HIGH YIELD Flashcards
Define General Anesthesia?
Chemically induced coma including: o Analgesia - (pain relief) o Amnesia - (memory loss) o Unconscious o No sensory or autonomic reflexes o Skeletal muscle Relaxation
What are some Regional anesthesia types?
Topical anesthesia, infiltration blocks, field blocks, spinal & epidural blocks.
A regional anesthetic block with IV sedation is termed what?
MAC (see below for more info) – 3 drug cocktail
How would you classify a ______ with the American society of anesthesiologists surgical risk classification?
healthy patient
pt with mild systemic disease
pt with severe systemic
disease that limits activity
pt with incapacitating systemic disease that is a constant threat to life
morbid patient not expected to live 24 hours with or without surgery
class 1
class 2
class 3
class 4
class 5
Explain what occurs in the 4 stages of analgesia.
stage 1, stage of analgesia
stage 2, stage of excitement, keep it short
stage 3, stage of surgical anesthesia (4 planes)
stage 4, stage of medullary depression, pt needs full respiratory support
What is an epidural?
Spinal nerves blocked as needle is passed between vertebral spines and local anesthetic is deposited.
Sensory block only!
No post spinal headache.
What is the main difference between Epidurals vs. Spinal blocks in terms of what they block?
Epidurals = sensory block only
Spinal = Sensory, Motor & Autonomic block.
Why would you give a delivering mother an epidural and NOT a spinal block?
So they can still push!! They just need pain relief.
T/F There will be no post spinal headache with epidurals.
True - if they do, you went to far….
Define Spinal Anesthesia.
Local anesthesia is placed in the subarachnoid space via puncturing the dura and arachnoid in the lumbar area.
Provides a sensory, motor, & autonomic block.
Side effect = Headache, palsies, cauda equina syndrome.
What should you make sure your spinal anesthetic patient can do prior to discharge from surgery?
VOID – you want to make sure they have regained nerve control and can do #1 & #2.
Describe a Bier Block?
Bier block anesthesia is an intravenous regional anesthesia technique in which an extremity is made numb for surgery by injecting a local anesthetic solution into a vein after the blood has been squeezed out of the extremity and a tourniquet has been placed on it.
Local anesthetics are weak _____. What is the result when injected into acidic (infected) areas?
Bases; Results in decreased penetration into nerve membrane and decreased potency.
Explain the differences in Lidocaine & Marcaine.
Lidocaine will diffuse very well into the surrounding tissues. Marcaine will not - must be more accurate in placement.
How do local anesthetics work?
They prevent Na+ migration through the nerve membrane thus preventing depolarization of nerve.
What is the effect on Local anesthetics if it is injected in an area of infection?
Decreased penetration into nerve membrane and decreased potency.
where are Esters hydrolyzed? Amides hydrolyzed? Is there cross sensitivity between them?
Esters = In BLOOD
Amides In LIVER
No cross sensitivity
What Amide should not be used in renal patients?
Mepivacaine should not be used in renal pts.
What Amide is most cardiotoxic, should not be used in kids under 12, and has longer onset & DOA than lidocaine?
Bupivacain (Marcaine)
Which Amide is the fastest acting? Shortest Duration?
Lidocaine is both!
Which of the following is true about EPI?
A potent vasoconstrictor
Gives anesthetics a longer duration of action
Increases the toxic threshold
Should NOT be used in the digits for digital blocks. (according to Dr. Campbell)
note: all are true!
What is MAC?
3 drug cocktail that produces period of SLEEP, AMNESIA, & MILD ANESTHESIA. Then local block is done are surgical area.
Midazolam (Versed) & Fentanyl are given prior to going to OR. Then once ready, the patient gets Propofol (Dipravan), causing them to
fall asleep. Then they get local block. Patient is conscious enough to inform DR if they need more drugs.
Midazolam & Propofol create amnesia. (Fentanyl is an opioid, so it won’t produce amnesia!)
