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Intro to Anesthesiology > Introduction > Flashcards

Introduction Flashcards

1
Q

What is anesthesia

A

Drug induced reversible CNS depression

  • loss of response and perception of external stimuli
  • low therapeutic index
  • combines pharmacology, physiology, clin path, medicine, surgery
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2
Q

Anesthetic

A

Compound or element that by itself can produce general anesthesia
- ex: isoflurane, propofol, alfaxalone

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3
Q

Anesthesia

A

State achieved by combination of agents, none of which alone produces anesthesia
- ex: combo of alpha2-agnoist, opioid, dissociative

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4
Q

Anesthetic agents are used for

A
  • exam
  • diagnostics
  • surgery
  • seizure control
  • euthanasia
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5
Q

Anesthetic agents are administered

A
  • IV, IM, SC, IN
  • inhaled
  • topically
  • epidural
  • subarachnoid
  • infiltration
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6
Q

Inhaled anesthetics

A
  • volatile hydrocarbons
  • noble gases
  • carbon dioxide
  • nitrous oxide
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7
Q

Injectable anesthetics

A
  • barbiturates
  • chloral hydrate/chloralose
  • imidazoles
  • phenolics
  • steroids
  • benzodiazepines
  • cyclohexamines
  • Na+ channel blockers
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8
Q

Where do anesthetics work?

A

Subcellular target is synaptic function via ligand-gated ion channels

  • n-methyl-d-aspartate (NMDA) antagonists –> dissociatives (ketamine_
  • gamma aminoibutyric acid (GABA) agnoists –> inhalants
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9
Q

_______ is primary site where anesthetics act to inhibit purposeful responses

A

Spinal cord

- brainstem, cerebral cortex involved in conscious perception and memroy

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10
Q

What are the 4 components of general anesthesia

A
  • amnesia
  • unconsciousness
  • immobility (dose-dependent)
  • analgesia: attenuation of autonomic responses to noxious stimuli
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11
Q

Unresponsiveness _____ unconsciousness

A

Does NOT equal to!!

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12
Q

Consciousness

A

Subjective experience

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13
Q

Connectedness

A

Awareness of the environment

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14
Q

Responsiveness

A

Spontaneous or goal-directed movement

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15
Q

____ likely depends on integrity of the corticothalamic networks

A

Consciousness

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16
Q

Spontaneous _______ may depend on subcortical and spinal cord networks

A

Responsiveness

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17
Q

______ may depend on continued information integration in corticothalamic circuits and unperturbed norepinephrinergic signaling

A

Connectedness

18
Q

What takes the highest anesthetic concentration to block?

A

Blocked autonomic response

19
Q

Loss of righting reflex associated with onset of unconsciousness is _____

A

Drug dependent

- memory and awareness ablated at anesthetic concentration <50% of that needed to abolish movement

20
Q

Anesthetized animals may move in response to ______

A

Noxious stimuli

  • unconscious animals can produce complex movements at the level of the brainstem or spinal cord
  • connection to cerebral cortex not required
21
Q

Pain

A

Unpleasant sensory and emotional experience associated with actual or potential tissue injury

  • conscious awreness of nociception
  • response to nociception
22
Q

Nociception

A

Activation of nociceptors by noxious stimulus

23
Q

Analgesia is absence of _____

A

Pain

- pain is a conscious experience

24
Q

Anesthetized patients ____ experience pain

A

Do Not

  • may respond physiologically, autonomically and reflexively to noxious stimuli
  • supplemental analgesia useful to reduce anesthetic requirement, improve comfort at recovery
25
Q

Analgesia

A
  • conscious: reduced pain perception

- unconscious: reduced autonomic response to nociception

26
Q

Preventive analgesia

A

Use analgesic drugs and techniques before, during, and after pain begins
- prevents plastic wind up of pain pathways

27
Q

Anesthetic care plan

A

Meets unique medical needs of the individual patient

  • consists of patient evaluation and patient preparation
  • informed anesthetic choices
28
Q

Anesthetic sequence of events

A
  • preanesthetic evaluation, preparation, medication
  • anesthetic induction
  • maintenance of anesthesia
  • recovery phase (24 hr following awakening)
29
Q

50% of anesthetic deaths occur ______

A

Post-op

30
Q

Patient evaluation

A
  • positive patient identification
  • history
  • physical exam findings
  • lab data
31
Q

Lab tests should be chosen based on ________

A

Physical exam and history

- extensive non-directed pre-anesthetic lab screening does not improve patient outcome!!

32
Q

ASA status assignment

A
  • class 1: no systemic dz
  • class 2: mild compensated systemic dz
  • class 3: serious systemic dz, stable vital signs
  • class 4: serious systemic dz, decompensated
  • class 5: moribund, requires intensive life support
33
Q

Why hospitalize patient overnight?

A
  • acclimatize to clinic
  • time for evaluation
  • time for stabilization, if needed
34
Q

Fasting

A

May decrease aspiration risk

  • improves abdominal access
  • may improve ventilatory function
  • species differences
  • not recommended in young patients
35
Q

Monogastrics vs ruminants

A
  • monogastrics: water access up to time of premedication

- ruminants: usually recommended (associated with increased parasympathetic tone)

36
Q

Patient stabilization

A

Very important!

  • provide analgesia
  • treat blood, fluid, or electrolyte deficits ahead of time
  • decreases anesthetic risk
37
Q

Equipment

A
  • venous catheterization
  • fluid therapy
  • patient monitoring
  • materials for treatment of anticipated complications (anesthetic and surgical)
  • induction and maintenance
38
Q

Awake EEG

A
  • low voltage ampllitude

- many high frequency components (fast) –> desenchronized

39
Q

Deep anesthesia EEG

A
  • higher voltage
  • slow oscillations
  • synchronized, dose dependent
40
Q

EEG does not determine _______

A

Onset of consciousness

  • limited ability to indicate presence or absense of unconsciousness around the transition point
  • unclear which patterns are indicators of activation by stress or pain
41
Q

Wakefulness

A

State of being awake

  • implies brain physiological state that differs from that found with sleep or anesthesia
  • does not by itself signify presence of consciousness

Intro to Anesthesiology (10 decks)

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