Test 6 Anesthesia Flashcards
1
Q
Agonist
A
Stimulates or prolongs the effects of a drug
2
Q
Amnesia
A
Lack of recall
3
Q
Anesthesia
A
Absence of sensation
4
Q
Antagonist
A
Blocks the action of a drug
5
Q
Considerations for anesthesia are
A
Duration of surgery
Surgical position
Patient
Surgeon
Type of anesthesia
6
Q
Ideal anesthetic for a patient
A
Rapid acting
Easily reversed
Analgesic lasts into recovery
7
Q
Ideal anesthetic for the surgeon
A
Produces muscular relaxation
Minimal side effects
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
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
10
Q
Patient considerations
A
Age
Height
Weight
Allergies
General health
Current meds and supplements
Co-morbid conditions (diabetes, bp, heart disease)
11
Q
Patient factor considerations are
A
General health
Psychological state
Substance abuse
Emergency conditions
12
Q
ASA assessment tool Class 1
A
A healthy person
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
14
Q
ASA assessment tool Class 3
A
severe to systemic disease
-angina, past-MI, controlled hypertension, respiratory disease
COPD or massive obesity
15
Q
ASA assessment tool Class 4
A
severe, systemic life-threatening disorders
-congestive heart failure, unstable angina, liver/renal failure, & debilitating respiratory disease
16
Q
ASA assessment tool Class 5
A
Moribund- at point of death
little chance of survival
operated on in desperation
17
Q
ASA assessment tool Class 6
A
brain dead
life support provided
organ procurement intended
18
Q
Preanesthetic Preparation- Brief H&P
A
-allergies
-Hx of liver, kidney, heart disease, endocrine disorders
-patient medication
-evaluate lab data & x-rays
19
Q
Preanesthetic Preparation- Evaluate patient
A
-age
-overall physical condition
-body build
-nature of operation/ length of operation
20
Q
Arterial line
A
Intravascular catheter
AKA A-line
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
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
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
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
25
Bispectral index
BIS monitor- on forehead
Monitors does of anesthesia delivered
Noninvasive
26
Pulse oximeter
Noninvasive assessment of O2 levels
On Fingertip
Dyes/ nail polish may affect accuracy
27
Noninvasive temperature monitors
surface monitor- usually placed on forehead
28
Invasive temperature monitors
esophageal probe
bladder probe
rectal probe
29
Stethoscope
osculate chest
assess lung sounds
proper ET placement
esophageal probe may be used for this purpose
30
Doppler
ultrasonic device
assess vascular status of peripheral arteries & veins
magnifies sound of blood through vessel
31
Peripheral nerve stimulator aka transcutaneous electrical nerve stimulation(TENS)
assess level of neuromuscular blockade by attempting to make muscle twitch
electrodes placed along ulnar nerve
32
Urinary catheter
monitor urine output30mL/hr
33
transesophageal echocardiogram (TEE)
monitors the functionality of the heart
34
Preinduction phase of anesthesia
starts when preop meds are given
ends when induced
In OR, patient preoxygenated & adjunct drugs given
35
Induction phase of anesthesia
-consciousness to unconsciousness
-airway maintenance -important- depressed reflexes, resp depression, inadequate airway
-sense of hearing remains
-endotracheal tube placed
-cricoid pressure (PRN) Sellick maneuver
36
Maintenance phase of anesthesia
unconscious and stable
surgery occurs
37
Emergence phase of anesthesia
-surgery complete
emerges from unconsciousness
-patient extubated
38
Recovery phase of anesthesia
optimal level of consciousness
begins in OR continues to PACU
39
Anesthesia- Stage 1
-administration of anesthetic agent
-lasts until unconscious
-may appear drowsy, dizzy, inebriated
-stay quiet in OR
40
Anesthesia- Stage 2
loss of consciousness to relaxation
may appear excited, irregular breathe, movement
patient aware of noise and touch
41
Anesthesia- Stage 3
relaxation to loss of reflex/ vital functions
loss of auditory
prepping of patient begins
level of anesthesia maintained
42
Anesthesia- Stage 4
Don't want to get to this level
Can lead to death
Vitals are too depressed
Respiratory failure/ cardiac arrest
Patient not breathing
43
General anesthesia- Inhalation
Breathes in anesthetic
Absorbed into blood stream
Exhaled gases collected for safety of all
44
General anesthesia- Intravenous
rapid acting
Catheter in vein
Easily metabolized
45
General anesthesia-
IV Agents
Induction agents
