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Surgery > General Anesthesia > Flashcards

General Anesthesia Flashcards

1
Q

Define Anesthesia

A

Combination of amnesia, analgesia, & muscle relaxation to allow the performance of surgery or other procedures

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2
Q

3 Phases of Anesthesia

A

Induction
Maintenance
Emergence

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3
Q

Induction

A

Putting to sleep
Most common: propofol
Alternatives: etomidate, ketamine

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4
Q

Propofol Effects in Induction

A

Drop in BP
Drop in cardiac output
Antiemetic properties

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5
Q

When is ketamine used for induction?

A 
Hemodynamic instability
Cardiac stimulant
Significant analgesia
Bronchodilation
Hallucinations
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6
Q

Maintenance Phase of Anesthesia

A

Inhaled or IV anesthetics

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7
Q

Inhalation Anesthetic Agents

A

Sevoflurane
Desflorane
Nitrous Oxide

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8
Q

IV Anestetics

A

Propofol

Remifentanil

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9
Q

Emergence Phase of Anesthesia

A

Waking up

Can result in autonomic hyper-responsiveness

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10
Q

Autonomic Hyper-Responsiveness During Emergence

A

Tachycardia
Hypertension
Bronchospasm
Laryngospasm

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11
Q

What medications can block the autonomic hyper-responsiess during emergence?

A

Short acting narcotics
Beta blockers
Lidocaine

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12
Q

In what surgeries is Propofol used?

A

General surgeries
Cardiac surgery
Neurosurgery
Pediatric surgery

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13
Q

How is propofol metabolized & cleared from the body?

A

Metabolized in the liver

Excreted in the urine

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14
Q

SE of Propofol

A

Support rapid growth of microorganisms
Hypotension
Hypertonia & movement
Respiratory depression

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15
Q

In what populations is ketamine used?

A

Pediatrics- IM shot
Geriatrics
Shock patients (cardiac stimulant)

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16
Q

Which types of gasses take longer to eliminate from the body?

A

Soluble gasses
More soluble, longer
Less soluble, quicker

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17
Q

How do inhaled anesthetics work?

A

Interfere with release of neurotransmitters
Alter re-uptake of neurotransmitters
Change the binding of neurotransmitters to the post-synaptic receptor sites

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18
Q

Isoflurane

A

Higher blood-gas solubility

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19
Q

Effects of Isoflurane

A

Tachycardia
Peripheral vasodilation
Airway irritant
Coughing

20
Q

Desflurane

A

Requires heated-pressurized vaporizer for delivery

21
Q

Effects of Desflurane

A 
Tachycardia
Peripheral vasodilation
Coughing
Bronchospasm
Not for mask induction
22
Q

Sevoflurane

A

NO tachycardia
Peripheral vasodilation
Well-tolerated for mask induction

23
Q

Which spaces can increase in size when nitrous oxide is used?

A 
Bowel
Middle ear
Pneumothorax
Pneumocranium
Pneumo-peritoneum
Cuffs of ET tubes
24
Q

Effects of Nitrous Oxide

A

Post op nausea

Analgesic properties

25
Q

Advantages of Nitrous Oxide

A 
Inexpensive
Readily available
Odorless/slightly sweet
Limited effect
No special equipment
Sympathomimetic
No malignant hypertension
26
Q

Disadvantages of Nitrous Oxide

A

High MAC/limits FIO2
Sympathomimetic
Methionine syntheses inhibitor
Expands air-filled spaces

27
Q

Contraindications to Potent Inhaled Anesthetic Agents

A

Inability to tolerate physiologic alterations

Malignant hyperthermia

28
Q

Reasons for Neuromuscular Blocking Drugs (NMBDs)

A

Endotracheal intubation
Surgical immobility/relaxation
Mechanical ventilation

29
Q

2 Types of NMBDs

A

Depolarizing

Non-depolarizing

30
Q

Depolarizing NMBD Medication

A

Succinylcholine (Anectine)

31
Q

Non-depolarizing NMBDs Medication

A

Rocuronium (Zemuron)
Vecuronium (Norcuron)
Pancuronium (Pavulon)
Cistracurium (Nimbex)

32
Q

MOA of Depolarizing Agents

A

Brief twitching or fasciculations

Flaccid paralysis

33
Q

Succinylcholine (Anectine)

A

Depolarization at the motor end plate

Slowly dissociates from ACh receptors

34
Q

When is succinylcholine (Anectine) used most frequently?

A

RSI

35
Q

Disadvantages of Succinylcholine

A 
Cardiac dysrhythmias
Sinus bradycardia
Myalgias
Myoglobinuria
Hyperkalemia
Patient restrictions (children)
Masseter spasm
Malignant hyperthermia trigger
Possible intraocular, gastric, & ICPs
36
Q

Long Acting Non-depolarizing Agents

A

Pancurounium

37
Q

Intermediate Acting Nondepolarizing Agents

A

Vecuronium
Rocuronium
Cistracurium

38
Q

Short Acting Non-Depolarizing Agent

A

Mivacurium

39
Q

4 Twitches Seen with NMBDs

A

0-75% of receptors blocked

40
Q

3 Twitches Seen with NMBDs

A

75% of receptors blocked

41
Q

2 Twitches Seen with NMBDs

A

80% of receptors blocked

42
Q

1 Twitch Seen with NMBDs

A

90% of receptors blocked

43
Q

No Twitches Seen with NMBD Use

A

100% of receptors blocked

44
Q

Reversal of NMBDs

A

Acetycholine esterase inhibitors

45
Q

Examples of Acetylcholine Esterase Inhibitors

A

Neostigmine
Edrophonium
Sugammeadex: vecuronium & rocuronium

Surgery (20 decks)

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