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Pharmacology > Part 4 - Anesthesia > Flashcards

Part 4 - Anesthesia Flashcards

1
Q

Types of Anesthesia

A

General Anesthetics

Local Anesthetics

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2
Q

General Anesthesia Goal

A

Absence of all perceived sensations

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3
Q

General Anesthesia Purpose

A

Allow detailed surgical procedures, etc with minimal harm to patient

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4
Q

General Anesthesia Requirements

A 
Loss of consciousness; perceived sensations
Amnesia
Inhibition of reflexes
Skeletal Muscle Relaxation
Safe, transient, predictable
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5
Q

Stages of General Anesthesia

A
  1. Analgesia
  2. Excitement/delirium
  3. Surgical Anesthesia
  4. Medullary paralysis
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6
Q

Types of general anesthetics

A

Inhalation agents

IV agents

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7
Q

Inhalation agents

A

Halogenated liquids
Nitrous Oxide
Other gases

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8
Q

IV agents

A

Barbiturates
Benzodiazepines
Opioids

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9
Q

Choice of anesthetic

A

Often use 2 or more agents to provide balanced anesthesia

Traditionally injected followed by inhaled

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10
Q

General Anesthetic MOA

A

Increase inhibition or decrease excitation throughout the CNS by:

  • Direct effect on lipid bilayer
  • Direct effect on neuronal receptors
  • Combination of lipid and receptor effect
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11
Q

Anesthetic Adjuvants

A

Given with or before anesthesia

  • Relax and sedate patient prior to sx
  • Reduce post-op nausea and vomiting
  • Reduce other problems related to anesthesia
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12
Q

Neuromuscular Junction Blockers

A

Used to paralyze skeletal muscle to facilitate positioning on table, prevent spasms, allow easier mechanical ventilation

  • Depolarizing blocker: doesn’t let ACh receptor recover
  • Nondepolarizing blocker: Don’t let ACh bind
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13
Q

NMJ Blockers effects

A

Short duration of action
Some patients may lack metabolizing enzymes; pt remains paralyzed at end of sx
Effects can be reverse by cholinesterase inhibitors or inactivating drugs
These drugs don’t cause anesthesia, so anesthesia could wear off

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14
Q

Dissociative Anesthesia

A

Patient may remain conscious but indifferent to surrounding
Achieved by use of ketamine or combination of antipsychotic with opioid
Useful in diagnostic/radiologic procedures, dressing changes, emergency surgeries

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15
Q

General Anesthetic Rehabilitation concerns

A 
Use in burn debridement, dressing changes
Dealing with residual effects
-Respiratory hygiene
-Short-term confusion, lethargy
-Possible long term effects on cognition
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16
Q

Local Anesthesia Goal

A

Interrupt nerve conduction at site of application

17
Q

Local Anesthesia Purpose

A

Prevent or relieve pain without LOC or systemic effects

18
Q

Typical local anesthetics

A

“-caine”; lidocaine, procaine, bupivacaine

19
Q

Local Anesthetics MOA

A

Bind to sodium channels in nerve membrane

Inactivate Na channel; prevent action potential conduction

20
Q

Clinical Use and Administration

A 
Topical
Transdermal
Infiltration
Nerve Block
Spinal Block
Sympathetic Block
Intravenous regional anesthesia
21
Q

Topical Administration

A

Applied to surface of skin
Pain, relief, minor burns, abrasions
Also used prior to injections, IV insertion
Use in spasticity?

22
Q

Transdermal Administration

A

Movement through skin by electricity or ultrasound

Also use patches

23
Q

Infiltration

A

Injecting drug subcutaneously
Allowed to penetrate selected area
Commonly used before suturing wound

24
Q

Peripheral Nerve Block

A

Injected close to nerve or nerve plexus

Commonly used for dental procedures, other minor surgeries

25
Q

Spinal/Epidural Block

A

Epidural: Administration outside of dura
Spinal: Administration into subarachnoid space

26
Q

Sympathetic Block

A

Drug injected around sympathetic chain ganglia

27
Q

Intravenous Regional Anesthesia (Bier Block)

A

Local anesthesia injected into venous system
Tourniquet placed proximally
Used for some surgical procedures or to treat CRPS/RSDS

28
Q

Continuous Nerve Block

A

Small catheter implanted near peripheral nerve to a specific region
Local Anesthetic dripped slowly onto nerve
Excellent post op pain control

29
Q

Differential Nerve Block

A

Smallest, unmyelinated fibers affected first

Largest myelinated fibers affected last

30
Q

Differential Nerve Block order of functional loss

A
  1. Pain
  2. Temperature
  3. Touch
  4. Proprioceptive
  5. Motor
31
Q

Local anesthetics implications for rehab

A

Transdermal application especially

Be aware for possible absorption into systemic circulation

32
Q

Local Anesthetic Systemic Toxicity CNS effects

A

Tinnitus
Agitation, restlessness, seizures
Decreased sensation in tongue and mouth
Later stages lead to CNS depression

33
Q

LAST Cardiotoxicity

A

Changes in heart rate (Bradycardia)
Other ECG abnormalities
Clinical signs of cardiac depression
Cardiac arrest

Pharmacology (15 decks)

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