Lecture Anesthesia and Headaches Flashcards
Types of headaches
sinus
pain is usually behind the forehead and/or cheekbones
Cluster
pain is in and around one eye; often a series of headaches
Tension
pain is like a band squeezing the head
Migraine
pain, nausea, and visual changes are typical of classic form; unilateral
2 types: w aura and without aura (more common)
Migraine triggers:
A LOT!!
Emotions Foods (1) Tyramines - aged cheese, red wine (2) Nitrates - cured meats (3) Phenylethylamine – chocolate (4) monosodium glutamate (MSG) - canned soups, Chinese food (5) aspartame - diet sodas (6) yellow food coloring drugs (1) EtOH (2) Analgesics - too often / withdrawal (3) Caffeine - too much / withdrawal (4) Cimetidine (5) Cocaine (6) Estrogens - i.e. oral contraceptives (7) Nitroglycerin carbon monoxide hormonal changes flickering lights weather (1) low temp + low humidity (2) high temp + high humidity (3) major change over 1-2 days (4) high or low barometric pressure glare loud noises hypoglycemia altitude change
Prevention is recommended for patients with ___ headaches a month.
three or more
headaches are treated with:
nonspecific analgesics - ASA-like drugs, opioids
migraine-specific - triptans and ergot alkaloids
sumatriptan [Imitrex]
vasoconstriction of intravascular vessels & vascular inflammation
used to abort ongoing migraine, relieve HA & symptoms
PO or intranasal
AEs
Chest (50%) – feeling of heavy arms or chest pressure
coronary vasospasm (angina)
teratogenesis
vertigo, malaise, fatigue, tingling sensations, bad taste (intranasal)
Interactions – with Ergot alkaloids and other triptans
Ergotamine
2nd line for migraine – unresponsive to triptan
risk for dependence with regular use
Toxicity – ergotism (too much vasoconstriction)
Convulsive
S/S: N/V/D, itching, spasms, paresthesias, HA, mania, psychoses, seizure
gangrenous
excessive vasoconstriction of fingers/toes
S/S: peeling, weak peripheral pulse, loss of peripheral sensation, edema, death/loss of tissue
General anesthesia
Produce unconsciousness & lack of responsiveness to all painful stimuli
Local anesthesia
Loss of sensation to limited body area, no LOC changes
Regional anesthesia
Similar to local; Loss of sensation encompasses larger body area, such as entire limb
Monitored anesthesia care (MAC)
Responsive, respirations without assistance
3 levels
(1) Minimal sedation (anxiolysis)
Patient responds to verbal commands.
(2) Moderate (conscious) sedation
Patient responds to verbal or light tactile prompting.
Pt may not remember
(3) Deep sedation/analgesia
Patient aroused by repeated or painful stimulation
Airway, ventilation interventions
Cardiovascular functions usually adequate
Balanced anesthesia
Combination of medications
(1) Neuromuscular blockers
(2) Short-acting benzodiazepines
(3) Opioids
(4) General anesthetics
(5) Order of IV medications, then general anesthetic, then inhaled anesthetics
Anesthesia staging
Stage I
(1) Analgesia
(2) Lose sensation, but may remain awake
Stage II
(1) Excitement and hyperactivity
(2) May have irregular pulse and respirations with increased BP
Stage III
(1) Surgical anesthesia
(a) Want to get to this stage with surgical pts
(2) Skeletal muscle relaxation
Stage IV
(1) Paralysis of medulla
(2) Death could result.
(3) Too much!! Don’t want to get to this stage!
IV anesthetics
Rapid progression through stages I and II
Commonly used classes
Benzodiazepines
Opioids
Miscellaneous agents - Propofol and ketamine
The primary indication for benzodiazepine use is ___.
to treat symptoms of anxiety.
