Test G, H Flashcards
Who is the pre medication ordered by?
Surgeon
Anesthesiologist
class V
limited amounts of narcotic drugs ex: cough syrup with codeine
agonist
prolongs the response of a drug
disadvantage of spinal anesthesia
BP drop rapidly
respiratory difficulties
headache
What are essential features of the preinduction phase?
Pre mad along with caring visit
what is the last phase of consciousness?
hearing is exaggerated
Where is the endotracheal tube placed?
Oral or nasal cavity into the trachea
agents of inhalation general anesthesia
ultane
suprane
forane
Muscle relaxation
Blocking agents producing muscle relaxation
CO2 canister
prevents rebreathing of carbon dioxide
inhalation route of administration med
gases or fine mists
aminophylline
relaxes smooth muscle
CPR
Cardio pulmonary resuscitation
When is patient experiencing maximum effect of pre med?
At time of induction
what is an epidural used for?
manage post op pain
decreases amount of anesthetic used
antagonist
prevents agonist from binding then causing desired effect
More relaxed patients with anesthesia
Less anesthetic given
sodium pentothal-thiopental
hypnotic, stored in fate tissue
Hypnosis
Induce sleep from natural sleep sedation to full unconsciousness
class IV
low abuse potential ex: ativan
IV injection
most rapid
most reliable to ill patients
LMA
used on elective surgeries where patient has been NPO
what does MAC do?
decrease fear and anxiety but cooperative
asleep but can arouse patient
CNS agents
codeine
morphine
IM premedication
One hour before surgery starts
example of antiemetics
ondansetron (zofran)
what should not be done with the patient once the premedication is given?
NEVER sign surgical permit
not be left alone
be careful talking around them, may misinterpret
antibiotics
kill/inhibit MO’s in body
synergist
enhances action of another
contraindications
drug that may be undesirable in a certain situation
what does an anesthesia machine do?
delivers a precisely known mixture of gases
When does prep for anesthesia start?
Before the patient enters the OR
what is nitrous oxide?
compressed gas
colorless, fruity smell
epinephrine emergency drug
raises BP, increase heart beat
trade name for medication
actual company responsible for manufacture of the drug Ex: Bay, Excedrin
ways inhalation anesthetics is delivered
anesthesia mask
ET tube
LMA
pseudocholinesterase
inability to wear off muscle relaxants after anesthetic is worn off
patient is awake but paralyzed
class III
less potential for abuse, current approved
class II
high abuse, current approved
when are antiemetics given?
when pt has had past history of N/V
agents for nerve block
xylocaine-lidocaine
examples of IV method drugs
sodium pentothal
propofol
What does a sedative do for a patient?
Help patient go to sleep, but doesn’t put them to sleep
what is epinephrine never used on?
tips of body
therapectic effects
responses after tx
MAC
conscious sedation
why is pt NPO?
patient losses normal gag reflex
aspiration of stomach contents into lungs
3 factors for explosion
flammable gas
source of ignition
oxygen
steriod hormones
reduce postop swelling
lidocaine emergency drug
cardiac arrhythmias
Reasons to premedicate a patient
Anesthesia reduced Smoother induction Reduce anxiety Increase pain threshold Amnesic
where is spinal injected?
between 3rd and 4th lumbar vertebrae
antiemetics
prevent postop N/V
example of muscle relaxants
anectine-succinylcholine
norcuron-vercuronium
curare-tubocurarine chloride
Examples of narcotics
Demerol- meperidine*
Morphine*
Sublimaze- fentanyl
what is pharmacology?
study of medicine
digitoxin
reduces high BP
does the LMA take place of the ET tube?
no
what does anticoagulant prevent?
thrombosis
muscle relaxants
affect skeletal muscles only, make body flaccid
what does the IV method do?
produces rapid general anesthesia
Mid 1800’s social events
Ether frolics- nitrous oxide
3 times a drug is ID’d
removed from storage
on field
ST passes to surgeon
hypnoanesthesia
entranced state where painful stimulation is lost and cooperation is complete
concern with local anesthesia
not used on young, nervous, apprehensive patients
position for administration of spinal anethesia
on side
sitting up
what happens in danger stage of general anesthesia?
could cause death
generic name for medication
proposed by the company that first develops a drug
Ex: aspirin
is the IV method sterile?
yes
6 rights
Patient Drug Dose Time/frequency Label Route
hearing during anesthesia
last sense to go
be careful what you say
don’t say knife, blade
measurement for volume
liter
why does patient need to be relaxed?
intubate
retract
abd viscera
NPO
after midnight
fasting required
indications
reasons to prescribe a certain drug
invasive monitoring devices
arterial catherization
CVP
art line
what is the disadvantage of epinephrine?
rise in BP
What are patient fears of surgery?