Dissociative agents
Opioids
Sedatives/tranquilizers
Neuromuscular blocking agents
Antimuscarinic agents
Adjunction agents
46
Common types of regional anesthesia
nerve plexus
bier- arm
spinal
epidural blocks
*Proximal to surgery site*
47
Nerve Plexus Block
injected into nerve plexus
includes tissue innervated by the plexus
used with IV sedation
48
Nerve block AKA local
-regional anesthesia
intramuscular
retrobulbar
topical
49
Nerve conducting Blocking Agents
-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
50
Bier blocker
-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
Spinal block
AKA intrathecal block
into CSF in subarachnoid space
injected L2-L3 or L3-L4
patient positioned in lateral or sitting position
52
Spinal block- advantages
patient is conscious
excellent muscle relaxation
no irritation to respiratory system
53
Spinal block- disadvantages
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
Epidural anesthesia
-Injected into tissue above dura mater
-lumbar approach
-catheter secured in place for continuous anesthesia
-used in obstetrics & post op pain control
55
Caudal block
-Specific nerve root
-Peri and post operative agent
-pediatric surgeries
-inguinal hernia repair
-Urologic intervention
-Atresia repair
-Lower extremity repair
56
Monitored Anesthesia Care (MAC)
-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
Local anesthesia
-pain control at surgical site
-patient conscious
-no anesthesiologist
-RN monitors vitals
58
Instillation
Medication administered into area- rectum, vagina, or eye
59
Anesthesia equipment
-Bite block
-Bougies
-Endotracheal tubes
-Laryngeal Mask Airway
-Face mask
-Oropharyngeal/ nasal mask
-McGill forceps
-Stylet
60
Anesthesia devices
Anesthesia machine
Ventilator
Double cuffed pneumatic tourniquet
Fluid infusion pump
Fluid warming devices
Hypo/hyperthermia unit
61
Endotracheal tubes
-stylet stiffens tube (removed after placement
-through nose or mouth
-different sizes
-Laryngoscope exposes glottis
62
Laryngeal Mask Airway (LMA)
-in laryngopharynx through the mouth
-forms low pressure seal
-minimal stimulation to airway
63
Anesthesia machine
-gas delivery system
-deliver O2 and gases to patient
=monitors vitals
64
Ventilator
-mechanical ventilation of patient
-controls rate and volume of respirations
-Has alarms if a break in circuit
65
Preoperative medications do what?
-relieve anxiety
-produce some amnesia
-raise pain threshold (sedatives and tranquilizers DO NOT counteract pain)
-Assist in induction
-Inhibit nausea and vomiting
66
Define anesthesia
freedom from pain
67
Define amnesia
provides a lack of recall for the patient
68
Define muscle relaxation
facilitates retraction and exposure of the surgical site
69
Define hypnosis
-altered state of consciousness
-varies from light to deep unconsciousness
70
What is the pathway of pain?
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
Order of delivery of anesthetics
100% oxygen
a-line medication
intubation
anesthetic gases
72
Define and list analgesics
Relieves pain
Natural opioid:
Morphine
Synthetic opioids:
Alfentanil
Fentanyl
Meperidine
Remifentanil
Sufentanil
Ketamine/Ketalar
73
Define opiate/opiods
natural and synthetic
analgesic and sedation
Adjunct to general anesthesia
74
Morphine
natural opioid
severe pain
permits reduction in dosage of other agents
side effects:
CNS & respiratory depression
N&V
drop pulse and B/P
75
Alfenta/ alfentanil
alters pain perception and response
short acting
respiratory depression may outlast analgesic effects
76
fentanyl/ Sublimaze
excellent intra-op narcotic
increase in pain threshold
given by IV
rapid onset/ short duration
contraindicated in myasthenia graves
77
meperidine/ Demerol
moderate to severe pain
may cause life threatening breathing problems
used in obstetrics
PACU for shivering
Pain patches/pregnancy
78
remifentanil/ Ultiva
ultra short acting
easy to titrate dosage
can cause chest wall rigidity
79
sufentanil/ Sufenta
5x more potent than fentanyl
sedation with euphoria
short acting
rapidly eliminating
primary anesthetic or adjunct
80
ketamine/ Ketalar
by IV or IM
generally kids 2-10yrs
cause flashbacks in adults
81
What is the opioid antagonist?
Narcan/ naloxone
82
Local anesthesia- Amides
-Bupivacaine (4X stronger) (AKA Sensorcaine or Marcaine)
-Lidocaine (gyn)
-Mepivacaine (dental)
-Ropivacaine (heart)
83
Local anesthesia- Esters
-Cetacaine
-Cocaine-Never injected (nose)
-Tetracaine (eye)
-Novocain(not as used)
84
Local medication given how?
