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Anesthesia (Resp 314) > Pricniples of Anesthesia (Mod 1) > Flashcards

Pricniples of Anesthesia (Mod 1) Flashcards

1
Q

What is Anesthesia?

  • Generalized vs regional?
A

When there is a reduction and lack of perception of all sensations

  • General anethestics induce generalized, reversible depression of the CNS
  • Regional (needs fact check) usually involves complete and full depression sensation in a area
  • Anesthesia can also be described as a state of reversible loss of sensation and unconsciousness
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2
Q

What does the Anesthetic state include? (4)

  • aka what are the primary desired affects?
A
  • loss of consciousness
  • Amnesia
  • Immobility (lack of response to noxious stimuli)
  • Some analgesia
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3
Q

What are secondary desirable effects provided by anaesthetics that could be useful during Sx?

A
  • Muscle relaxation
  • Loss of autonomic reflexes
  • Analegsia
  • Anxiolysis
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4
Q

Where is generalized anaesthetics most concentrated?

A

Distribute well to all parts of the body, but most concentrated in the fatty tissue

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5
Q

Where is the primary site of action that is affected/disrupted by Anesthesia?

A

The CNS

  • Ensue from action in the brainstem, midbrain, and cerebral cortex (Suprasternal region)
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6
Q

How is immobility caused by Anesthesia?

A

Caused by depression of both the supraspinal and spinal sensory and motor pathways

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7
Q

What are the 4 stages of Anesthesia?

A
  1. Induction
  2. Maintenance
  3. Emergence
  4. Recovery
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8
Q

What is the Induction phase of Anesthesia?

A

Induction is the rapid and safe transition in states of unconsciousness

  • Time elapsed between the admin of anesthetic and the development of effective surgical anesthesia
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9
Q

What is the Maintenance phase of Anesthsia?

A

Time during which the Pt is surgically anesthetize

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10
Q

What is the Emergence phase of Anesthsia?

A

Transition from general anesthesia to consciousness

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11
Q

What is the Recovery phase of Anesthsia?

A

Time from d/c of anesthetic drugs until consciousness if fully recovered

  • when fully conscious, they’re in recovery
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12
Q

4 Stages of Anesthesia?

A
  1. Analegsia or Disorentation
  2. Excitement (hyperexcitable state)
  3. Surgical Anesthesia
  4. Medullary Depression/Overdose
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13
Q

Can stages of Anesthesia be skipped?

A

No, they need to transition from stage to stage.

  • The most dangerous stage is stage 2 (hyperexcitable state)
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14
Q

What is Stage 1 Anesthesia (Analgesia/disorientation)?

A

Period between admin of induction agent and loss of consciousness

  • Pt is sedated but conversational
  • Breathing is slow and regular
  • stage ends w/loss of consciousness
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15
Q

What is Stage 2 Anesthesia (Excitement)?

A

Short Dangerous stage, you wanna move quick in this stage. Depends on dose and admin.

  • Paradoxical excitation from loss of conscious to onset of automatic breathing
  • Uncontrolled movements; period of involuntary movements
  • Resp can be irregular w/breath holding
  • Excitement, delirium and combativeness.
  • Eyelash reflex disappears, but other reflexes remain intact
  • Elevated hemodynamic status
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16
Q

What is Stage 3 Anesthesia (Surgical Anesthesia)?

A

Sweet spot for Anesthesia

  • Normal automatic function but unconscious
  • Big risk of resp depression bc of intercostal paralysis which means shallow rests
  • loss of laryngeal reflexes (safe to intubate/extuabte)
17
Q

What is Stage 4 Anesthesia (Medullary depression)?

A

Overdose; too much anesthetic agent relative to amount of surgical stimulation

  • Respiratory arrest (cardiac can occur too)
  • Fixed and dilated pupils (eyes don’t react)
  • Hypotensive, weak, and thready pulse bc of suppression of cardiac pump and vasodilation
18
Q

Generally what are the hallmarks for each planes of stage 3 surgical anesthesia?

  • Hint what is the hemodynamic, muscle, and/or vital profile of each stage
  • 4 planes
A
  1. Light anesthesia (normal vital profile and tone, poor/no swallow)
  2. Moderate anesthesia (Elevated normal vitals, relaxed muscle tone, loss of laryngeal reflex)
  3. Deep anesthesia (target) (closed eyes + resp depression, low vitals and flaccid tone)
  4. Overdose ( jerky, irregular RR; apnea, no reflexes)
19
Q

Nystagmus?