Death
Experiencing pain
Remaining awake during general anesthesia
Types of premeds?
IV or IM
class I
high abuse, no approved use
Atropine
Dries up secretions
side effects
expected reaction to a medication
oxycel
form clot
example of a dye?
methylene blue
what does a low dose of IV anesthesia produce?
conscious sedation
antacid
alters pH of gastric secretions and reduces gastric volume
gelfoam
form clot
adverse effects
undesirable affect of a med that can lead to organ damage
example of diuretic
mannitol
PRBC’s
left from one unit of whole blood after most of plasma is removed
Amnesic medication
Medication causing loss of memory during its time of effect
instillation route of administration med
body cavity, eye, ears, nose
flowmeter
measures the flow of gas
whole blood
provides all clotting factors
example of epidural
procaine-novocaine*
what is the rule with thrombin?
use immediately after mixing
Analgesia
Freedom from pain
infiltration local anesthesia
drug injected directly into tissue
treatment for shock
oxygen
volume replacement of blood
bier block
anesthesia for distal portion of upper extremity
nerve block
injected between operative site and entry of nerve to spinal cord
atropine emergency drug
increase heart and respiration rates
symptoms of shock
pale
clammy skin
rapid, weak pulse
observations regarding postop care of patient
skin remains dry
BP normal
no aspiration of secretions
propofol-diprivan
used for outpatient surgeries
intrathecal
not administered by nurse!!
administered into spinal fluid
example of contrast media
hypaque, renografin
sodum bicarbonate
treats metabolic acidosis
criccoid pressure
pressure on criccoid to reduce risk of aspiration
don’t let go until anesthesia says so
What is general anesthesia free from?
Infection
Hemorrhage
Pain
contrast media
radiopaque dye injected to identify its inner form
what does the anesthesia provider do at the end of surgery with oxygen?
100% oxygen to get rid of n20 and other agents
Bronchospasm
Spasmodic contraction of the muscular coat of the smaller divisions of the bronchi
what is preoxygenation?
100% of oxygen for 3-5 minutes
topical route of administration med
sublingual, buccal, nasal, vaginal, rectal
chemical name
actual formulation of its constituents
Ex: acetylsalicylic acid
Demerol
Reduces fear and anxiety
Risk factor of anesthesia
There is always risk involved even in the most ideal situation
What are examples of anticholinergics?
atropine*
robinul (glycopyrrolate)
scopolamine
oxygen fail safe valves
shut off flow of gas in absence of oxygen
family history important
if any close relative had unexplained death from anesthesia, you must be alerted about possible MH episode
subcutaneous injection
slow absorption
risk of tissue damage
what local anesthetic shouldn’t be injected?
cocaine
How can you reduce risk factor for anesthesia by reducing length of time?
Work efficiently
Knowledge of procedure
Be ready
local anesthesia
patient is awake
Endotracheal tube
Flexible tube used to maintain a patients airway
What is the purpose of anesthesia?
No discomfort
Normal physiology
Maintain optimal conditions
anticoagulant
prolongs blood clotting time
Who decides on anesthesia?
Surgeon
Anesthesia provider
Patient
dyes
stain skin
Examples of sedatives
Valium- diazepam*
Ativan- lorazepam
Versed- midazolam
spinal or intrathecal
local injected into subarachnoid space
Intubation
Insertion of endotracheal tube into the trachea by means of laryngoscope
example of antacids
ranitidine (zantac) citric acid (bacitra)
phases of general anesthesia
induction
maintenance
emergence
advantages of spinal anesthesia
inexpensive
rapid onset
muscle relaxs
Analgesics/ narcotics
Produces sleep, depresses CNS relieving pain
oxytocics
pitocin, ergotrate, methergine
What is balanced anesthesia?
Inhalation
Narcotics
Muscle relaxants
protamine sulfate
anticoagulant, binds with heparin to inactivate heparins effect
Anesthesia
Absence of essentially all sensation with or without the loss of consciousness
Anticholinergic
inhibits secretion of mucous
vaporizer
vaporizes liquid anesthetic into gas
What is constantly being monitored by anesthesia provider?
