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Peds III > General anesthesia > Flashcards

General anesthesia Flashcards

1
Q

Define general anesthesia (2)

A
  • Controlled unconsciousness

- loss of protective reflexes

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2
Q

Define unconsciousness (3)

A

amnesia, analgesia and hypnosis

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3
Q

Define protective reflexes (3)

A
  • Capacity to keep airways permeable

- respond to stimuli and verbal orders

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4
Q

General anesthesia: Paracelsus? (2)

A

(XVI century)—ether

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5
Q

General anesthesia: Priestley?

A

(1172)—-nitrous oxide

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6
Q

1st general anesthesia? (5)

A

19th century

  • Ethyl chloride, ethylene, propilene
  • Chloroform
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7
Q

Effects of general anesthesia? (4)

A
  • Analgesia
  • Amnesia
  • Reflex inhibition
  • Absence of skeletal muscles tone
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8
Q

Drugs used for general anesthesia must be…(5)

A
  • Of reversible action
  • Of foreseeable action
  • Of controlled action
  • High therapeutic coefficient
  • Have minimal secondary effects
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9
Q

Which ASAs can be treated with general anesthesia?

A

ASA I - healthy

ASA II - mild systemic disease

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10
Q

Which ASAs can not be treated with general anesthesia?

A

ASA III - severe systemic disease

and up should be treated at the hospital

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11
Q

The patient selection for general anesthesia must be based on 3 factors:

A
  • Child’s capacity to collaborate
  • Pathology that must be treated
  • Age/weight
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12
Q

General anesthesia indications? (8)

A
  • small child with a lot of pathology
  • physically and mentally disabled
  • patients with severe systemic diseases
  • cerebral palsy, down syndrome, severe mentally disabled
  • patients with phobia to the dentist
  • ineffectiveness of the local anesthesia
  • big orofacial traumas and oral surgry
  • protection against psychological alterations
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13
Q

General anesthesia indications: small child with a lot of pathology? (2)

A
  • Big destructions, baby bottle tooth decay

* Evaluate if we can wait

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14
Q

General anesthesia indications: Physically and mentally disabled? (3)

A
  • Paraplegia, scoliosis, tetraplegia, spina bifida
  • Some airways problems
  • Some cases of blindness, deafness
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15
Q

General anesthesia indications: With severe systemic diseases (8)

A
  • Kidney diseases
  • Blood dyscrasias, severe coagulopathies
  • Convulsive disorders
  • Inmunodepressed and transplanted patients
  • Oncologic patients
  • Patients that have been hospitalized for a long time
  • Severe infections
  • With craneofacial alterations
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16
Q

General anesthesia indications: Cerebral palsy, Down syndrome, severe
mentally disabled

A

Those patients that are unable to maintain a minimum of voluntary immobility

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17
Q

General anesthesia indications: Patients with phobia to the dentist

A

Those that even with strong premedication or

inhaled sedation can´t control their behavior

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18
Q

General anesthesia indications: Ineffectiveness of the local anesthesia

A

Due to systemic or metabolic alterations

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19
Q

General anesthesia indications: Big orofacial traumas and oral surgery

A

Oral surgery procedures that other way would be

very unpleasant

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20
Q

General anesthesia indications: Protection against psychological alterations

A

Patients with psychosis, schizophrenia,…

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21
Q

General anesthesia counter indications (4)

A
  1. Family history of malignant hypertension
  2. Severe renal or hepatic failure that can´t be
    controlled
  3. Pulmonary edema
  4. Full stomach (no eating or drinking 6 hours before)
22
Q

Advantages of general anesthesia?

A

It enables us to achieve a good quality in our treatments

23
Q

Disadvantages of general anesthesia? (4)

A
  1. Hospitalization as a frequent cause of anxiety: Studies demonstrate that
    children that have been hospitalized may present some kind of behavior
    alteration after the hospitalization
  2. Fear or phobia to the general anesthesia: Accidents in the past
  3. Treatment limitations: The treatments must be done in one session, great
    reconstructions are not recommended, do less conservative treatments
  4. Increase in the treatment cost
24
Q

General anesthesia: Order of the treatment plan? (3)

A
  1. Pulp treatment
  2. Fillings
  3. Teeth extractions
25
Q

General anesthesia: We avoid the normal order of the treatment plan in these cases: (3)

A
  • Complex pulp treatments
  • Crowns
  • Space maintainers
26
Q

What does the preoperative protocol for general anesthesia consist of? (5)

A
  1. Medical chart, intraoral exam, x-rays
  2. Informed consent of the pediatrician
  3. Instructions to parents
  4. Hospital admission
  5. Informed consent for the procedure
27
Q

Preoperative protocol general anesthesia: informed consent of the pediatricion consists of ? (2)

A

• Lab tests: ECG, blood clotting tests, blood
count, urine, torax X-ray
• Report from the specialist if the patient has an
ASA classification higher than II

28
Q

What are the 2 anesthesia guidelines?

