Test 6 Anesthesia Flashcards

1
Q

Agonist

A

Stimulates or prolongs the effects of a drug

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2
Q

Amnesia

A

Lack of recall

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3
Q

Anesthesia

A

Absence of sensation

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4
Q

Antagonist

A

Blocks the action of a drug

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5
Q

Considerations for anesthesia are

A

Duration of surgery
Surgical position
Patient
Surgeon
Type of anesthesia

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6
Q

Ideal anesthetic for a patient

A

Rapid acting
Easily reversed
Analgesic lasts into recovery

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7
Q

Ideal anesthetic for the surgeon

A

Produces muscular relaxation
Minimal side effects

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8
Q

Ideal anesthetic for anesthesiologist

A

Wide margin of safety
Leaves body unaltered
Potent
Allows increase % of O2 to be used
Decreased level of toxicity

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9
Q

Balanced anesthesia does what?

A

Permeates entire body
Transported via the blood
Loss of consciousness and blockage of pain-transmitting center
Immobile and quiet patient

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10
Q

Patient considerations

A

Age
Height
Weight
Allergies
General health
Current meds and supplements
Co-morbid conditions (diabetes, bp, heart disease)

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11
Q

Patient factor considerations are

A

General health
Psychological state
Substance abuse
Emergency conditions

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12
Q

ASA assessment tool Class 1

A

A healthy person

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13
Q

ASA assessment tool Class 2

A

mild to moderate systemic disease
-history of asthma, smoking, anemia, controlled diabetes, or mild obesity
-less then 1yr or over age 70

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14
Q

ASA assessment tool Class 3

A

severe to systemic disease
-angina, past-MI, controlled hypertension, respiratory disease
COPD or massive obesity

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15
Q

ASA assessment tool Class 4

A

severe, systemic life-threatening disorders
-congestive heart failure, unstable angina, liver/renal failure, & debilitating respiratory disease

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16
Q

ASA assessment tool Class 5

A

Moribund- at point of death
little chance of survival
operated on in desperation

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17
Q

ASA assessment tool Class 6

A

brain dead
life support provided
organ procurement intended

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18
Q

Preanesthetic Preparation- Brief H&P

A

-allergies
-Hx of liver, kidney, heart disease, endocrine disorders
-patient medication
-evaluate lab data & x-rays

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19
Q

Preanesthetic Preparation- Evaluate patient

A

-age
-overall physical condition
-body build
-nature of operation/ length of operation

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20
Q

Arterial line

A

Intravascular catheter
AKA A-line

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21
Q

Pulmonary Artery Catheter

A

Intravascular catheter
AKA Swan
Invasive into PA (pulmonary artery)
Subclavian or jugular into R atrium into PA
provides cardiac output from right side of heart
monitors function and fluid status

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22
Q

Central Venous Catheter

A

Intravascular catheter
Invasive
In Subclavian or jugular into R atrium
monitors vena cava and RA
Indicates patient fluid status

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23
Q

SARA

A

System for anesthetic & respiratory analysis
- (capnography) breath by breath analysis of end-tidal volume of expired co2
- spirometry- monitor ventilation, lung compliance/resistance, and indicates ards or emphysema

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24
Q

Monitoring of ABG’s

A

Respiratory acidosis- ⬇️ph ⬆️CO2
Respiratory alkalosis- ⬆️ph ⬇️ CO2
Metabolic acidosis ⬇️ph normal CO2
Metabolic alkalosis ⬆️ph normal CO2

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25
Q

Bispectral index

A

BIS monitor- on forehead
Monitors does of anesthesia delivered
Noninvasive

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26
Q

Pulse oximeter

A

Noninvasive assessment of O2 levels
On Fingertip
Dyes/ nail polish may affect accuracy

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27
Q

Noninvasive temperature monitors

A

surface monitor- usually placed on forehead

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28
Q

Invasive temperature monitors

A

esophageal probe
bladder probe
rectal probe

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29
Q

Stethoscope

A

osculate chest
assess lung sounds
proper ET placement
esophageal probe may be used for this purpose

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30
Q

Doppler

A

ultrasonic device
assess vascular status of peripheral arteries & veins
magnifies sound of blood through vessel

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31
Q

Peripheral nerve stimulator aka transcutaneous electrical nerve stimulation(TENS)

A

assess level of neuromuscular blockade by attempting to make muscle twitch
electrodes placed along ulnar nerve