A

Eyes jitter back and forth rapidly

  • Agents like Propofol and ketamine can cause this reaction to the eyes
20
Q

What is Plane 1 of Stage 3 Anesthesia?

edit

A

Plane 1

  • Depth: Light anesthesia
  • Regular RR
  • Strong pulse
  • Normal BP
  • May respond to surgery with movement
  • Normal pupil size; PERRLA; nystagmus may be present; Eyelid reflex lost
  • Muscle tone present
  • Reflexes: Swallowing is poor or absent; others present but diminished
21
Q

What is Plane 2 of Stage 3 Anesthesia?

edit

A

Plane 2:

  • Depth: Moderate
  • RR is automatic and regular with intermittent cessations of respiration
  • HR strong, approaching tachycardic
  • Loss of laryngeal reflex
  • Hypotension
  • HR and RR may increase in response to surgery
  • Pupils slightly dilated. Pupil response is sluggish
  • Relaxed muscle tone
  • Majority of reflexes absent
22
Q

What is Plane 3 of Stage 3 Anesthesia?

edit

A

Plane 3:

  • Depth: Deep
  • Targeted level of procedures requiring general anesthesia
  • Closed eyes(hallmark)
  • Respiratory depression (hallmark)
  • Complete relaxation of the intercostal and abdominal muscles
  • Pulse less strong
  • Increasing hypotension
  • No response to surgery
  • Loss of pupillary light reflex
  • Flaccid tone
23
Q

What is Plane 4 of Stage 3 Anesthesia?

edit

A

Plane 4:

  • Depth: Overdose
  • Jerky, irregular RR; apnea
  • Paradoxical ribcage movement (diaphragm paralysis)
  • Bradycardia
  • Significant hypotension
  • No response to surgery
  • Flaccid tone
  • No reflexes
24
Q

what are the 3 phases of Anethesia care

A
  1. Preoperative phase
  2. Intraoperative phase
  3. Post operative phase
25
Q

What is involved in the Preopartive phase of Anethesia Care?

A
  • Preop assessment; involves detailed assessment of risk that determines if they are fit for the procedure
  • Choice of Anesthesia (options based on pt status and procedure
  • Premedication
26
Q

What is included in the preoperative assessment?

A

Detailed assessment of comorbid disease, fitness level, addressing patient concerns. **determines if they are fit for the procedure)

  • What is the indication of the proposed surgery
  • Addressing patient concernns
27
Q

What are premedication considerations of anethesia care?

A

What conditions require stabilization before surgery (uncontrolled htn)

  • What can be prescribed to optimize the surgery
  • What can be d/c to optimize surgery
28
Q

What considerations are included in the intraoperative phase of Anesthesia care?

A

Plans in relation to monitoring need to be kept in mind when procedure is ongoing.

  • Physiologic monitoring and vascular access (plan based on preop assessment)
  • General anesthesia
    (plan of induction, maintaince, and emergence meds used for each stage, airway/vent management?)
  • Regional Anesthesia
    (plan for anesthetic block, i.e epidural)
29
Q

What are types of ames ethic blocks?

A

Infiltration via spinal route, epidural, or peripheral

30
Q

What are considerations for postoperative anethesia care?

A

Patient is recovering (PACU)

  • special monitoring or treatment based on surgery or anesthetic where they basically follow up with the pt post op
  • Pt may require differing levels of post op pain control via pea, opioids, acetaminophen, nsaids etc. etc.
31
Q

How does vapor pressure relate to anesthetic gas?

  • Don’t worry about memorizing

edit

A

Most anesthetic gasses are volatile liquids in closed containers.

  • Basically, the molecules transition from a liquid to gas phase really easy, directly correlated w/temperature.
  • don’t worry about this last bit but…increase in temp increases ratio of gas:liq molecules, which increases vapor pressure
32
Q

Boiling points of

  • Sevoflurane
  • Desflurane
  • N20?
  • Don’t worry about memorizing
A

All in deg celsius

  • Sevoflurane: 58.5
  • Desflurane: 22.8
  • N2O: -88
  • Remember, the greater the pressure, the higher the boiling point
33
Q

Why is Desflurane a unique anesthetic gas?

A

It a volatile gas that requires a special vaporizer for proper utilization of the gas. W/O it, the gas would boil off and the patient would most likely wake up.

  • the vaporizer provides a external heat source for sig heat loss associated w/desflurane vaporization
34
Q

What is latent heat of vaporization

  • Don’t worry about memorizing, just review if you have time.
A

latent heat of vaporization = number of calories needed to change 1g of liquid into a vapor w/o changing temp

35
Q

Why is the hyperexcitable state of anesthesia (stage 2) dangerous?

A

The excitement or delirium stage is dangerous due to increased sympathetic nervous system activity. The following can be expected:

  • increased HR, BP, and RR
  • Delirium and involuntary movement
  • Laryngospasm and hypertension
36
Q

What are the hallmarks of stage 3 Anesthesia (surgical anesthesia) ?

A
  • Respiratory depression (needs vent support)
  • Ceased eye movements
37
Q

What does paradoxical ribcage movement suggest?

A

Diaphragm paralysis

38
Q

What sections of the body are included within the supraspinal region?

A
  1. Brainstem
  2. Midbrain
  3. Cerebral cortex

Anesthesia (Resp 314) (9 decks)

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