Surgical: anesthetics Flashcards
general anesthesia: what are the most common inhaled/volatile anesthetics ?
(4)
-Sevoflurane, Isoflurane, Desflurane, Nitrous Oxide*
general anesthesia: what are the most common IV anesthetics
TIVAs; total IV anesthetics) ? (3
-Propofol, Dexmetatomadine,
Remifentanyl
5 different types of anesthesia administration
- Sedation - ex/ propofol, fentanyl, versed
- MAC – monitored anesthesia care
- General - inhalational, TIVA
- Neuraxial – ex/ epidural, spinal
- Regional – ex/ femoral block
what is a “MAC” case? - monitored anesthesia care
a case that requires anesthesia providers there in order to conduct the required …
- anesthesia assessment and mgmt
- continual assessment of level of consciousness and mgmt of cardiac, respiratory function
- ability to manage airway and ventilation
- ability to convert to general anesthesia
what is “MAC”- minimum alveolar conc. ? what would a lower MAC mean?
indicator of potency: level at which 50% pts do not respond to sx stimulation
- lower MAC = more potent agent
PKs of anesthesia: uptake and distribution
- uptake in the lungs: passive diffusion
- higher ratio = more soluble in blood
- distribution + uptake in the brain: blood- brain partition coefficient
- higher coeff = higher brain solubility
PKs of anesthesia: onset of effect and elimination
ONSET OF EFFECT – *the lower the blood – gas partition coefficient, the faster the onset/induction
ELIMINATION – via lungs: *the lower the blood-gas partition coefficient, the quicker the recovery
how does obesity effect the elimination of inhaled anesthetics
prolonged exposure with high solubility ->prolonged recovery
3 phases of anesthesia
Pre-Operative – pre-op evaluation, testing, clearance
Peri-operative –
–Induction
–Maintenance
–Emergence
Post-operative - PACU, discharge, first 24 hours out
monitoring requirements: ASA standards (2 )
1 – Anesthesia provider shall be present in room for all GA, MAC, and regional anesthetics.
2 –Continual monitoring:
-oxygenation
-ventilation: observation, end-tidal CO2 verification
-circulation: EKG, HR, BP
-temperature
PCP role in pre-op clearance (3)
To address chronic and acute medical issues
To consider perioperative challenges (especially Cardiac Risk)
To optimize patient for surgery
3 Main Factors in determining risk for non-cardiac surgery and need for further perioperative testing (kinda weeds)
- Clinical presentation of the patient
- Inherent cardiac risk of the procedure
- The patient’s functional capacity
5 parts of determining cardiac risk of surgery (kinda weeds)
- Is the surgery emergent?
- Are there active cardiac conditions?
- What is the level of risk of the surgery?
- Does the patient have good functional capacity without symptoms?
- Does the patient have clinical risk factors?
airway classification (kinda weeds)
based on how much of the back of the throat/airway you can visualize
Class 1: soft palate, uvula, pillars (open)
Class 2: soft palate, portion of uvula
Class 3: soft palate, base of uvula
Class 4: hard palate only (more closed)
3 phases of intra-op
- Induction (“take-off”)
- Maintenance
- Emergence (“landing”)
what are the steps for intra-op induction of anesthesia?
- monitors: EKG, Pulse ox, RR , BP, ETCO2, Temp
- obtain baseline vitals
- pre-oxygenate/ de-nitrogenate
- pushing Rx
- securing airway
- patient positioning
- Protect the eyes!
malignant hyperthermia: how serious is it? what is it caused by?
an anesthesia EMERGENCY!
Paralytics and Volatile Agents are the triggers
what is included in malignant hyperthermia? what do you do to txt this?
Hypermetabolic Crisis
- Elevated temp is a late sign!
- HUGE influx of Calcium!
txt: STOP volatile agent, flood with oxygen Administer Dantrolene (a CCB)
what is the role of paralytics in anesthesia?
Facilitate intubation, diminish hoarseness and risk of vocal cord injury, improves ventilation, pt safety
(ex/ succinylcholine)
what is the modified aldrete score?
assesses level of activity, respiration, circulation, consciousness and O2 saturation
- used for post-op assessment after anesthesia
PACU pain mgmt: what do you need to balance paine mgmt along with?
Must balance with breathing, recovery, co-morbidities
and avoid post-op N/V
