Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

SURGERY EXAM II > GENERAL ANESTHESIA > Flashcards

GENERAL ANESTHESIA Flashcards

1
Q

anesthesia is the combination of

A

combo of amnesia + analgesia + muscle relaxation to allow the performance of surgery or other procedures

amnesia + analgesia + muscle relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 phases of general anesthesia

A

1) Induction
2) Maintenance
3) Emergence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

most commonly used induction agent

A

Propofol (Diprivan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Propofol causes a drop in

A

BP & CO

also has antiemetic properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

INDUCTION AGENTS

A

Propofol
etomidate
ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Etomidate

A

⦁ Doesn’t cause vasodilation
⦁ higher rate of post-op nausea
⦁ inhibits the biosynthesis of cortisol
⦁ use is limited due to increased risk of death by 2.5x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

higher rate of post op nausea

use is limited due to increased risk of death by 2.5x

A

ETOMIDATE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

used in pts with hemodynamic instability
hallucinations
often used in kids
significant analgesic

A

ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

KETAMINE

A

⦁ Used in patients with hemodynamic instability
⦁ is a cardiac stimulant
⦁ significant analgesia, bronchodilation, and hallucinations
⦁ can cause severe hallucinations to where patient may not want to ever have surgery again…used more in children, pain management & treatment resistant depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

INDUCTION PHASE

A
  • “putting to sleep”
  • most commonly used induction agent = PROPOFOL

PROPOFOL CAUSES
- a drop in BP & cardiac output, antiemetic properties

OTHER AGENTS
o Etomidate
⦁	Doesn't cause vasodilation
⦁	higher rate of post-op nausea
⦁	inhibits the biosynthesis of cortisol
⦁	use is limited due to increased risk of death by 2.5x

o Ketamine
⦁ Used in patients with hemodynamic instability
⦁ is a cardiac stimulant
⦁ significant analgesia, bronchodilation, and hallucinations
⦁ can cause severe hallucinations to where patient may not want to ever have surgery again…used more in children, pain management & treatment resistant depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MAINTENANCE PHASE

A
  • use of inhaled (volatile) or IV anesthetics
  • Inhalation Anesthetic Agents
    ⦁ Volatile Anesthetic Agents = Sevoflurane & Desflurane
    ⦁ Nitrous Oxide: can be used in combo with volatile gases
  • IV anesthetic agents
    ⦁ Propofol and Remifentanil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

EMERGENCE

A

“WAKING UP”
last phase of general anesthesia

  • can result in autonomic hyper-responsiveness
    ⦁ tachycardia, hypertension, bronchospasm, laryngospasm

to blunt these responses = can give

  • short acting Narcotics
  • Beta blockers
  • Lidocaine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

emergence autonomic hyper-responsiveness can cause

A
  • tachycardia
  • hypertension
  • bronchospasm
  • laryngospasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

to help blunt autonomic hyper-responsiveness in emergence

A
  • short acting narcotics
  • beta blockers
  • lidocaine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PROPOFOL (DIPRIVAN)

A
  • Non-barbiturate hypnotic agent
  • rapidly metabolized in liver & excreted in the urine - so can be used for long durations of anesthesia
  • used for general surgery, cardiac surgery, neurosurgery & pediatric surgery
  • rapid onset of action (distribution = 2-4 minutes)
  • rapid clearance
  • reversibility of effect once the drip is shut off
  • duration of action = 1-3 hours, onset = 40 seconds
  • Has some anti-emetic effect - so less Nausea / vomiting associated with use
  • weaker amnestic effect than Midazolam (versed)
  • no analgesic effect
  • milky looking solution (emulsion) - so called “milk of amnesia”
  • clear-headedness during recovery (rapidly clears, so don’t have much of a hangover during recovery period)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

adverse effects of Propofol (diprivan)

A

⦁ can support rapid growth of microorganisms
⦁ hypotensive (so administer slowly)
⦁ may cause hypertonia & movement
⦁ respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

is a cardiac stimulant

A

KETAMINE (KETALAR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

KETAMINE

A
  • affects the senses
  • produces a dissociative anesthesia (catatonia, amnesia, analgesia) in which the patient may appear awake and reactive, but cannot respond to sensory stimuli
  • frequently used in pediatric patients because anesthesia and analgesia can be achieved with an IM injection
  • also used in high-risk geriatric patients and in shock cases - because it also provides cardiac stimulation
  • rapid onset (30 seconds)
  • short duration (5-10 minutes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ANESTHETIC GASES

A

⦁ Isoflurane (Forane)
⦁ Desflurane (Suprane)
⦁ Sevoflurane (Ultane)
⦁ Nitrous Oxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

the more soluble the anesthetic gas is in the blood =

A

the longer it takes to eliminate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

which anesthetic gases are the shortest acting

A

nitrous oxide
desflurane (suprane)

because they are the LEAST SOLUBLE in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ANESTHETIC GASES

