Inhaled Anesthetics

Question 1

What is the role of lidocaine in inducing anesthesia.

Answer 1

• suppresses airway reflexes to prevent coughing during laryngoscopy
• reduces airway responsiveness to noxious stimuli
  - reduces airway responsiveness to drugs that cause bronchospasm
• minimizes pain caused by IV induction agents
• supplements sedation and reduces dose requirement of IV induction agent

Question 2

What is the dose of lidocaine for inducing anesthesia

Answer 2

• For suppressing airway reflexes
  - 0.5 — 1.5 mg/kg
• For older adults >71 yo
  - 0.5 — 1 mg/kg
• For the reduction of pain on injection of other agents
  - 20 — 30 mg total

Question 3

What are the potential side effects lidocaine for induction

Answer 3

• mild increases in airway tone
• increases ventricular rate in patients with A fib
• avoid in patients with high grade heart block

Question 4

What are the roles of opioids in inducing anesthesia

Answer 4

• suppresses airway reflexes to prevent coughing or bronchospasm during laryngoscopy and intubation
• attenuates stress response to prevent tachycardia and hypertension during laryngoscopy and intubation
• minimizes pain caused by IV injection of induction agent
  -supplements sedation and reduces dose requirement of IV induction agents

Question 5

What are the potential adverse effects of opioids for induction

Answer 5

• dose dependent respiratory depression
  - possible apnea
• pruritus
• postoperative nausea and vomiting

Question 6

What are the doses of opioids for induction of anesthesia

Answer 6

• Fentanyl
  - 25 — 100 mcg
  - 0.5 — 1 mcg/kg
  - administered in divided doses
• Sufentanil
  - 0.05 — 0.1 mcg/kg in divided doses
• Reduce doses in older pts above 70yrs

Question 7

What is the role of midazolam prior to induction of anesthesia

Answer 7

• reduces anxiety
• produces amnesia
• supplements sedation and reduces dose of required IV induction agents
• anticonvulsants

Question 8

What is the dose of midazolam given in preop

Answer 8

• 1 — 2 mg administered in 1mg increments
• older adults >70yrs 0.5mg increments up to 2mg

Question 9

What are the adverse side effects of versed prior to intubation

Answer 9

• mild systemic vasodilation and increased cardiac output
  - may cause severe hypotension in hemodynamically unstable patients
• dose dependent respiratory depression