A
  1. Patient guideline

2. Selection of the anesthesia

29
Q

What are the 2 anesthesia guidelines/ decisions that need to be made?

A
  1. Patient guideline

2. Selection of the anesthesia

30
Q

General anesthesia: Patient guideline? (2)

A

• To check the medical chart: Medical history, actual
pathology, medication
• Evaluate the ASA level of the patient

31
Q

General anesthesia: Selection of the anesthesia technique? (3)

A
  • With intubation or without it
  • At the hospital or not
  • Prescribe premedication if necessary
32
Q

Operating room protocol? (4)

A
  • Sterile environment
  • Intravenous via in the patient’s arm
  • Monitoring: Heart activity and oxygen saturation
  • Perfect pharynx packing with a damp gauze
33
Q

What are the 4 stages of anesthesia?

A
  1. Premedication (preanesthesia room)
  2. Induction
  3. Anesthesia/ventilation
  4. Maintenance/awakening
34
Q

Where does the premedication stage of anesthesia occur and with who?

A
  • Preanesthesia room

- The child is with their parents

35
Q

What occurs during the premedication stage of anesthesia? (3)

A
  • Goal: diminish anxiety levels
  • Given intranasally: Midazolam (sedative), Atrpine (anticholinergic)
  • Optionally: benzodiazepine can be given the night before
36
Q

What occurs during the induction stage of anesthesia? (3)

A

• Intravenous via: It is the most used in children. It has an hypnotic (propofol) and an opiate (fentanyl)

• Inhalation: With an halogenated anesthesia
(sevoflurane)

• A muscle relaxant is given to facilitate the
nasotracheal intubation: Rocuronium (Esmerón)

37
Q

Anesthesia induction: drug Intravenously? (2)

A
  • Propofol (hypnotic)

- Fentanyl (opiate)

38
Q

Anesthesia induction: inhaled drugs?

A

Sevoflurane (halogenated anesthesia)

39
Q

Anesthesia induction: muscle relaxant drugs?

A

Esmeron (Rocuronium)

40
Q

What drugs are administered during anesthesia/ventillation stage of anesthesia? (5)

A

Inhalation: Applied with a face mask

  • Sevoflurane ***
  • Desflurane (not in children. Very irritating)

Intravenous:
• Barbituates (pentathol)
• Benzodiazepines (midazolam)
• Hypnotics (propofol)

41
Q

Anesthesia /ventillation stage: inhaled drugs? (2)

A
  • Sevoflurane ***

* Desflurane (not in children. Very irritating)

42
Q

Anesthesia /ventillation stage: intravenous drugs? (3)

A
  • Barbituates (pentathol)
  • Benzodiazepines (midazolam)
  • Hypnotics (propofol)
43
Q

During nesthesia /ventillation stage it is necessary to…? How do we do this? (3)

A

Maintain breathing with mechanic ventilation with insufflation of O2

  • with nasotracheal intubation
  • larynx intubation
44
Q

During anesthesia it is necessary to monitor the patient using… (3)

A
  • pulse oximeter
  • oscilloscope
  • sphygmomanometer
45
Q

What is a pulse oximeter?

A

It determines the saturation of O2 of the hemoglobin in the arterial blood

46
Q

What is a oscilloscope?

A

Complete monitorization of the

heart rate

47
Q

What is a sphygmomanomter?

A

it determines the blood

pressure

48
Q

Once the child is asleep and prepared, it is essential to

use: (3)

A
  • Mouthblocks
  • Posterior packing (gauze, larynx mask)
  • Complete dental equipment
49
Q

What drugs are used during the maintenance phase? (4)

A

• Strong analgesic (fentanile)
• Muscle relaxant (rocuronium)
• Intravenous hypnotic (Propofol) or inhaled anesthesic
(sevoflurane)

50
Q

What happens during the awakening phase?

A

Reverse of the anesthesia, elimination of the anesthesia gases (10 minutes)

51
Q

How long is the awakening stage?

A

10 mins

52
Q

When is the patient dischraged after general anesthesia?

A

that same day or the day after

Peds III (9 decks)

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