A
  • an important property of anesthetics = reversibility
  • once the anesthetic gas is turned off, the blood stream brings the gas back to the lungs, where it is eliminated; the more soluble the gas in the blood, the longer it takes to eliminate
  • Nitrous oxide & Desflurane = shortest acting anesthetic gases because they are the least soluble in the blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how do inhaled anesthetics work

A
  • Inhaled anesthetics act in different ways at the level of the CNS
  • They disrupt normal synaptic transmission by:

⦁ interfering with the release of neurotransmitters from presynaptic nerve terminals (enhance or depress excitatory or inhibitory transmission)
⦁ alter the re-uptake of neurotransmitters
⦁ change the binding of neurotransmitters to the post-synaptic receptor sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

DOSING OF INHALED AGENTS

MAC

A

o MAC = Minimum Alveolar Concentration = the inhaled anesthetic concentration (steady state) at which 50% of patients move in response to a standard midline abdominal incision

⦁ Nitrous Oxide = 105%
⦁ Isoflurane = 1.15%
⦁ Sevoflurane = 1.8%
⦁ Desflurane = 6.2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
inhaled agent with highest MAC
nitrous oxide then desflurane (these are the shortest acting agents...are the least soluble in blood)
26
inhaled agent with the lowest MAC
isoflurane then Sevoflurane
27
MAC & AGE
- the MAC required for adequate anesthesia decreases with age, due to alterations in metabolism (need lower dose with age)
28
ISOFLURANE = inhaled agent
- Higher blood-gas solubility => so it takes longer for onset, and longer for emergence - causes tachycardia - causes peripheral vasodilation (hypotension) - airway irritation & coughing (bronchospasm)
29
fastest onset & offset inhaled agent
desflurane
30
has highest airway irritation | least well tolerated on the airway (can cause coughing / bronchospasm)
desflurane
31
DESFLURANE
- requires a heated-pressurized vaporizer for delivery - causes tachycardia (just like isoflurane) - causes peripheral vasodilation (hypotension - just like isoflurane) - least well-tolerated on the airway - can cause coughing, bronchospasm - not used for mask induction - fastest onset & offset
32
which inhaled agent does NOT cause tachycardia
sevoflurane still causes peripheral vasodilation though
33
not used for mask induction well-tolerated for mask induction
desflurane sevoflurane
34
SEVOFLURANE
- does NOT cause tachycardia - causes peripheral vasodilation - well tolerated for mask induction - fast onset & quick awakening
35
NITROUS OXIDE
MAC = 104 - therefore, nitrous oxide alone cannot provide anesthesia - nitrous oxide diffuses into air-containing cavities 34x faster than nitrogen can leave the space - so bowel, middle ear, pneumothorax, pneumocranium, pneumo-peritoneum, or cuffs of endotracheal tubes can all increase in size when nitrous oxide is being used - Increases post-op nausea - has analgesic properties (nice for dental procedures)
36
alone cannot provide anesthesia
nitrous oxide
37
increased post op nausea (2) decreased nausea (1)
etomidate & nitrous oxide propofol
38
no analgesic effect analgesic effect
Propofol nitrous oxide
39
advantages of nitrous oxide
``` Inexpensive Readily available Odorless/slightly sweet Limited effect No special equipment Sympathomimetic Will not cause malignant hyperthermia ```
40
will not cause malignant hyperthermia
nitrous oxide inexpensive & readily available
41
disadvantages to nitrous oxide
High MAC/Limits FIO2 Sympathomimetic Methionine synthetase inhibitor Expands air-filled spaces
42
expands air filled spaces
nitrous oxide
43
PHARMACOKINETICS OF INHALED AGENTS
uptake time: Isoflurane > Sevoflurane > Desflurane > Nitrous Oxide elimination time: Isoflurane > Sevoflurane > Desflurane > Nitrous Oxide
44
physiologic responses to inhaled anesthetic agents
- Tachycardia (except Sevoflurane) - Hypotension (vasodilation) - decreased cardiac output - respiratory depression (decreased ventilation)
45
CONTRAINDICATIONS TO INHALED ANESTHETIC AGENTS
⦁ inability to tolerate the physiologic alterations produced (can pt tolerate decreased CO, hypotension, tachycardia, decreased ventilation?) ⦁ Malignant hyperthermia (does pt have a hx of MH?)
46
NEUROMUSCULAR BLOCKING DRUGS (NMBDs)
``` ⦁ Succinylcholine (Anectine) ⦁ Rocuronium (Zemuron) ⦁ Vecuronium (Norcuron) ⦁ Pancuronium (Pavulon) ⦁ Cisatracurium (Nimbex) ```
47
function of NMBDs