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32
Q

Urinary catheter

A

monitor urine output30mL/hr

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33
Q

transesophageal echocardiogram (TEE)

A

monitors the functionality of the heart

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34
Q

Preinduction phase of anesthesia

A

starts when preop meds are given
ends when induced
In OR, patient preoxygenated & adjunct drugs given

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35
Q

Induction phase of anesthesia

A

-consciousness to unconsciousness
-airway maintenance -important- depressed reflexes, resp depression, inadequate airway
-sense of hearing remains
-endotracheal tube placed
-cricoid pressure (PRN) Sellick maneuver

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36
Q

Maintenance phase of anesthesia

A

unconscious and stable
surgery occurs

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37
Q

Emergence phase of anesthesia

A

-surgery complete
emerges from unconsciousness
-patient extubated

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38
Q

Recovery phase of anesthesia

A

optimal level of consciousness
begins in OR continues to PACU

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39
Q

Anesthesia- Stage 1

A

-administration of anesthetic agent
-lasts until unconscious
-may appear drowsy, dizzy, inebriated
-stay quiet in OR

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40
Q

Anesthesia- Stage 2

A

loss of consciousness to relaxation
may appear excited, irregular breathe, movement
patient aware of noise and touch

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41
Q

Anesthesia- Stage 3

A

relaxation to loss of reflex/ vital functions
loss of auditory
prepping of patient begins
level of anesthesia maintained

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42
Q

Anesthesia- Stage 4

A

Don’t want to get to this level
Can lead to death
Vitals are too depressed
Respiratory failure/ cardiac arrest
Patient not breathing

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43
Q

General anesthesia- Inhalation

A

Breathes in anesthetic
Absorbed into blood stream
Exhaled gases collected for safety of all

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44
Q

General anesthesia- Intravenous

A

rapid acting
Catheter in vein
Easily metabolized

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45
Q

General anesthesia-
IV Agents

A

Induction agents
Dissociative agents
Opioids
Sedatives/tranquilizers
Neuromuscular blocking agents
Antimuscarinic agents
Adjunction agents

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46
Q

Common types of regional anesthesia

A

nerve plexus
bier- arm
spinal
epidural blocks
Proximal to surgery site

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47
Q

Nerve Plexus Block

A

injected into nerve plexus
includes tissue innervated by the plexus
used with IV sedation

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48
Q

Nerve block AKA local

A

-regional anesthesia
intramuscular
retrobulbar
topical

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49
Q

Nerve conducting Blocking Agents

A

-prevent initiation/ transmission of impulses
- IM or topical
-local or regional
-Amino AMIDE group: lidocaine, xylocaine, bupivacaine, Marcaine, sensorcaine
-Amino ESTER group: cocaine, Novocain

50
Q
A
50
Q

Bier blocker

A

-distal portion of extremity
-Exsanguinated before injected (blood removed)
-tourniquet placed to prevent into body
-no more than 2 hours
slowly released to allow blood to return

51
Q

Spinal block

A

AKA intrathecal block
into CSF in subarachnoid space
injected L2-L3 or L3-L4
patient positioned in lateral or sitting position

52
Q

Spinal block- advantages

A

patient is conscious
excellent muscle relaxation
no irritation to respiratory system

53
Q

Spinal block- disadvantages

A

May cause hypotension (IV fluids increased to raise BP)
N&V
Inability to change dosage once injected
Spinal headache
Rarely- temporary or permanent paralysis

54
Q

Epidural anesthesia

A

-Injected into tissue above dura mater
-lumbar approach
-catheter secured in place for continuous anesthesia
-used in obstetrics & post op pain control

55
Q

Caudal block

A

-Specific nerve root
-Peri and post operative agent
-pediatric surgeries
-inguinal hernia repair
-Urologic intervention
-Atresia repair
-Lower extremity repair

56
Q

Monitored Anesthesia Care (MAC)

A

-pain control with local
-local agent with IV to provide sedation, systemic analgesia, or amnesia effects
-monitored by anesthesia
-minor surgery or low tolerance

57
Q

Local anesthesia

A

-pain control at surgical site
-patient conscious
-no anesthesiologist
-RN monitors vitals

58
Q

Instillation

A

Medication administered into area- rectum, vagina, or eye

59
Q

Anesthesia equipment

A

-Bite block
-Bougies
-Endotracheal tubes
-Laryngeal Mask Airway
-Face mask
-Oropharyngeal/ nasal mask
-McGill forceps
-Stylet

