Test 6 Anesthesia Flashcards
Agonist
Stimulates or prolongs the effects of a drug
Amnesia
Lack of recall
Anesthesia
Absence of sensation
Antagonist
Blocks the action of a drug
Considerations for anesthesia are
Duration of surgery
Surgical position
Patient
Surgeon
Type of anesthesia
Ideal anesthetic for a patient
Rapid acting
Easily reversed
Analgesic lasts into recovery
Ideal anesthetic for the surgeon
Produces muscular relaxation
Minimal side effects
Ideal anesthetic for anesthesiologist
Wide margin of safety
Leaves body unaltered
Potent
Allows increase % of O2 to be used
Decreased level of toxicity
Balanced anesthesia does what?
Permeates entire body
Transported via the blood
Loss of consciousness and blockage of pain-transmitting center
Immobile and quiet patient
Patient considerations
Age
Height
Weight
Allergies
General health
Current meds and supplements
Co-morbid conditions (diabetes, bp, heart disease)
Patient factor considerations are
General health
Psychological state
Substance abuse
Emergency conditions
ASA assessment tool Class 1
A healthy person
ASA assessment tool Class 2
mild to moderate systemic disease
-history of asthma, smoking, anemia, controlled diabetes, or mild obesity
-less then 1yr or over age 70
ASA assessment tool Class 3
severe to systemic disease
-angina, past-MI, controlled hypertension, respiratory disease
COPD or massive obesity
ASA assessment tool Class 4
severe, systemic life-threatening disorders
-congestive heart failure, unstable angina, liver/renal failure, & debilitating respiratory disease
ASA assessment tool Class 5
Moribund- at point of death
little chance of survival
operated on in desperation
ASA assessment tool Class 6
brain dead
life support provided
organ procurement intended
Preanesthetic Preparation- Brief H&P
-allergies
-Hx of liver, kidney, heart disease, endocrine disorders
-patient medication
-evaluate lab data & x-rays
Preanesthetic Preparation- Evaluate patient
-age
-overall physical condition
-body build
-nature of operation/ length of operation
Arterial line
Intravascular catheter
AKA A-line
Pulmonary Artery Catheter
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
Central Venous Catheter
Intravascular catheter
Invasive
In Subclavian or jugular into R atrium
monitors vena cava and RA
Indicates patient fluid status
SARA
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
Monitoring of ABG’s
Respiratory acidosis- ⬇️ph ⬆️CO2
Respiratory alkalosis- ⬆️ph ⬇️ CO2
Metabolic acidosis ⬇️ph normal CO2
Metabolic alkalosis ⬆️ph normal CO2
Bispectral index
BIS monitor- on forehead
Monitors does of anesthesia delivered
Noninvasive
Pulse oximeter
Noninvasive assessment of O2 levels
On Fingertip
Dyes/ nail polish may affect accuracy
Noninvasive temperature monitors
surface monitor- usually placed on forehead
Invasive temperature monitors
esophageal probe
bladder probe
rectal probe
Stethoscope
osculate chest
assess lung sounds
proper ET placement
esophageal probe may be used for this purpose
Doppler
ultrasonic device
assess vascular status of peripheral arteries & veins
magnifies sound of blood through vessel
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
Urinary catheter
monitor urine output30mL/hr
transesophageal echocardiogram (TEE)
monitors the functionality of the heart
Preinduction phase of anesthesia
starts when preop meds are given
ends when induced
In OR, patient preoxygenated & adjunct drugs given
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
Maintenance phase of anesthesia
unconscious and stable
surgery occurs
Emergence phase of anesthesia
-surgery complete
emerges from unconsciousness
-patient extubated
Recovery phase of anesthesia
optimal level of consciousness
begins in OR continues to PACU
Anesthesia- Stage 1
-administration of anesthetic agent
-lasts until unconscious
-may appear drowsy, dizzy, inebriated
-stay quiet in OR
Anesthesia- Stage 2
loss of consciousness to relaxation
may appear excited, irregular breathe, movement
patient aware of noise and touch
Anesthesia- Stage 3
relaxation to loss of reflex/ vital functions
loss of auditory
prepping of patient begins
level of anesthesia maintained
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
General anesthesia- Inhalation
Breathes in anesthetic
Absorbed into blood stream
