Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Basics of Anesthesia > Postop Pain > Flashcards

Postop Pain Flashcards

1
Q

What are the three groups of peripheral nerve afferent fibers?

A

Class A (alpha, beta, gamma, delta)
Class B
Class C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Class A Peripheral Nerve Fibers (3)

A
  1. large, myelinated
  2. low threshold for activation
  3. 1-20 um in diameter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A-Delta speed

A

5 - 25 m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A-Alpha & A-Beta Speed

A

60 - 120 m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A-Gamma

A

15 - 35 m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does class A-Delta mediate?

A

pain sensation; transmits fast or first pain

-sharp, stinging, pricking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does class A-Alpha mediate?

A

motor & proprioceptive impulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does class A-Beta mediate?

A

cutaneous touch & pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does class A-Gamma mediate?

A

cutaneous touch & pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Class B Peripheral Nerve Fibers (4)

A

medium sized & myelinated
speed 3 - 14 m/s
diameter < 3 um
postganglionic sympathetic & visceral afferents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Threshold for Nerve Fibers

A

class a < class b < class c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Speed for Nerve Fibers

A

class a > class b > class c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Size for Nerve Fibers

A

a > b > c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Class C peripheral Nerve Fibers

A

myelinated or unmyelinated
speed = 0.5 - 2 m/s
diameter 0.4 - 1.2 um
preganglionic autonomic fibers & pain fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of pain does Class C transmit

A

slow or second pain
burning, persistent, aching, throbbing
duration exceeds stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What fiber carries visceral pain?

A

Class C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the major NT & receptor in Class C Fibers?

A

Substance P –> NK-1 on postsynaptic membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the major NT & receptor in A-Delta Fibers?

A

Glutamate –> NMDA & AMPA on postsynaptic membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A-Delta Fibers

A

myelinated
1 - 4 um
first or fast pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What fiber carries parietal peritoneum?

A

A-Delta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What tract modulates pain

A

Descending Dorsolateral Spinal Tract

@SC in dorsal horn or @ brainstem & midbrain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name inhibitory NT (7)

A 
AMPA
NMDA
Enkephalin
NE
GABA
GAMMA
opioid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name substances released after cells are damaged

A 
bradykinin
cations (protons, potassium ions)
free radicals (nitric oxide)
histamine
prostaglandins, leukotrienes
ATP
serotoinin
tachykinins (NK-a, Substance P)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Discuss pain pathway

A

Stimulus –> (C&A delta fibers) Dorsal root ganglion –> dorsal horn
crosses
brainstem –> midbrain –> thalamus

limbic, cingulate, somatosensory cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Pain pathway is called…

A

spinothalamic tract

26
Q

What tract modulates pain?

A

descending dorsolateral spinal tract

27
Q

Where do IV opioids primarily act?

A

limbic
hypothalamus
thalamus

SUPRASPINAL ANALGESIA- MU 1

28
Q

Other than supraspinally, where do opioids act at?

A

periventricular/periaqauductal gray

SPINAL ANALGESIA- MU2

29
Q

Spinal anesthesia

A

neuraxial opioids work at same receptor site as enkephalin

MOA: decrease substance P by binding to Mu-2

30
Q

Surgical stress response - cardiac (5)

A
  1. HTN & tachycardia
  2. enhanced myocardial irritability
  3. increased SVR (AT2)
  4. CO increases
  5. MVO2 increases
31
Q

Surgical stress response - respiratory (4)

A
  1. increase in O2 consumption & CO2 production increasing minute ventilation
  2. wob increases
  3. pain decreases chest expansion
  4. skeletal muscle tension increases - v/q mismatch
32
Q

Surgical stress response - endocrine (3)

A
  1. hyperglycemia
  2. vasoconstriction, contractility, tachycardia (d/t increased cortisol)
  3. salt & water retention (aldosterone and adh)
33
Q

Surgical stress response - GI (2)

A
  1. increased sphincter tone, decreased sm. muscle tone = ileus = PONV
  2. decreased oral intake –> septic complications, ulcers, abdominal distention
34
Q

Immune & Hematology complications from surgical stress

A

leukocytosis w/lympopenia, depression of reticuloendothelial system (infection risk)

increased plt adhesiveness diminished fibrinolysis

35
Q

Anesthetic influence on surgical stress response

A

GA does not attenuate it

Regional does decrease catecholamine and other stress hormone responses

36
Q

Highest POP scores

A

ortho/trauma

37
Q

Top 25 highest POP scores (4)

A

appendectomy, cholecystectomy, hemorrhoidectomy, tonsillectomy

38
Q

opioid induced hyperalgesia

A

diminished pain threshold & enhanced pain sensitivity

  1. enhanced NT release
  2. sensitization
  3. upregulation of spinal & supraspinal pathways
39
Q

main NT in hyperalgesia

A

glutamate (activation of NMDA receptor)

40
Q

How do you target hyperalgesia?

A

alpha 2: clonidine
NMDA: ketamine
COX2: METHADONE

41
Q

what pt are at risk of se from opioids

A

osa, elderly, chronic pain

42
Q

drugs that act central, spinal, & peripherally

A

clonidine, dexmedetomidine
ketamine
lidocaine

43
Q

drugs that act centrally and spinally

A

gabapentin, magnesium

44
Q

where does decadron act

A

peripherally

45
Q

nsaids adr

A

GI bleeding, ARF, hepatotoxicity

46
Q

nsaids c.i

A

hypersensitivity, renal problems, pud

caution w/elderly

47
Q

ketamine

A

0.5 mg/kg bolus

4 mcg/kg/m infusion

48
Q

methadone

A

d-isomer nmda antagonist

0.2 mg/kg

49
Q

gabapentin

A

anticonvulsant that blocks VG ca ch inhibiting glutamate

  • manages spontaneous firing of sensory neurons associated w/neuropathic pain
  • reduces incidence of chronic postop pain

600 mg q8h or 1200 mg IV
2h onset

50
Q

dexmedetomidine

A

0.5 - 1 mcg/kg bolus over 15m
0.2 - 0.7 mcg/kg/h
onset: 5m
DOA: 203h
CYP450
hypotension bradycardia risk
decreased PONV and opioid consumption

51
Q

acetaminophen

A

pre-emptive 15mg/kg

52
Q

magnesium

A

1-2 g/h or 30-50 mg/kg bolus

blocks VG Ca Ch, blocks NMDA
hypotension, bradycardia
prolongs nmbd

53
Q

regional anesthesia advantage vs disadvantage

A

eliminate need for IV pain meds, earlier d/c

block failure, bleeding, neuro injury

54
Q

neuraxial opioid adr

A

itching
nausea/urinary retention
sedation
cns excitation

55
Q

hydrophilic opioids

A

slow onset, prolonged duration

56
Q

hydrophilic opioids intrathecal

A

late respiratory depression (6-12h) rostral

minimal systemic circulation uptake

57
Q

hydrophilic opioids epidural

A

early respiratory depression (2h) may occur

late respiratory depression d/t rostral spread in CSF

58
Q

lipophilic opioids

A

rapid onset, short duration

59
Q

lipophilic opioids intrathecal

A

early respiratory depression d/t systemic uptake

60
Q

lipophilic opioids epidural

A

early respiratory depression d/t systemic uptake more pronounced

Basics of Anesthesia (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions