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Pain Control Final > Lecture Notes - HIGHLIGHTS > Flashcards

Lecture Notes - HIGHLIGHTS Flashcards

1
Q

what are the 4 desirable attributes of an anesthetic?

A

· lack of toxicity
· non-flammable
· non-addictive
· minimal allergenicity

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2
Q

what does “balanced anesthesia” mean?

A

This a concept in which combinations of drugs are used to produce general anesthesia, with each drug chosen for a specific effect.

In this context, the following drugs might be selected: nitrous oxide for its analgesic and anesthetic actions, a benzodiazepine for amnesia, a neuromuscular blocking drug for muscle relaxation, and an opioid for additional analgesia and hemodynamic stability.

Lecture: piecing together the desirable attributes of different drugs

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3
Q

what are the 4 components of “balanced anesthesia”?

A

· analgesia - no pain
· amnesia - no memory
· relaxation and immobility
· loss of consciousness (hypnosis)

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4
Q

what are the 7 desirable attributes of N2O

A 
· analgesic
· anxiolytic
· relative amnestic
· rapid onset
· titration possible
· rapid cognitive recovery
· minimal side effects
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5
Q

define moderate sedation

A

minimally depressed level of consciousness that retains the patient’s ability to maintain an airway independently and continuously and respond appropriately to physical stimulation or verbal command

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6
Q

define deep sedation

A

depressed consciousness accompanied by partial loss of protective reflexes, including the inability to maintain an airway contiuously and independently and or respond purposefully to physical stimulation and verbal command

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7
Q

define general anesthesia

A

unconsciousness accompanied by partial or complete loss of protective reflexes, including the inability to maintain an airway continuously and independently and respond purposefully to physical stimulation or verbal command

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8
Q

what are the 4 stages of anesthesia as classified by Guedel?

A

· stage I - analgesia
· stage II - delerium/excitment
· stage III - surgical anesthesia
· stage IV - respiratory paralysis

MUST KNOW THESE!

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9
Q

what characterizes stage I as classified by Guedel?

A

· ANALGESIA
· this stage starts with the administration of anesthesia and ends with the loss of consciousness
· the patient unresponsive to mild pain provoking stimuli and is able to respond to verbal commands
· this is where moderate sedation occurs in this stage (i.e. N2O)

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10
Q

what characterizes stage II as classified by Guedel?

A

· DELIRIUM/EXCITEMENT
· patients are hyperresponsive
· uncontrolled movements
· retching (sound/movements of vomiting, heaving, almost vomiting)
· laryngospasm can occur
· it is desirable to bypass this stage rapidly

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11
Q

what characterizes stage III as classified by Guedel?

A

· SURGICAL ANESTHESIA
· this is the stage where you can actually preform surgical procedures
· pupil diameter
· loss of reflexes
· muscle relaxation
· depth/regularity of respirations
· separation of the thoracic and abdominal (diaphragmatic) phases of respiration

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12
Q

what characterizes stage IV as classified by Guedel?

A

· RESPIRATORY PARALYSIS
· this stage begins with the disappearance of the purely diaphragmatic respiration and ends with complete respiratory collapse
· use of ventilator and monitoring of positive pressure is required

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13
Q

average minute ventilation

A

6-7 L/min

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14
Q

why is minute ventilation important?

A

· Lecture: If you think about N2O, it affects the amount you will give the patient, if you cranked the flow rate up to say 20 L/min you are giving the patient more gas then they can actually take in.

· Text: Minute ventilation is significant in terms of N2O administration, because it considers the amount of gas mixture (N2O/O2) that should be given to a patient. Inadequate amounts are likely to produce a suffocating feeling and make the act of breathing laborious. Conversely, too much gas forced into the nasal hood of the delivery system will cause some to be wasted. The gas will escape, because it is not being consumed by the patient. This excess airflow not only blows into the patient’s eyes, causing dryness, but also exposes personnel to unnecessary amounts of trace gas.

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15
Q

how is alveolar ventilation different then minute ventilation?

A

Text: Alveolar ventilation is the amount of air per minute entering the alveolar units capable of gas-blood exchange. This volume is less than the minute volume, because not all of the inspired air reaches the alveoli during inspiration. A portion of the inhaled air occupies the conducting airways and does not enter the lungs and, therefore, is not utilized by the exhaust system. Hence, this air is not able to participate in the gas-blood exchange. This is known as anatomic dead space. Therefore, alveolar ventilation is calculated by subtracting the dead space volume (approximately 150ml) from the tidal volume and then multiplying by the respiration rate.

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16
Q

gas exchange of nitrous oxide

A
  • N2O is NOT dissolved in the blood

- this allows for quick equilibrium in the blood and brain

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17
Q

diffusion hypoxia

A
  • likely cause of post operative headache, nausea, and lethargy
  • treated with post operative 100% O2 for 3-5 minutes
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18
Q

is the oxygen tank gauge an accurate?

A

yes, the oxygen tank gauge is rarely accurate

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19
Q

is the N2O tank gauge accurate?

A
  • NO
  • Text: Because the liquid is vaporized as the gas is used, this reading is not proportional to the actual amount of gas available in the cylinder. Therefore, the gauge will show a pressure decrease when the tank contains approximately 20% N2O. The drop in the dial on the N2O tank is not proportional to the contents of the tank as with O2. Figure 6-7 illustrates pressure gauge readings for full and empty N2O and O2 cylinders.
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20
Q

second gas effect

A

· with high concentrations N2O causing rapid uptake there is a simultaneous effect of increasing uptake of a second gas
· this second gas uptake occurs FASTER than it normally would
· web resource: The “second gas effect” says that large volume intake of one gas enhances the intake of a second gas
IMPORTANT CONCEPT TO UNDERSRAND

21
Q

minimum alveolar concentration (MAC)

A

· amount of drug necessary to prevent movement in 50% of individuals with surgical stimulation

· text: the alveolar concentration of anesthetic at which 50% of patients do not respond to a standard surgical stimulus. MAC is used for quantifying the relative potencies of inhalation anesthetics.

22
Q

what is the MAC value for N2O and what does it mean?

A

· 104%
· it takes a higher concentration then we even provide (70% is the highest dose to which we titrate) for 50% of patient to not respond to a surgical stimulus
· it is the LEAST POTENT of all anesthetic gasses

23
Q

what receptor does N2O act on?

A

the opioid receptor

24
Q

t/f N2O is metabolized in the liver

A
  • false (0.004% is metabolized in the GI tract)
25
Q

where is N2O eliminated?

A

the lungs (recovery in 3-5 minutes)

26
Q

why is N2O so used so frequently?

A
  • it relieves anxiety
  • it reduces intra-operative awareness
  • it provides a SYNERGISTIC effect with sedative and hypnotic agents, thereby REDUCING the DOSE the primary anesthetic agents required (second gas effect)
  • has ANALGESIC effects which seem to be related to activation of OPIOID receptors in the PERIAQUEDUCTAL gray matter and NORADRENERGIC neurons in the LOCUS CERULEUS
27
Q

what agencies regulate N2O?

A

DOT - hazardous transport

FDA - drug status

28
Q

what color are the N2O tanks?

A

blue

29
Q

what color are the O2 tanks?

A

green

30
Q

what prevents the inadvertent attachment of N2O cylinder to O2 yoke site?

A

pin index safety system

31
Q

what prevents the inadvertent attachment of N2O hose to O2 outlet?

A

diameter index safety system

32
Q

what provides automatic termination of N2O flow if O2 supply is inadequate or depleted?

A

O2 failsafe mechanism

33
Q

what provides rapid delivery of 100% O2 when needed?

A

O2 flush valve

34
Q

t/f N2O will suppress the respiratory rate?

A

false

35
Q

what is the primary organ system affected by N2O?

A

CNS (however its affect is less than other inhaled anesthetics)

36
Q

chronic exposure of N2O leads to what type of changes to the hematopoietic system?

A

megaloblastic bone marrow changes

37
Q

patients with what vitamin deficiency should use N2O with caution?

A

vitamin B12 deficiency

38
Q

t/f patients with malignant hyperthermia can use N2O safely

A

true

39
Q

N2O use is contraindicated for patients on what cancer drug because it can increase pulmonary fibrosis?

A

bleomycin sulfate

40
Q

what trimester of pregnancy should N2O be avoided?

A

first trimester

41
Q

N2O absolute contraindications

A
  • pneumothorax
  • cystic fibrosis
  • chronic obstructive pulmonary disease
  • recent pneumoencephalography
  • pernicious anemia or vitamin B12 deficiency
  • significant bowel obstruction
  • first trimester of pregnancy
  • cancer therapy using bleomycin sulfate
  • psychological impairment
  • current psychotropic drug use
  • current or recovering drug use/addiction
  • patient in shock, semi-conscious or with serious head/facial injuries
  • inability to understand procedure or unwilling to consent to procedure
42
Q

N2O relative contraindications

A
  • current upper respiratory tract infection
  • middle ear disturbance/surgery (e.g., grafting)
  • recent eye surgery using perfluoropropane or sulfur hexafluoride
43
Q

N2O appropriate sedation symptoms

A
  • light headedness
  • tingling hands/feet
  • wave of warmth
  • numbness hands/feet
  • euphoria
  • feeling of lightness/heaviness of extremities
  • analgesia
44
Q

N2O appropriate sedations signs

A
  • BP / heart rate – initial rise from baseline
  • respirations – normal / smooth
  • peripheral vasodilation
  • flushing
  • decreased muscle tone
45
Q

N2O mild oversedation symptoms

A
  • Hearing more acute
  • Confused visual images
  • Sleepiness
  • Laughing / Crying
  • Dreaming
  • Nausea
46
Q

N2O mild oversedation signs

A
  • Movement
  • Heart rate
  • Blood pressure
  • Sweating
  • Lacrimation
47
Q

N2O profound oversedation symptoms

A 
· Spontaneous mouth breathing
· Persistent closing of mouth
· Complaints of:
- Nausea
- Uneasiness
- Too intense an experience
48
Q

N2O profound oversedation signs

A
  • Failure to respond rationally
  • Sleepiness / dreaminess
  • Incoherent speech
  • Uncooperative
  • Laughing / crying / giddy
  • Uncoordinated movements
49
Q

diffusion hypoxia

A
  • Capillarly tension quickly rises to that above alveolar pressure
  • N2O is quickly forced into the alveoli & exhaled through the lungs
  • N2O exits faster than the N2 that replaces it, diluting the supply of O2
  • O2 blood saturation (SaO2) is reduced

Pain Control Final (2 decks)

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