HR breathing Temperature BP pH CO2
xylocaine emergency drug
treats cardiace arrhythmias
PRN
as needed or when required
examples of infiltration local anesthesia
lidocaine*
sensorcaine*
emergence phase of anesthesia
patient begins to wake up
relaxation stage of general anesthesia
homeostasis maintained
topical local anestheisa
applied directly to surface
inhalation general anesthesia
anesthesia machine through respiratory system then absorbed by the blood
intra-articular injection
within a joint
what is the goal of general anesthesia?
asleep pain free muscles relaxed airway secured no memory
dermal injection
between the layers of the skin
neuromuscular blockade antagonism
neostigmine bromide-prostigmine*
heparin
needs to be counteracted by protamine sulfate
narcotic antagonists
narcan*
why is it not possible for an anesthetist to give the same anesthetic agent to every patient?
age/condition of patient
oral or enteral route of administration med
most convenient, comfortable, economical
What type of surgery did dr Morton and dr long do?
Removed tumor from face of patient
induction phase of anesthesia
begins with administration of agent
what stage do you want the patient to be in for surgery?
between 2 and 3
regional anesthesia
injected in or around particular group of nerves
excitement stage of general anesthesia
no eyelid reflux
pharmacodynamics
the action of the drug
noninvasive monitoring devices
pulse ox
temperature
BIS
sethoscope
What two men are known for their work with ether?
Dr. Long and Dr. Morton
maintenance phase of anesthesia
incision until near completion of procedure
agents for topical local anesthesia
cocaine (spray)
what happens with the liquids for inhalation?
they are poured into vaporizer then converted into gas
diuretics
draws fluid away from tissue and released into urinary system
intramuscular injection
active muscle+faster absorption
how does the ET tube protect the airway?
no aspiration or regurgitation
what is the reaction with an epidural?
agent is slowly absorbed into CSF through the dura mater
narrow spectrum antibiotics
for a few types of pathogens
examples of antibiotics
penicillin, erythromycins
drug used to treat malignant hyperthermia
dantrolene
epidural or peridural
injected into spinal column outside dura
broad spectrum antibiotic
long range of MO’s
additive
alters some aspects of the agent
what does local anesthesia go by?
body weight
example of spinal anesthesia
procaine-novocaine*
what is a patient feeling once premedicated?
still aware of surroundings but senses are not as sharp as normal
pharmacokinetics
movement of drugs within the body
where is the ET tube placed?
trachea to ensure an open airway
can go in nose if necessary
characteristics of general anesthesia
affects entire body
blood stream
loss of consciousness
blocks pain
Airway
A device used to prevent or correct obstructed respiratory passage
What is the most dangerous component of any surgical invention?
Anesthesia, because it’s a state close to death
methods of general anesthesia
inhalation
IV
rectal
benefits of local anesthesia
simple to use
post op care lessened
ideal for short operations
Extubation
Removal of endotracheal tube
IV premedications
Given in the holding area
Versed
plasma
fluid fraction of blood containing all clotting factors
measurement for length
meter
intravenous method
administered directly into blood stream by way of IV
what do you do for a child putting on the anesthesia mask?
flavor mask
Rx
take thou
what does cry do with anesthesia?
speeds action of anesthetic
Factors influencing anesthesia
Patient wishes
State of health
Mental status
Patient position
measurement for weight or mass
gram
what does epinephrine do?
lowers bleeding
increases duration of numbing effect
uses for topical local anesthesia
bronch
laryngoscopy
saying for converting
king, hector, did, drink, chocolate, milk
Sedative
Agent which exerts a soothing or tranquilizing effect
intra-cardiac injection
within the heart
What is the 11th principle?
The edge of any container that holds sterile supplies is not sterile
What is the 12th principle?
Contact with sterile goods is kept to a minimum
What is the fourteenth principle?
Some operative areas cannot be sterile. Steps are taken to keep contamination to a minimum
What is the sixteenth principe?
Sterile areas are continuously kept in view
What is an example of the 11th principle?
The ST would lift the instrument straight up and out of the package being careful not to let the item touch the edges because the edges of packages are not sterile
What is an example of the 12th principle?
The ST will pick and place an item where it belongs because excessive handling increases the chance of contamination
What is an example of the 14th principle?
The ST will put on a hat, mask, scrub suit perform the surgical scrub to eliminate as many MO’s as possible because the skin cannot be sterilized only surgically clean
What is an example of the 16th principle?
Once a sterile field is created the ST or CN would stay in the room because if the room is unattended an unidentified contamination may occur
Volatile
Liquid that evaporated at room temperature
What doesn’t LMA stop?
Aspiration
Profofol
More alkaline than blood
Ketamine
For children
BIS
Brain waves
50/50
Rapid onset, extends time
Overdose of bier block
Ringing in the ears
Adrenalin
Epinephrine
1 liter
Quart
500 cc
Pint
Eye irrigation
Balanced salt solution
Ad lib
As freely as desired
