Local and General Anesthetics Flashcards
Name 3 types of regional anesthesia.
1) Spinal
2) Epidural
3) Nerve blocks
Define general anesthesia.
Global, but reversible state of depressed central nervous system function
What are the characteristics of general anesthesia (5)?
1) Amnesia
2) Analgesia
3) Immobility in response to a surgical incision
4) Control of unwanted autonomic reflexes
5) Unconsciousness
What are the major steps in conducting general anesthesia?
1) Induction (usually with IV drugs)
2) Maintenance and monitoring (usually with inhalational agents: “Gases”)
3) Supplement inhalational anesthetics with IV opioids and sedatives
4) Emergence
5) Postoperative pain management
What are the major issues associated with general anesthesia?
1) Emergence delirium
2) Nausea and Vomiting
3) Awareness under anesthesia
Define pain.
Subjective appreciation of actual or potential tissue damage
- unconscious patients cannot have “pain” by this definition, they can have “reflexes”
What are the steps to cardiac resuscitation during local anesthesia?
1) Immediate hyperventilation
2) Immediate chest compression
3) Acidosis and hypoxia make resuscitation difficult
4) Lipid Rescue Therapy
- lots of local anesthetics are lipid soluble
What is the most important factor in obtaining nerve blockade?
Applying the local anesthetic close to a nerve is the most important factor in obtaining nerve blockade
What toxicity is associated with local anesthesia?
1) Systemic toxicity is related to blood level
2) Central nervous system presents first
3) Cardiovascular manifestations occur with higher levels
How is CNS toxicity treated?
- Maintain airway and oxygenation
- If BP is normal, midazolam (or other anti-seizure medication)
Name 5 IV anesthetic agents.
1) Propofol
2) Ketamine
3) Midazolam
4) Etomidate
5) Remifentanil
What are the advantages of propofol?
1) Antiemetic
2) More rapid and complete recovery
3) Euphoria
What is the mechanism of action of propofol?
Propofol potentiates GABAa receptor activity, thereby slowing the channel-closing time and also acting as a sodium channel blocker
