Pre-Operative Drugs Flashcards
what is the definition of general anesthesia
reversible depression of the CNS with drugs that produce unconsciousness
what is the ideal anesthetic technique
balanced/multimodal
what is the objective of multimodal anesthetic technique
uses less of each drug than if each drug were administered alone, and therefore reduces the likelihood of side effects and increases the likelihood of desired effects
what are the 3 goals of pre-medication
1) sedation/anxyolisis
2) muscle relaxation
3) analgesia
one goal of premedication is to provide _________ analgesia
preventative
T/F premedication makes it easier to monitor and pre-oxygenate patients before induction
T
what is the definition of preventative analgesia
block nociceptive input using several analgesic agents, acting on different sites, starting before surgery and continuing for several hours or days following surgery
what are 5 advantages of preventative analgesia
1) decreases peripheral inflammation
2) reduces anesthetic needed during surgery
3) reduces pain signalling reaching the CNS during surgery
4) less analgesia needed post-op
5) rapid hospital discharge
what anesthetic causes dose dependent hypotension and respiratory depression
propofol and alfaxalone
what anesthetic causes dose dependent hypotension and vasodilation
inhalants
heavy sedation protocols carry heavier risk of: (3)
- cardiovascular side effects
- respiratory depression
- airway obstruction
what is the ideal pre-anesthetic protocol flow (6)
sedation/anxyolisis, analgesia and muscle relaxation -> opioid, anesthetic agent, sedative
Opioids:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?
analgesia: +++
anxiolysis: -
sedation: +
reversible: yes (naloxone)
reduces anesthetic requirements: +++
Acepromazine:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?
- analgesia: -
- anxiolysis: ++
- sedation: ++
- reversible?: no
- reduces anesthetic requirements?: ++
A2 agonists:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?
- analgesia: +
- anxiolysis: -
- sedation: +++
- reversible? yes (yohimbine, atipamezole)
- reduces anesthetic requirements?: +++
benzodiazepines:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?
- analgesia: -
- anxiolysis: +
- sedation: +/-
- reversible? yes
- reduces anesthetic requirements? +
ketamine:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?
- analgesia: ++
- anxiolysis: -
- sedation: +++
- reversible? no
- reduces anesthetic requirements? +++
alfaxalone:
- analgesia
- anxiolysis
- sedation
- reversible?
- reduces anesthetic requirements?
- analgesia: -
- anxiolysis: -
- sedation: +++
- reversible? no
- reduces anesthetic requirements? +++
what is a neuroleptic combination
combining a sedative and an opioid
what is the goal of neuroleptic combination
achieve desired degree of analgesia, sedation, anxiolysis, and immobilization while decreasing doses and therefore side effects
for neuroleptic combinations, you want to combine drugs with what action
synergistic action
what are 4 general considerations when choosing a protocol
1) ASA status of patient, age and any diseases present
2) degree of sedation needed
3) degree of analgesia needed
4) onset and length of effects needed (dose and route of administration)
T/F drugs and doses need to be tailored to the individual patient
T
for what type of patients would you use mild sedation and give some examples of mild sedatives
- very friendly, sick, or debilitated patients
- benzodiazepines, low acepromazine, opioids
for what type of patients would you use heavy sedation and what are some examples of heavy sedatives
- aggressive or healthy patients
- ketamine, alpha-2 agonists, high doses of acepromazine
which opioid would you choose for the following:
- diagnostics (non-invasive)
- minor procedures
- surgery or already painful condition
diagnostics (non-invasive): partial μ agonists/antagonsists, ex. buprenorphine or butorphanol
minor procedures: partial or full μ agonist
surgery or already painful condition: full μ agonist: morphine, fentanyl, hydromorphone
T/F you can use an opioid alone
T
what are the advantages of using an opioid alone
- less cardiorespiratory depression, more sedation in sick patients
when using opioids alone, they cause more sedation in ______ patients but mild sedation in _______ patients
sick; healthy
which sedative would you choose for the following:
- mild sedation
- moderate sedation
- profound sedation
- mild sedation: benzodiazepines, opioids, low dose acepromazine
- moderate sedation: acepromazine, low dose α2, alfaxalone
- profound sedation: α2, ketamine
T/F you can use a sedative alone
F
what are the 4 levels to the sedation score
1) no sedation
2) mild sedation (quiet but still alert and active)
3) moderate sedation (quiet, reluctant to move, slightly ataxic)
4) profound sedation (flat, unable to walk)
