
True or false: propofol has a large therapeutic range?
False, it has a very narrow therapeutic range
Why must propofol(diprivan) be given with aseptic technique?
Because it can cause necrosis if bacteria in body are able to use it as good
What pieces of equipment is needed if a provider is giving a pt propofol?
Intubation and respiratory assistance equipment
What is etomidate(Amidate)? How is it given? What is is MOA? What is it used for? How does it effect BP or cardiac output? PONV? Pain w/ injection? Analgesic and amnesia activity?
General anesthetic
Given thru injection
Enhances GABA-A
Used for PSA and RSI
No effect on BP and cardiac output
Cause PONV
Pain w/ injection
Amnesia effect w/ No analgesic activity
What is dexmedetomidine(Precedex)? What does it cause? Respiratory depression? Analgesic or amnesia effect? Indications? Why used in ventilator pt?
Alpha 2 agonist
Reduces NE release from Pons
Causes no respiratory depression
Small analgesic activity with amnesia
Used for PSA and RSI
Used on ventilator pt to not fight ventilator
What is ketamine(Ketalar)? Indications? MOA? Analgesic and amnesia effect? Respiratory depression? Route?
General anesthetic
General anesthesia and setting broken bones
NMDA receptor antagonist (blocks excitation)
Good analgesic w/ amnesia
Oral or injected
What does ketamine have effect on a pt eyes?
Eyes remain open
What effect on skeletal muscle does ketamine have?
No effect
What is midazolam(Versed)? What is it used for? Analgesic or amnesia effect? What is it used with? route? What age of pt often receive this medication?
Benzodiazepine
Minimal sedation (PSA)
Amnesia effect with no analgesic effect
Oral and rectal
Used with kids to calm them down
What is another name for nitrous oxide? What must it be given with? PONV? Analgesic effect?
Laughing gas
Oxygen
Causes PONV
Analgesic effect
Drugs that are GABA-A receptor enhancers?
Barbiturates Benzodiazepines Etomidate Propofol Volatile anesthetics
Drugs that are NMDA glutamate antagonists?
Ketamine
Nitrous oxide
Glutamate
What is a local anesthetic pH before injection into body? Solution? ECF? Inside cell?
Weak base
Acidic
Basic
Acidic
What is the MOA of local anesthetics?
Blocks Na inactivation gate
What fibers are effected from local anesthetics?
A-delta fibers
C fibers
Small nerve fibers
Non-myelinated fibers
What are the two different types of local anesthetics? How are they broken down? How long are they active?
Esters(broken down by AChase)
-short acting
Amides(broken down by liver)
-long acting
What category of local anesthetic is cocaine? Route?
Ester
Given as injection
What is Benzocaine? What category is it? What can long use cause? What is it used for?
Local anesthetic
Ester group
Causes allergies
Skin abrasions
Sunburn
Insect bite
What is bupivicaine(Marcaine)? How long does it last? What is it used for?
Amide local anesthetic
Long acting
Used as epidural and nerve block
What is lidocaine(Xylocaine)? What is the onset time? How long does it last?
Amide local anesthetic
Rapid onset
Intermediate lasting
What is lidocaine(lidoderm patch)? What is it used for?
Amide local anesthetic
Used for postherapetic neuralgia (shingles)
What are the difference route of local anesthetics?
OTC
EMLA
Injection
Infiltration analgesia
What is intradermal injection with local anesthetic?
Infiltration analgesic
What effects does epi w/ lidocaine cause? This helps with what?(2)
Vasoconstriction
Increase half life
Prevents it going systemic
What local anesthetics penetrate the dura mater? Where must they be inserted below?
Spinal injections and taps
Below L2
What are the ADR if local anesthetic goes systemic?
Cardiovascular collapse
Convulsions…leading to coma
Spinal headache
How can you take away a spinal headache?
Inject blood into leaking area of spinal entry
Have pt Lay down
What are the two type of skeletal muscle blockers/paralytic/NMBD?
Non-depolarize gets
Depolarizing
What is succcinylcholine? MOA? Indication? ADR?
Depolarizing NMBD antagonist
Binds to N1 receptor causing twitching (agonist)
Then alters N1 receptor to not respond to ACh(antagonist)
RSI
Can cause malignant hyperthermia
What are the two drugs that cause malignant hyperthermia?
Volatile liquids
Succcinylcholine
What do non-depolarizing blockers end in?
-curium or -curonium
How long does a blockade for non-depolarizing blockers last? How long is the onset to occur?
20-30min
3-5min wait for onset
What is vecuronium bromide(Norcuron)?
Non-depolarizing blocker (paralytic)
What is cisatracurium(Nimbex)?
Non-depolarizing blocker (paralytic)
What is rocuronium bromide(Zemuron)?
Non-depolarizing blocker (paralytic)
What is pancuronium bromide(Pavulon)?
Non-depolarizing blocker (paralytic)
Before using NMBD what should a Hx been known on pt?
Hx of response time analgesia
Hx of allergies and medications
Hx of alcohol and opioids