Exhaled gases collected for safety of all
General anesthesia- Intravenous
rapid acting
Catheter in vein
Easily metabolized
General anesthesia-
IV Agents
Induction agents
Dissociative agents
Opioids
Sedatives/tranquilizers
Neuromuscular blocking agents
Antimuscarinic agents
Adjunction agents
Common types of regional anesthesia
nerve plexus
bier- arm
spinal
epidural blocks
Proximal to surgery site
Nerve Plexus Block
injected into nerve plexus
includes tissue innervated by the plexus
used with IV sedation
Nerve block AKA local
-regional anesthesia
intramuscular
retrobulbar
topical
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
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
Spinal block
AKA intrathecal block
into CSF in subarachnoid space
injected L2-L3 or L3-L4
patient positioned in lateral or sitting position
Spinal block- advantages
patient is conscious
excellent muscle relaxation
no irritation to respiratory system
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
Epidural anesthesia
-Injected into tissue above dura mater
-lumbar approach
-catheter secured in place for continuous anesthesia
-used in obstetrics & post op pain control
Caudal block
-Specific nerve root
-Peri and post operative agent
-pediatric surgeries
-inguinal hernia repair
-Urologic intervention
-Atresia repair
-Lower extremity repair
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
Local anesthesia
-pain control at surgical site
-patient conscious
-no anesthesiologist
-RN monitors vitals
Instillation
Medication administered into area- rectum, vagina, or eye
Anesthesia equipment
-Bite block
-Bougies
-Endotracheal tubes
-Laryngeal Mask Airway
-Face mask
-Oropharyngeal/ nasal mask
-McGill forceps
-Stylet
Anesthesia devices
Anesthesia machine
Ventilator
Double cuffed pneumatic tourniquet
Fluid infusion pump
Fluid warming devices
Hypo/hyperthermia unit
Endotracheal tubes
-stylet stiffens tube (removed after placement
-through nose or mouth
-different sizes
-Laryngoscope exposes glottis
Laryngeal Mask Airway (LMA)
-in laryngopharynx through the mouth
-forms low pressure seal
-minimal stimulation to airway
Anesthesia machine
-gas delivery system
-deliver O2 and gases to patient
=monitors vitals
Ventilator
-mechanical ventilation of patient
-controls rate and volume of respirations
-Has alarms if a break in circuit
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
Define anesthesia
freedom from pain
Define amnesia
provides a lack of recall for the patient
Define muscle relaxation
facilitates retraction and exposure of the surgical site
Define hypnosis
-altered state of consciousness
-varies from light to deep unconsciousness
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
Order of delivery of anesthetics
100% oxygen
a-line medication
intubation
anesthetic gases
Define and list analgesics
Relieves pain
Natural opioid:
Morphine
Synthetic opioids:
Alfentanil
Fentanyl
Meperidine
Remifentanil
Sufentanil
Ketamine/Ketalar
Define opiate/opiods
natural and synthetic
analgesic and sedation
Adjunct to general anesthesia
Morphine
natural opioid
severe pain
permits reduction in dosage of other agents
side effects:
CNS & respiratory depression
N&V
drop pulse and B/P
Alfenta/ alfentanil
alters pain perception and response
short acting
respiratory depression may outlast analgesic effects
fentanyl/ Sublimaze
excellent intra-op narcotic
increase in pain threshold
given by IV
rapid onset/ short duration
contraindicated in myasthenia graves
meperidine/ Demerol
moderate to severe pain
may cause life threatening breathing problems
used in obstetrics
PACU for shivering
Pain patches/pregnancy
remifentanil/ Ultiva
ultra short acting
easy to titrate dosage
can cause chest wall rigidity
sufentanil/ Sufenta
5x more potent than fentanyl
sedation with euphoria
short acting
rapidly eliminating
primary anesthetic or adjunct
ketamine/ Ketalar
by IV or IM
generally kids 2-10yrs
cause flashbacks in adults
What is the opioid antagonist?
Narcan/ naloxone
Local anesthesia- Amides
-Bupivacaine (4X stronger) (AKA Sensorcaine or Marcaine)
-Lidocaine (gyn)
-Mepivacaine (dental)
-Ropivacaine (heart)
Local anesthesia- Esters
-Cetacaine
-Cocaine-Never injected (nose)
-Tetracaine (eye)
-Novocain(not as used)
Local medication given how?
