Pharmacology Anasthetics Flashcards
What is the goal of anesthesia
The absence of all perceived sensations. Usually used for major surgeries with minimal harm to patient
What was used in the past before anesthesia
Blunt blows to the head to knock them out, strangulation, alcohol, physical restraint
When was anesthesia introduced
1846
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
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
What are the stages of anesthesia
1) Analgesia
2) Excitement
3) Surgical anesthesia
4) Medullary Paralysis
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
What are the two types of anesthetics
Inhaled and intravenous (IV)
What are some inhalation agents for anesthesia
Halogenated liquids
Nitrous Oxide
What are some intravenous agents for anesthesia
Barbiturates
Benzodiazepines
Opioids
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.
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
How do anesthetics effect the lipid bilayer
Embeds within the bilayer and effects the opening and closing of the bilayer.
Neuromuscular Juncture blockers
Used to block the excitability of the skeletal muscles. Can be either de-polarizing or non-depolarizing based on patients needs
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.
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
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