60
Q

Anesthesia devices

A

Anesthesia machine
Ventilator
Double cuffed pneumatic tourniquet
Fluid infusion pump
Fluid warming devices
Hypo/hyperthermia unit

61
Q

Endotracheal tubes

A

-stylet stiffens tube (removed after placement
-through nose or mouth
-different sizes
-Laryngoscope exposes glottis

62
Q

Laryngeal Mask Airway (LMA)

A

-in laryngopharynx through the mouth
-forms low pressure seal
-minimal stimulation to airway

63
Q

Anesthesia machine

A

-gas delivery system
-deliver O2 and gases to patient
=monitors vitals

64
Q

Ventilator

A

-mechanical ventilation of patient
-controls rate and volume of respirations
-Has alarms if a break in circuit

65
Q

Preoperative medications do what?

A

-relieve anxiety
-produce some amnesia
-raise pain threshold (sedatives and tranquilizers DO NOT counteract pain)
-Assist in induction
-Inhibit nausea and vomiting

66
Q

Define anesthesia

A

freedom from pain

67
Q

Define amnesia

A

provides a lack of recall for the patient

68
Q

Define muscle relaxation

A

facilitates retraction and exposure of the surgical site

69
Q

Define hypnosis

A

-altered state of consciousness
-varies from light to deep unconsciousness

70
Q

What is the pathway of pain?

A

1 nerve ending in wound
2 nerves
3 paravertebral space
4 epidural space
5 subarachnoid space
6 spinal cord
7 sensory cortex in cerebrum of brain

71
Q

Order of delivery of anesthetics

A

100% oxygen
a-line medication
intubation
anesthetic gases

72
Q

Define and list analgesics

A

Relieves pain
Natural opioid:
Morphine
Synthetic opioids:
Alfentanil
Fentanyl
Meperidine
Remifentanil
Sufentanil
Ketamine/Ketalar

73
Q

Define opiate/opiods

A

natural and synthetic
analgesic and sedation
Adjunct to general anesthesia

74
Q

Morphine

A

natural opioid
severe pain
permits reduction in dosage of other agents
side effects:
CNS & respiratory depression
N&V
drop pulse and B/P

75
Q

Alfenta/ alfentanil

A

alters pain perception and response
short acting
respiratory depression may outlast analgesic effects

76
Q

fentanyl/ Sublimaze

A

excellent intra-op narcotic
increase in pain threshold
given by IV
rapid onset/ short duration
contraindicated in myasthenia graves

77
Q

meperidine/ Demerol

A

moderate to severe pain
may cause life threatening breathing problems
used in obstetrics
PACU for shivering

Pain patches/pregnancy

78
Q

remifentanil/ Ultiva

A

ultra short acting
easy to titrate dosage
can cause chest wall rigidity

79
Q

sufentanil/ Sufenta

A

5x more potent than fentanyl
sedation with euphoria
short acting
rapidly eliminating
primary anesthetic or adjunct

80
Q

ketamine/ Ketalar

A

by IV or IM
generally kids 2-10yrs
cause flashbacks in adults

81
Q

What is the opioid antagonist?

A

Narcan/ naloxone

82
Q

Local anesthesia- Amides

A

-Bupivacaine (4X stronger) (AKA Sensorcaine or Marcaine)
-Lidocaine (gyn)
-Mepivacaine (dental)
-Ropivacaine (heart)

83
Q

Local anesthesia- Esters

A

-Cetacaine
-Cocaine-Never injected (nose)
-Tetracaine (eye)
-Novocain(not as used)

84
Q

Local medication given how?

A

Injection or topical

85
Q

General anesthesia by Inhalation (5 types)

A

Oxygen
Desflurane
Isoflurane
Sevoflurane
Nitrous oxide

86
Q

Oxygen

A

Not an anesthetic agent
Vital to anesthesia
Every patient receives O2

87
Q

Inhaled volatile agents

A

Sevoflurane, Desflurane, and Isoflurane
-Can trigger MH malignant hyperthermia

88
Q

Desflurane (Suprane)

A

-Newer halogenated agent- requires heated vaporizer
-Pungent aroma
-Safe to use in liver insufficiency
-very rapid onset and recovery

89
Q

Isoflurane (Forane)

A

-Halogenated agent
-rapid onset and recovery
-causes profound respiratory depression
-may cause hypotension
-neuromuscular blockade
increased intracranial pressure- reversible with hyperventilation

90
Q

Sevoflurane (Utane)

