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