Injection or topical
General anesthesia by Inhalation (5 types)
Oxygen
Desflurane
Isoflurane
Sevoflurane
Nitrous oxide
Oxygen
Not an anesthetic agent
Vital to anesthesia
Every patient receives O2
Inhaled volatile agents
Sevoflurane, Desflurane, and Isoflurane
-Can trigger MH malignant hyperthermia
Desflurane (Suprane)
-Newer halogenated agent- requires heated vaporizer
-Pungent aroma
-Safe to use in liver insufficiency
-very rapid onset and recovery
Isoflurane (Forane)
-Halogenated agent
-rapid onset and recovery
-causes profound respiratory depression
-may cause hypotension
-neuromuscular blockade
increased intracranial pressure- reversible with hyperventilation
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
Nitrous oxide
-clear colorless gas
-interacts with CNS to produce analgesia
-not potent for anesthesia or muscle relaxation
Name 3 induction agents
-methohexital sodium/ Brivatal
-thiopental/ Sodium Pentothal
-propofol/ Diprivan
Methohexital/ Brevital
-Sedative
-short-acting barbiturate
-short onset and duration
-short-term loss of consciousness
ophthalmology & electroconvulsive therapy
propofol/ Diprivan
-milk of amnesia
-irritating to vein
-rapid induction/ little hangover
-not used in head cases
Thiopental sodium/ Sodium Pentothal
-CNS depression
-does not produce analgesia
-short acting
-potent
-hypnotic, amnesiac, sedative effects
-Hangover post op
-OB for c-sections
Name 3 Intravenous hypnotics
-Benzodiazepines
-Ketamine
-Etomidate
Describe Benzodiazepines.
And Name 3 types.
-Sedative tranquilizer
-pre-op to reduce anxiety
-adjunct for other meds
-Diazepam
-Lorazepam
-Midazolam
What is the Benzodiazepine Antagonist?
-Flumazenil (Mazicon)
-rapid-acting
-rebound sedation, respiratory depression, and convulsions possible
Ketamine
-Dissociative
-by IV or IM
-Only in kids 2-10yrs
-can cause flashbacks in adults
Etomidate
-Hypnotic
-rapid induction and emergence
-minimal effect on CV system
-increased post-op N&V
Name 3 Antacid/ H-2 receptor blocking agents
Cimetidine
Famotidine
Sodium citrate with citric acid
Name 3 anti-cholingeric agents
-Atropine (most frequent/ dry mouth)
-Scopolamine
-Glycopyrrolate
Name 3 antiematics
Metoclopramide
Ondansetron
Promethazine
What are the 4 types of neuromuscular blockers?
Depolarizing
non-depolarizing
neuroleptic
reversal (non-depolarizing)
Name the depolarizing neuromuscular blocker
Succinylcholine
-wears the muscle out
can trigger MH
-used for intubation
Name 4 non-depolarizing neuromuscular blockers
Atracurium
Cisatracurium
Rocuronium
Vecuronium
Name the neuroleptic neuromuscular blocker
Droperidol
Name 2 reversal (non-depolarizing) neuromuscular blockers
Edrophonium
Neostigmine
Main Complications of anesthesia include
-Anaphylactic reaction
-Aspiration Pneumonia
-Cardiac Arrest
-Cardiac Dysrythmias
Other possible complications include
-Fluid/electrolyte imbalance
-Hypothermia
-Disseminated intravascular coagulation
-Hemolytic transfusion reaction
-Idiosyncratic
What is malignant hyperthermia?
-life threatening
-rare genetic predisposition
-reaction to anesthetic gases
Signs and symptoms of Malignant hyperthermia
-tachycardia (first sign)
-unstable BP
-muscle rigidity
-tachypnea
-cyanosis
-increased body temp (last sign)
Treatment of malignant hyperthermia meds
Dantrolene and Ryanodes
Other treatments of malignant hyperthermia include
-Chill body cavaties
-sodium bicarbonate
Describe shock signs and symptoms
cardiogenic
hemorrhagic
caused by trauma/ blood loss
-abnormal physiologic state
Cerebral complications
cerebral vascular accident (CVA)
delirium
syncope
convulsions/seizures
Grand mal seizure
loss of consciousness
convulsive body movement
warning signs- numbness, flashing lights, dizziness
Petit mal seizure
shorter duration
occur suddenly
no warning
“space out”
Laryngospasm and Bronchospasm
spasm and rigidity of upper tract
can lead to obstruction
occurs during induction
treatment= succinylocholine