Injection or topical
85
General anesthesia by Inhalation (5 types)
Oxygen
Desflurane
Isoflurane
Sevoflurane
Nitrous oxide
86
Oxygen
Not an anesthetic agent
Vital to anesthesia
Every patient receives O2
87
Inhaled volatile agents
Sevoflurane, Desflurane, and Isoflurane
-Can trigger MH malignant hyperthermia
88
Desflurane (Suprane)
-Newer halogenated agent- requires heated vaporizer
-Pungent aroma
-Safe to use in liver insufficiency
-very rapid onset and recovery
89
Isoflurane (Forane)
-Halogenated agent
-rapid onset and recovery
-causes profound respiratory depression
-may cause hypotension
-neuromuscular blockade
increased intracranial pressure- reversible with hyperventilation
90
Sevoflurane (Utane)
-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
Nitrous oxide
-clear colorless gas
-interacts with CNS to produce analgesia
-not potent for anesthesia or muscle relaxation
92
Name 3 induction agents
-methohexital sodium/ Brivatal
-thiopental/ Sodium Pentothal
-propofol/ Diprivan
93
Methohexital/ Brevital
-Sedative
-short-acting barbiturate
-short onset and duration
-short-term loss of consciousness
ophthalmology & electroconvulsive therapy
94
propofol/ Diprivan
-milk of amnesia
-irritating to vein
-rapid induction/ little hangover
-not used in head cases
95
Thiopental sodium/ Sodium Pentothal
-CNS depression
-does not produce analgesia
-short acting
-potent
-hypnotic, amnesiac, sedative effects
-Hangover post op
-OB for c-sections
96
Name 3 Intravenous hypnotics
-Benzodiazepines
-Ketamine
-Etomidate
97
Describe Benzodiazepines.
And Name 3 types.
-Sedative tranquilizer
-pre-op to reduce anxiety
-adjunct for other meds
-Diazepam
-Lorazepam
-Midazolam
98
What is the Benzodiazepine Antagonist?
-Flumazenil (Mazicon)
-rapid-acting
-rebound sedation, respiratory depression, and convulsions possible
99
Ketamine
-Dissociative
-by IV or IM
-Only in kids 2-10yrs
-can cause flashbacks in adults
100
Etomidate
-Hypnotic
-rapid induction and emergence
-minimal effect on CV system
-increased post-op N&V
101
Name 3 Antacid/ H-2 receptor blocking agents
Cimetidine
Famotidine
Sodium citrate with citric acid
102
Name 3 anti-cholingeric agents
-Atropine (most frequent/ dry mouth)
-Scopolamine
-Glycopyrrolate
103
Name 3 antiematics
Metoclopramide
Ondansetron
Promethazine
104
What are the 4 types of neuromuscular blockers?
Depolarizing
non-depolarizing
neuroleptic
reversal (non-depolarizing)
105
Name the depolarizing neuromuscular blocker
**Succinylcholine**
-wears the muscle out
can trigger MH
-used for intubation
106
Name 4 non-depolarizing neuromuscular blockers
Atracurium
Cisatracurium
Rocuronium
Vecuronium
107
Name the neuroleptic neuromuscular blocker
Droperidol
108
Name 2 reversal (non-depolarizing) neuromuscular blockers
Edrophonium
Neostigmine
109
Main Complications of anesthesia include
-Anaphylactic reaction
-Aspiration Pneumonia
-Cardiac Arrest
-Cardiac Dysrythmias
110
Other possible complications include
-Fluid/electrolyte imbalance
-Hypothermia
-Disseminated intravascular coagulation
-Hemolytic transfusion reaction
-Idiosyncratic
111
What is malignant hyperthermia?
-life threatening
-rare genetic predisposition
-reaction to anesthetic gases
112
Signs and symptoms of Malignant hyperthermia
-tachycardia (first sign)
-unstable BP
-muscle rigidity
-tachypnea
-cyanosis
-increased body temp (last sign)
113
Treatment of malignant hyperthermia meds
Dantrolene and Ryanodes
114
Other treatments of malignant hyperthermia include
-Chill body cavaties
-sodium bicarbonate
115
Describe shock signs and symptoms
cardiogenic
hemorrhagic
caused by trauma/ blood loss
-abnormal physiologic state
116
Cerebral complications
cerebral vascular accident (CVA)
delirium
syncope
convulsions/seizures
117
Grand mal seizure
loss of consciousness
convulsive body movement
warning signs- numbness, flashing lights, dizziness
118
Petit mal seizure
shorter duration
occur suddenly
no warning
"space out"
119
Laryngospasm and Bronchospasm
spasm and rigidity of upper tract
can lead to obstruction
occurs during induction
treatment= succinylocholine
120