- Produce the immobility that is needed for: ⦁ endotracheal intubation (if pt isn't tolerating mechanical ventilation) ⦁ surgical immobility / relaxation (ex: abdominal) ⦁ mechanical ventilation
48
depolarizing NMBD
succinylcholine (anectine)
49
nondepolarizing NMBDs
⦁ Rocuronium (Zemuron) ⦁ Vecuronium (Norcuron) ⦁ Pancuronium (Pavulon) ⦁ Cisatracurium (Nimbex)
50
ACh is rapidly inactivated by
acetylcholinesterase
51
DEPOLARIZING AGENT MOA
Depolarizing agents cause brief twitches or fasciculations, followed by flaccid paralysis - Paralysis is due to depolarization of the nerve terminal, and the nerve being in a refractory state, because the membrane is depolarized; In a refractory state = cannot receive another impulse ex: Succinylcholine (Anectine)
52
SUCCINYLCHOLINE (ANECTINE)
- causes depolarization at the motor endplate - in contrast to ACh, succinylcholine SLOWLY dissociates from the ACh receptors, resulting in an inactive state. as it dissociates, the effects wear off - broken down by Butyrylcholinesterase to Choline + Succinylmonocholine - Succinylcholine is often the agent of choice when rapid control of the airway is necessary - rapid onset (< 1 minute) & short duration (6 - 10 minutes) - the go to paralytic for rapid sequence intubation
53
SUCCINYLCHOLINE is broken down by
butyrylcholinesterase into choline + succinylmonocholine
54
go to paralytic for rapid sequence intubation
succinylcholine because of rapid onset (< 1 minute) and short duration (6-10 minutes)
55
DISADVANTAGES TO SUCCINYLCHOLINE
⦁ cardiac dysrhythmias ⦁ sinus bradycardia ⦁ myalgias (muscle pain = common complaint) ⦁ myoglobinuria ⦁ hyperkalemia ⦁ patient restrictions (ex: children) ⦁ masseter spasm = one of the first signs of malignant hyperthermia ⦁ malignant hyperthermia trigger ⦁ possible increases in intraocular, gastric and intracranial pressures ⦁ dependent upon normal butyrylcholinesterase (breaks down succinylcholine) ⦁ can have inappropriately prolonged response to medication with certain genotype (heterozygous or homozygous atypical)
56
non-depolarizing NMBD best clinical marker of strength
sustained head-lift
57
non-reversible NMBDs
- reversible competition between drug & ACh binding site - no fasciculations (unlike succinylcholine - depolarizing) - nerve stimulation exhibits a fade in train-of-four or tetany - best clinical marker of strength = sustained head-lift
58
long acting non-depolarizing NMBD intermediate acting short acting
Pancuronium Vecuronium, Rocuronium, Cisatracurium Mivacurium shortest onset, shortest duration = rocuronium longer onset, longest duration = pancuronium longest onset, shortest duration = cisatracurium
59
which non-depolarizing NMBD has vagolytic side effects
PANCURONIUM Vecuronium, Rocuronium, Cisatracurium = no SE
60
metabolism of 4 non-depolarizing NMBD
pancuronium = renal rocuronium & vecuronium = hepatic cisatracurium = other...spontaneously degenerates
61
TRAIN OF FOUR (non-depolarizing NMBDs)
⦁ When 4 twitches are seen, 0-75% of the receptors are blocked. ⦁ When 3 twitches are seen, at least 75% of the receptors are blocked. ⦁ When 2 twitches are seen, 80% of the receptors are blocked. ⦁ When 1 twitch is seen, 90% of the receptors are blocked. ⦁ When no twitches are seen, 100% of receptors are blocked.
62
reverses vecuronium & rocuronium
Sugammadex
63
REVERSAL OF NMBDs
- Acetylcholinesterase Inhibitors* ⦁ Neostigmine, Edrophonium = result in the accumulation of ACh at NMJ ⦁ Sugammadex = no anticholinergic effects like the 2 above...reverses Vecuronium and Rocuronium
64
MALIGNANT HYPERTHEMIA
- An uncommon and sometimes life-threatening reaction to some anesthetic agents - autosomal dominant condition of skeletal muscle; disruption of intracellular calcium metabolism - the build up of calcium causes violent sustained muscle contraction & rigidity, heat production, acidosis, muscle necrosis & rhabdomyolysis (myoglobinuria) TRIGGERS = Inhaled halogenated anesthetic agents & Succinylcholine - quick rise in CO2 (hypercarbia) - masseter muscle rigidity - increase in body temp (1-2 degrees q5 minutes) - tachycardia - cyanosis - muscle rigidity - compartment syndrome - rhabdomyolysis - Hyperkalemia TREATMENT = IV Dantrolene - rapid IV push - can give oral dantrolene for 1-2 days prior to surgery, and up to 3 days after for prophylaxis - cooling blankets - Mannitol or Sodium Bicarb for renal support - Treat Hyperkalemia & Compartment Syndrome

SURGERY EXAM II (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions