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Anesthesia > Lessons 1 & 2 > Flashcards

Lessons 1 & 2 Flashcards

1
Q

True/False

Antecubital Veins are NOT usable for perioperative IV during prone spine surgery

A

True

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2
Q

Biggest “con” for antecubital IV

A

They can “infiltrate” like any other IV, but (unlike other IVs) the infiltration may be hard to detect (even more so on very muscular or obese patients)

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3
Q

What size IV for massive transfusion?

A

Two 16G IVs

If you want to look up the “Poiseuille relationship” go crazy

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4
Q

True/False

You CANNOT induce with a 22G IV

A

False

22G is fine to induce, but you will need a bigger IV after

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5
Q

4 Goals/A’s of General Anesthesia

A
  • Amnesia (w/ LOC)
  • Analgesia
  • Akinesia (skeletal muscle relaxation)
  • Autonomic and sensory reflex blockade
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6
Q

Define General Anesthesia

A

A state of reversible coma intentionally induced by drugs in which the patient is not arousable even with painful stimuli

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7
Q

Define Balanced Anesthesia

A

General anesthesia with several agents

(can be a mixture of inhalational and IV medications)

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8
Q

Define Regional Anesthesia

A

Use of local anesthetics (sometimes with other additives) applied to an anatomically-familiar nerve root(s) or peripheral nerve, to numb a particular region of the body

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9
Q

Define Combined Technique

A

Regional Anesthesia + General Anesthesia

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10
Q

What is Monitored Anesthetic Care?

A

Sedation provided by an Anesthesiologist or CRNA

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11
Q

ASA I

A

No medical problems

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12
Q

ASA II

A

One or more systemic diseases under good control

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13
Q

ASA III

A

One or more systemic diseases which are not in perfect control or limit function to some extent

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14
Q

ASA IV

A

A systemic condition which is a constant threat to life

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15
Q

ASA V

A

Expected to die within a day, surgery is a desperation measure

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16
Q

ASA VI

A

Dead patient (organ harvesting)

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17
Q

ASA E

A

E = emergency

(can be added to any ASA status)

18
Q

Types of IV Anesthetics

A
  1. Sedative-hypnotics (barbiturates, etomidate, propofol, benzodiazepines)
  2. Opioids
  3. Dissociative anesthetics (ketamine)
19
Q

Thiopental

A

Barbiturate

Crosses BBB rapidly

Short acting even though elimination half life is several hours

20
Q

Difference between barbiturate and benzodiazepine in terms of mechanism of action?

A

Barb = prolonged Cl channel opening (potentiates GABA)

BZ = increased frequency of Cl channel opening (potentiates GABA)

21
Q

What is Etomidate?

A

Carboxylated imidazole (simply put = GABA potentiator)

Pro: Minimal CV effects

Con: Potential adrenocortical suppression

22
Q

Onset of action for Etomidate

A

Onset: 30-60 seconds

Peak effect: 1 min

Duration: 3-5 min

Metabolized by hepatic and plasma esterases to inactive product

23
Q

Why is propofol a popular induction agent?

A

Compared to thiopental, propofol has:

  • Antiemetic and antiepileptic activity
  • Associated w/ faster and more complete awakening
  • Easier to store in anesthesia carts
  • Cheap
  • Treats alcohol detox
  • Does not “mask pain”
24
Q

When is propofol contraindicated?

A

History of:

  1. Propofol infusion syndrome (PRIS)
  2. Pancreatitis from hypertriglyceridemia
  3. HFrEF (or concern for “soft pressures”)
25
Q

Propofol’s mechanism of action

A
  • Decreases dissociation of GABA from the receptor (increasing duration)
  • At supraclinical concentrations, it may directly activate the receptor’s chloride channel
  • Very similar to Etomidate in terms of MOA*
26
Q

Most popular benzodiazepine in anesthesia

A

Midazolam (primarily used as an anxiolytic or for amnestic effect)

Short half-life, water soluble (not painful on injection), coverts to highly lipid soluble form in blood pH

27
Q

Prototype Opioid Agent

A

Morphine

Synthetic agents = fentanyl, sufentanil, remifentanil

28
Q

Fentanyl vs Morphine

A

Fentanyl is:

  • 100x more potent
  • More liphophilic (crosses BBB faster)
  • Unlikely to cause hypotension, even with rapid administration of a relatively large dose*

*Morphine can cause hypotension via the release of histamine (especially with rapid administration)

29
Q

Side effect unique to fentanyl

A

Chest wall rigidity (especially when given as a rapid bolus)

30
Q

How if Fentanyl excreted?

A

Oxidized by hepatic microsomal cytochrome P450 into norfentanyl, an inactive metabolite that is then renally excreted

31
Q

What are the volatile liquids?

A

Halothane

Isoflurane

Desflurane

Sevoflurane

32
Q

Ideal Anesthetic Gas

A

Low blood solubility (i.e., faster onset)

Minimal metabolism

Compatible w/ Epi

Not irritating to the airway

No myocardial depression

33
Q

Blood Solubility

A

AKA partition coefficient

The distribution ration between 2 phases at equilibrium

Blood is an inactive reservoir (high blood solubility = decreased speed of onset)

34
Q

Blood Solubility for Inhalational Anesthetics (from fastest time of onset to slowest)

A

Des (0.42) > N2O (0.47) > Sevo (0.69) > Iso (1.4) > Hal (2.5)

“Do Not Shit In Here”

35
Q

Define MAC

A

The steady state concentration of an inhalational agent that maintains immobility in 50% of subjects exposed to a noxious stimulus

36
Q

True/False

MAC values are additive

A

True

Ex: 1 MAC of Iso + 0.5 MAC N2O = 1.5 MAC

37
Q

MAC 0.25

MAC 0.5

MAC 1

MAC 1.5

MAC 2

A
  1. 25 = 50% experience anterograde amnesia
  2. 5 = 50% unconscious

1 = 50% will not move at incision

1.5 = 95% will not move at incision

2 (aka MAC-BAR) = 50% blocked autonomic reflexes at incision

38
Q

Which Inhalational Agent is used for induction?

A

Sevo

The other agents cause airway irritation and bronchospasm

39
Q

Stages of Anesthesia

A

Stage 1: Analgesia

Stage 2: Excitement (Delirium)

Stage 3: Surgical Anesthesia

Stage 4: Medullary Depression

40
Q

How does cardiac output affect the speed of induction?

A

Increased CO = decreased rate of rise of arterial anestheic gas = slower induction

Low CO = faster induction

41
Q

Rare, inherited, potentially lethal syndrome almost exclusive to anesthesiology

A

Malignant Hyperthermia

Due to mutations in the ryanodine receptor 1 gene

Hypermetabolic state, Marked CO2 production, Altered skeletal muscle tone, Mixed respiratory & metabolic acidosis

Anesthesia (7 decks)

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