A

-rapid, smooth onset, and recovery
-can cause bradycardia, hypotension, cardiac arrhythmia, N&V
-safe for liver disease but may cause mild renal complication
-potentiates use of neuromuscular blockers

91
Q

Nitrous oxide

A

-clear colorless gas
-interacts with CNS to produce analgesia
-not potent for anesthesia or muscle relaxation

92
Q

Name 3 induction agents

A

-methohexital sodium/ Brivatal
-thiopental/ Sodium Pentothal
-propofol/ Diprivan

93
Q

Methohexital/ Brevital

A

-Sedative
-short-acting barbiturate
-short onset and duration
-short-term loss of consciousness
ophthalmology & electroconvulsive therapy

94
Q

propofol/ Diprivan

A

-milk of amnesia
-irritating to vein
-rapid induction/ little hangover
-not used in head cases

95
Q

Thiopental sodium/ Sodium Pentothal

A

-CNS depression
-does not produce analgesia
-short acting
-potent
-hypnotic, amnesiac, sedative effects
-Hangover post op
-OB for c-sections

96
Q

Name 3 Intravenous hypnotics

A

-Benzodiazepines
-Ketamine
-Etomidate

97
Q

Describe Benzodiazepines.
And Name 3 types.

A

-Sedative tranquilizer
-pre-op to reduce anxiety
-adjunct for other meds
-Diazepam
-Lorazepam
-Midazolam

98
Q

What is the Benzodiazepine Antagonist?

A

-Flumazenil (Mazicon)
-rapid-acting
-rebound sedation, respiratory depression, and convulsions possible

99
Q

Ketamine

A

-Dissociative
-by IV or IM
-Only in kids 2-10yrs
-can cause flashbacks in adults

100
Q

Etomidate

A

-Hypnotic
-rapid induction and emergence
-minimal effect on CV system
-increased post-op N&V

101
Q

Name 3 Antacid/ H-2 receptor blocking agents

A

Cimetidine
Famotidine
Sodium citrate with citric acid

102
Q

Name 3 anti-cholingeric agents

A

-Atropine (most frequent/ dry mouth)
-Scopolamine
-Glycopyrrolate

103
Q

Name 3 antiematics

A

Metoclopramide
Ondansetron
Promethazine

104
Q

What are the 4 types of neuromuscular blockers?

A

Depolarizing
non-depolarizing
neuroleptic
reversal (non-depolarizing)

105
Q

Name the depolarizing neuromuscular blocker

A

Succinylcholine
-wears the muscle out
can trigger MH
-used for intubation

106
Q

Name 4 non-depolarizing neuromuscular blockers

A

Atracurium
Cisatracurium
Rocuronium
Vecuronium

107
Q

Name the neuroleptic neuromuscular blocker

A

Droperidol

108
Q

Name 2 reversal (non-depolarizing) neuromuscular blockers

A

Edrophonium
Neostigmine

109
Q

Main Complications of anesthesia include

A

-Anaphylactic reaction
-Aspiration Pneumonia
-Cardiac Arrest
-Cardiac Dysrythmias

110
Q

Other possible complications include

A

-Fluid/electrolyte imbalance
-Hypothermia
-Disseminated intravascular coagulation
-Hemolytic transfusion reaction
-Idiosyncratic

111
Q

What is malignant hyperthermia?

A

-life threatening
-rare genetic predisposition
-reaction to anesthetic gases

112
Q

Signs and symptoms of Malignant hyperthermia

A

-tachycardia (first sign)
-unstable BP
-muscle rigidity
-tachypnea
-cyanosis
-increased body temp (last sign)

113
Q

Treatment of malignant hyperthermia meds

A

Dantrolene and Ryanodes

114
Q

Other treatments of malignant hyperthermia include

A

-Chill body cavaties
-sodium bicarbonate

115
Q

Describe shock signs and symptoms

A

cardiogenic
hemorrhagic
caused by trauma/ blood loss
-abnormal physiologic state

116
Q

Cerebral complications

A

cerebral vascular accident (CVA)
delirium
syncope
convulsions/seizures

117
Q

Grand mal seizure

A

loss of consciousness
convulsive body movement
warning signs- numbness, flashing lights, dizziness

118
Q

Petit mal seizure

A

shorter duration
occur suddenly
no warning
“space out”

119
Q

Laryngospasm and Bronchospasm

A

spasm and rigidity of upper tract
can lead to obstruction
occurs during induction
treatment= succinylocholine

120
Q
A