General Local & Regional anesthesia Flashcards
What are the behavioral states that occur under general anesthesia?
1- unconsciousness 2- amnesia 3- analgesia 4- akinesia 5- hemodynamic stability
What are the stages of general anesthesia?
1- analgesia or disorientation
2- excitement or delirium
3- surgical anesthesia
4- stoppage of respiration till death
What should be given during the induction of general anesthesia?
IV anesthesia
gas
analgesia
muscle relaxant
What should be given to maintain general anesthesia?
inhalation + TIVA (total intravenous anesthesia)
What should be done for emergence from general anesthesia?
- reverse anesthesia
- reverse muscle relaxant
- KEEP analgesic
What are the used hypnotics in GA?
propofol
ketamine
etomidate
What are the used analgesics for GA?
morphine
fentanyl
pethidine
What are the used muscle relaxants for GA?
succinylcholine
rocuronium
atracurium
What are the ASA standard monitors?
ECG
Pulse oximetry
blood pressure
capnographhy & temperature after sleep
What are the advanced monitoring systems?
DEPTH OF ANESTHESIA
- MAC: minimum alveolar concentration (0.7)
measured by gas analyzer
- EEG: BISPECTRAL INDEX (BIS) processes eeg data to numbers (40-60 is appropriate for GA)
INVASIVE MONITORS
- arterial blood pressure
- central venous pressure (IJV)
- transesophageal-echocardiogram TEE
CARDIAC OUTPUT MONITORS
esophageal doppler probe
What are the benefits or a carbon dioxide absorbent (sodalime)?
- prevents CO2 rebreathing
- saves heat & humidity
- saves anesthetic gases
- decreases air pollution
What are the products of the chemical reaction caused by sodalime?
- water
- heat
- calcium carbonate
How is oxygen stored in the main storage?
Liquid oxygen that’s transferred as gas through piplines to hospital rooms
What is the function of a double lumen endotracheal tube?
one lung ventilation
What type of anesthesia is the injection of local anesthesia into CSF?
Regional spinal anesthesia
used for any surgical procedure below the umbilicus
What are the absolute contraindications for spinal anesthesia?
- patient refusal
- infection at site of injection
- uncorrected hypovolemia
- allergy
- increased intracranial pressure
what are the relative contraindications for spinal anesthesia?
- coagulopathy
- sepsis
- fixed cardiac output states
- undetermined neurological disease
What level should spinal anesthesia be injected at?
any level below the spinal cord (L1 - L2)
What are the minor complications caused by spinal anesthesia?
nausea & vomiting mild hypotension shivering itch transient mild hearing impairment urinary retention
what are the moderate complications of spinal anesthesia?
failed spinal
postdural puncture headache
what are the major complications caused by spinal anesthesia?
direct needle trauma infection vertebral canal hematoma spinal cord ischemia cauda equina syndrome arachnoiditis peripheral nerve injury total spinal anesthesia cardiovascular collapse death
where is epidural anesthesia or analgesia injected?
local anesthesia injected at any level in the epidural space
Why is epidural anesthesia & analgesia used?
- to supplement general anesthesia
- provide analgesia in the intraoperative, postoperative, peripartum, & end-of-life settings
- primary anesthetic for some surgeries
What is the function of Tuohy’s needle?
- curved tip to allow easy insertion
- doesn’t puncture dura
Nerve block is used for?
blocking a single nerve, plexus, or fascial plane
What is local infiltration?
infiltration of local anesthesia at site of incision
