Pharmacology Anasthetics Flashcards by Nolan Christopher

What is the goal of anesthesia

The absence of all perceived sensations. Usually used for major surgeries with minimal harm to patient

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What was used in the past before anesthesia

Blunt blows to the head to knock them out, strangulation, alcohol, physical restraint

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When was anesthesia introduced

1846

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What was the first anesthesia and who discovered it

Ether was the first, but it was rather toxic. It was first used by a dentist

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What makes the ideal general aesthetic (5)

Want a rapid onset and recovery 
Want them unconscious 
Want skeletal muscle to relax 
Don't want them to recall procedure 
Minimal adverse effects

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What are the stages of anesthesia

1) Analgesia
2) Excitement
3) Surgical anesthesia
4) Medullary Paralysis

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What is the desired level of anesthesia

Third stage surgical anesthesia. Want to get them here quick but not long enough to enter Medullary paralysis

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What are the two types of anesthetics

Inhaled and intravenous (IV)

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What are some inhalation agents for anesthesia

Halogenated liquids

Nitrous Oxide

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What are some intravenous agents for anesthesia

Barbiturates
Benzodiazepines
Opioids

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What is the traditional method of using anesthesia

First use intravenous to get them to stage 3 fast and then use inhalation for the remainder of the procedure.

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What is the mechanism for anesthetics

Increase inhibition or decrease excitement throughout CNS by direct effect on libido bilayer, protein ion channels, or a combination of both

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How do anesthetics effect the lipid bilayer

Embeds within the bilayer and effects the opening and closing of the bilayer.

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Neuromuscular Juncture blockers

Used to block the excitability of the skeletal muscles. Can be either de-polarizing or non-depolarizing based on patients needs

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Drawbacks of NMJ blockers

Some patients don’t have the enzymes that are used to digest the drug. If this is the case it could stay in their system until the drug is excreted.

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Why must you take anesthetics with NMJ blockers

The NMJ blockers alone won’t block pain only spasms. The anesthesia is to assure no pain is felt

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What is dissociative anesthesia

Patient is under anesthesia but it seems like they are conscious. Could even be talking, but will be unaware of what is going on

When would you use dissociated anesthesia

If vomiting is an issue
Diagnostic/radiologic readings
Dressing changes
Emergency surgeries

When to use general anesthesia

Burn Debridement
Dressing changes
Surgery

What are some rehab concerns with general anesthetics

Redistribution where drug is absorbed in fat tissue and released later.
Hallucination effects
Cognition effects that could have a gradual onset lasting months. (personality)

What are local anesthetics

Different set of drugs that are administered at the site of the problem

Goal of local anesthesia

Interrupt the nerve conduction at the site of application

What is the purpose of local anesthesia

To prevent or release pain without the loss of conciousness

What are the typical local anesthetics

-caine drugs.

Idocaine, profane, bupivicane

What is the mechanism of local anesthetics

It is like a key in a lock. It will lock the doorway of Na | Channels so Na can't get into the membrane. No Na= no action potential

Administration methods of anesthetics

Topical Transdermal Infiltration Peripheral Nerve Block

What is the infiltration administration method

Inject the anesthesia near the wound and let it filtrate in to decrease pain

What is the nerve block method of anesthesia

Injected close to the plexus and it will dull the pain felt from the nerve

Compare and contrast spinal and epidural blocks

Epidural is administered outside of the Dura mater. Spinal is injected into the subarachnoid space. This will have stronger effect Both are effective at treating pain below the level of the spinal leision/injury

Explain the sympathetic block and what it is used for

Injected around sympathetic chain ganglia to decrees the excessive activation of the sympathetic nerve. Common in treating RSD or complex regional pain syndrome

What is the intravenous regional or Beir block

Local anesthetic injected and then tourniquet placed proximal to injection site to keep drug localized for about an hour

What is the Beir block used for

Complex regional pain syndrome, RSD, overactive empathetic ganglion

What is a continuous nerve block

Small catheter is placed near the peripheral nerve and local anesthesia is dripped onto nerve

What is the continuous nerve block often used for

Post op pain control

What are some precautions with the continuous nerve block

Will not feel the extremity No pain feedback Need to be careful with PROM because they have no pain feedback

When using a continuous nerve block on a TKR when would we have them weight bear

Needs to be able to actively contract the quads, should wear a brace.

What is the differential nerve block

Will not effect all fibers. Effects small fibers first and then the larger fibers

What is the order of nerve fibers from smallest to largest

``` Pain, Temp, Touch, Proprioception, Motor ```

What is LAST

Local anesthetic systemic toxicity

What are the sx of LAST

Tinnitus, Agitation/Seizures, Decreased sensation, Depression

What is associated with cardiotoxicity

Change in HR ECG abnormalities Depression/dizzyness Cardiac arrest