Benzodiazepines
-pam / -lam
diazepam, midazolam, lorazepam
used in anesthesia to produce relaxation, sedation, unconsciousness, and amnesia
diazepam [Valium]
IV – anesthesia induction
Unconsciousness within 1 minute
Little muscle relaxation, no analgesia**
moderate CV/Respiratory depression
midazolam [Versed]
IV – anesthesia induction, conscious sedation*
Unconsciousness within 80 seconds
sedation, analgesia, amnesia, lack of anxiety
Can cause dangerous cardiorespiratory effects
propofol [Diprivan]
most widely used IV anesthetic (90%)*
induction & maintenance of anesthesia, no analgesia
Unconsciousness in 60 sec, lasts 3-5 min
also for sedation
mechanical ventilation, radiation, procedures
Can cause 1. profound respiratory 2. depression 3. hypotension 4. ***bacterial infection (high risk)*** lipid based so ideal for bacteria; once opened, must be discarded within 6 hours
Risk for abuse
Widely used, not controlled – not monitored closely
no “high” – instant/brief sleep – awake refreshed & euphoric
Low therapeutic index – OD/death common
ketamine
dissociative anesthesia, sedation, immobility, analgesia, amnesia
Rapid action, last 10-15 min (full recovery hours)
Adverse psychologic reactions
hallucinations, disturbing dreams, delirium
(so want to provide a soothing environment for pt)
Drug of abuse – “K”, “Special K”
(a) High dose – “K-hole”, out-of-body or near-death experience
Minimum Alveolar Concentration (MAC)
measure of inhalation anesthetic potency
Concentration of drug vapor in alveoli that prevents a motor response in 50% of subjects when exposed to painful stimulus
low MAC = high potency
inhalation anesthetics
2 types
volatile liquids - fluranes
gas - nitrous oxide
what are the adverse effects of inhalation anesthetics?
Respiratory & cardiac depression (so often intubated/mechanical ventilation/ET tube)
Sensitization of heart to catecholamines (epi and norepi which cause dysrhythmias)
Aspiration of gastric contents (again ET tube!)
Malignant Hyperthermia
muscle rigidity & profound temperature elevation ( up to 109*F!)
Malignant hyperthermia
muscle rigidity & profound temperature elevation ( up to 109*F!)
also unstable BP, metabolic acidosis, cardiac dysrhythmias, and electrolyte abnormalities)
all inhalation anesthetics (except nitrous oxide)
and increased risk with succinylcholine
Treatment
- Stop succinylcholine
- COOL patient- IV cool saline and ice packs
- IV Dantrolene
succinylcholine
a neuromuscular blocking agent that is often combined with an inhalation anesthetic
the combo increases the risk for malignant hyperthermia
it reduces the amount of anesthesia needed and relaxes the skeletal muscles (including diaphragm and respiratory muscles)
to avoid systemic toxicity with local anesthetics:
(1) apply smallest amount needed
(2) avoid applying to large areas
(3) avoid applying to broken/irritated skin
(4) avoid strenuous exercise, wrapping or heating site
AE of local anesthetics include CNS excitation/depression, CV, allergic rxn, methemoglobinemia (hemoglobin can’t release O2)
What are the two major classes of local anesthetics?
Esters and Amides
Amides have a lower incidence of allergic reactions
Esters: cocaine, procaine, benzocaine, and tetracaine
Amides: lidocaine, debucaine
What are local injection anesthetics?
procain [Novocain] - ester type
lidocaine - amide type
What are topical local anesthetics?
benzocaine- ester type
lidocaine - amide type
treatment for cocaine OD
(1) IV diazepam or lorazepam,
(2) nitroprusside,
(3) sodium bicarb,
(4) ASA,
(5) external cooling
v) addiction treatment – anticocaine vaccine, disulfiram [Antabuse]
5 A’s model for treating tobacco use & dependence
(1) Ask - screen all patients for tobacco use
(2) Advise tobacco users to quit
(3) Assess willingness to make a quit attempt
(4) Assist with quitting; offer medication and provide or refer to counseling
(5) Arrange follow-up contacts beginning within the first week after the quit date
