general anesthetics

Question 1

what is general anesthesia

Answer 1

medication induced unconsciousness with loss of protective reflexes

Question 2

what are the goals of general anesthesia

Answer 2

• amnesia: memory loss
• analgesia: absence of pain
• hypnosis: unconsciousness
• immobility: muscle relaxation

Question 3

what is balanced anesthesia

Answer 3

using several drugs to reach the anesthetic goal

Question 4

what are the three phases of general anesthesia

Answer 4

1. induction
2. maintenance
3. emergence

Question 5

describe induction

Answer 5

patient becomes unconscious
- inhaled or IV anesthetics
- pt may have received benzos preop

Question 6

describe maintenance

Answer 6

during procedure
- continuous inhaled or IV anesthetic
- may receive anti-emetics, opioids, or neuromuscular blocking agents

Question 7

describe emergence

Answer 7

procedure ends
- meds wear off or reversal agents given

Question 8

what are the five classess for balanced anesthesia

Answer 8

1. benzos: amnesia (midazolam)
2. analgesics: pain relief (opioids like fentanyl)
3. inhaled anesthetics: hypnosis (isoflurane)
4. IV anesthetics: hypnosis (propofol)
5. neuromuscular blocking agents: muscle relaxation (vecuronium)

Question 9

give an example of an inhaled anesthetic

Answer 9

isoflurane

Question 10

describe the action of isoflurane

Answer 10

diffuses from the lungs, effecting neurotransmitters systemically

Question 11

what is isoflurane used for

Answer 11

induction or maintenance of anesthesia
- amnesia
- muscle relaxation
- hypnosis

Question 12

what are some adverse effects of isoflurane

Answer 12

• CV and resp depression
• airway irritation
• malignant hyperthermia (tachycardia, body rigidity, increased temp, sweating, hyperkalemia, renal failure)
• antidote is dantrolene

Question 13

whats a cotraindication of isoflurane

Answer 13

hx/family gx of malignant hyperthermia

Question 14

what are some nursing considerations for isoflurane

Answer 14

• monitor BP and resp status closely - depression may last 30mins
• have dantrolene available if needed

Question 15

give and example of an IV anesthetic

Answer 15

propofol

Question 16

describe the action of propofol

Answer 16

causes depression of the CNS, blocks perception of pain

Question 17

whats propofol used for

Answer 17

• rapid induction of anesthesia (<1min)
• amnesia
• euphoria
• hypnosis
• 10min recovery time
• can be used in mechanical ventilation (gtt)

Question 18

whats an adverse effect of propofol

Answer 18

pain and burning at IV site

Question 19

what are some contraindications of propofol

Answer 19

allergies to soy, eggs, or preservatives

Question 20

what are some nursing considerations for propofol

Answer 20

• nurse may be managing drip in ICU
• can be given IVP for procedures
• have airway equipment nearby
• rapid onset (<1min)
• short duration (10mins)

Question 21

name some neuromuscular blocking agents

Answer 21

vercuronium, succinylcholine

Question 22

describe the action of neuromuscular blocking agents

Answer 22

suspends nerve impulses, leading to paralysis

Question 23

what are neuromuscular blocking agents used for

Answer 23

anesthetic paralysis
- muscle relaxation
- intubation and mechanical ventilation

Question 24

whats an adverse effect of neuromuscular blocking agents

Answer 24

allergic reactions

Question 25

whats a contraindication of neuromuscular blocking agents

Answer 25

allergy

Question 26

what are some nursing considerations for neuromuscular blocking agents

Answer 26

- maintenance of airway and ventilation - can be given as drip or IVP - onset 3-5minutes - action 25-40mins - risk for return of weakness after presumed recovery - monitor closely

Question 27

describe benzos

Answer 27

example: midazolam - produces amnesia - reduces anxiety - sedation - high doses can cause hypnosis monitor for resp depression

Question 28

whats the antidote for benzos

Answer 28

flumazenil

Question 29

describe analgesics used in anesthesia

Answer 29

example: fentanyl - produce analgesia - 100x stronger than morphine monitor for resp depression

Question 30

whats the antidote for fentanyl

Answer 30

naloxone

Question 31

the nurse is circulating in the OR, the nurse anesthetist declares a malignant hyperthermia emergency! which of the following symptoms indicate malignant hyperthermia? 1. muscle rigidity 2. bradycardia 3. hypokalemia 4. increased urine output

Answer 31

1. muscle rigidity *this is a genetic disorder, the symptoms are tachycardia, body rigidity, increased body temp, sweating, hyperkalemia, and renal failure*

Question 32

a patient is admitted for a routine colonoscopy. propofol is th drug of choice for sedation. which of the food allergies should the nurse report? 1. strawberries 2. peanuts 3. shrimp 4. eggs

Answer 32

4. eggs *propofol has many allergens in it. patient with allergies to soy, eggs, or preservatives should avoid this med*