Nitrous

Question 1

Analgesia

Answer 1

A neurologic or pharmacologic state in which painful stimuli are moderated

Question 2

Anesthesia

Answer 2

Loss of sensation resulting from pharmacologic depression of nerve function or from neurologic dysfunction

Question 3

Anxiolysis

Answer 3

reduction of fear or apprehension

Question 4

Minimal sedation

Answer 4

• Retains pts ability to independently and continously maintain an airway and
• Respond normally to tactile stimulation and verbal command
• Ventilatory and cardiovascular functions are unaffected

Question 5

Minimal sedation Appropriate initial dosing

Answer 5

• Initial dosing of a single enteral drug is no more than the max recommended dose (MRD) of a drug that can be prescribed for unmonitored home use

Question 6

Minimal Sedation Drugs

Answer 6

• Short procedure 1-2hrs
  
  • Triazolam 0.25mg
• Int procedure 1/2 day
  
  • Apprazolam 0.5 mg
• Long full day
  
  • Lorazepam 2mg

Question 7

NO2 and sedative agents

Answer 7

• NO2 when used with a sedative agent may produce
  
  • Minimal, moderate, deep sedation
  • General anesthesia

Question 8

Incremental Dosing

Answer 8

Administration of multiple doses of a drug to achieve a desired, but not to exceed MRD

Question 9

Supplemental Dosing

Answer 9

• During min sedation supp dosing is a single additional dose of the initial dose of the initial drug that may be necessary for prolonged procedures
• The supp dose should not exceed 1/2 of the inital dose
• Should not be administered until the dr has determined the clinical half-life of the intial dose has passed
• Total aggregate dose must not exceed 1.5 X the MRD on the day of treatment

Question 10

Moserate Sedation

Answer 10

• Patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation
• No interventions are required to maintain an airway
• Spontaneous ventilation is adequate

Question 11

Titration

Answer 11

• Titration- incremental doses of a drug until desired affect is achieved
• Titration applies to moderate sedation or greater
• One must know whether the previous dose has taken full effect before administering an additional drug increment

Question 12

Deep Sedation

Answer 12

• Patients cannot be easily aroused by respond purposefully following repeated or painful stimulation
• Ability to independently maintain ventilatory function may be impaired

Question 13

General Anesthesia

Answer 13

• Patients are not arousable, even by painful stimulation
• Ability to maintain ventilatory function and cardiovascular function is often impaired

Question 14

Stages of General Anesthesia 4 stages

Answer 14

• Analgesia
  
  • drowsiness to loss of eyelash reflex
• Excitment
  
  • Agitation and delerium
• Surgical
  
  • Subdivided into 4 planes based on eye movements and status of respiratory musculature
• Medullary depression
  
  • Depression of vasomotor and respiratory centers leading to coma and death

Question 15

4 Planes of Surgical Anesthesia

Answer 15

• Plane I
  
  • rollinf eyes, plane ends when eyes become fixed
• Plane II
  
  • Loss of corneal and laryngeal reflexes
• Plane III
  
  • Pupil starts dilating and light reflex is lost
• Plane IV
  
  • Intercostal paralysis, shallow abdominal respiration, dilated pupil

Question 16

Enteral

Answer 16

• Agent is absorbed theough the
  
  • GI tract
  • Oral Mucosa ( oral, rectal, sublingual)

Question 17

Parenteral

Answer 17

• Drug bypasses the GI tract
• Intramuscular
• Intravenous
• Intranasal
• Submucosal
• Subcutaneous
• Intraosseous

Question 18

Transdermal

Answer 18

Drug is administered by patch or ionotophoresis through the skin

Question 19

Inhalation

Answer 19

Primary effect is due to absorption thru the gas/blood interface

Question 20

Sedatives and Anxiolytics 3

and effects

Answer 20

• Benzodiazepines (best) (anticonvulsant amnesia)
• Barbiturates (Anticonvulsant)
• Antihistamines (Antiemetic)
• All produce
  
  • Primary effect follows a dose response
  • Respiratory depression
  • Dependence
  • Paradoxical excitation

Question 21

Metabolism of Triazolam and half-life

Answer 21

• A benzodiazepine short half life of 2-4 hrs
• Metabolized via hepatic microsomal oxidation or glucorondidation
• Any patient with a compromised liver will have a longer half-life of the drug

Question 22

Patient Assesment for minimal sedation

Answer 22

• Healthy ASA I ASA II
  
  • review of med hx and medications
• ASA III ASA IV
  
  • Consultation with primary physician or med specialist

Question 23

Pre-op Preparation

Baseline vital signs to be obtained 6

Answer 23

• General activity level
• Respiration
• BP
• Pulse
• Mental status and alertness
• Room air oxygen saturation

Question 24

ASA Classifications

Answer 24

• ASA I - Healthy
• ASA II
  
  • Mild systemic disease, no functional limitation
• ASA III
  
  • Severe systemic disease, definite functional limitation
• ASA IV
  
  • Severe systemic disease that is constant threat
• ASA V
  
  • Unlikely to survive 24 hrs

Question 25

Mallampati Classification

Answer 25

• Class I
  
  • Full visibility of tonsils, uvula, SP
• Class II
  
  • Visibility of hard and soft palate
  • Upper portion of tonsils and uvula
• Class III
  
  • SP, HP, and base of uvula are visible
• Class IV
  
  • Only HP

Question 26

Reversal agent for Triazolam

Answer 26

Flumazenil