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Priniclpes Of Anesthesia > Week 1: Basics and assessment > Flashcards

Week 1: Basics and assessment Flashcards

1
Q

Basics to Anesthesia Set UP

A

SOAP: Suction, Airway, Pharm

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2
Q

Suction (in SOAP)

A

Make sure suction is on and accessible

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3
Q

Oxygen (SOAP)

A

Have oxygen setup and ambubag
Check gas machine

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4
Q

Airway (SOAP)

A

-ETT w/ or w/o stylet
-LMA
-Oral airway
-Esophageal stethoscope or temp probe
-Oral Airway

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5
Q

Pharm (SOAP)

A

Meds LABLED:
-Strength
-Date and time
-Initials

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6
Q

MS MAIDS (OR setup)

A

Machine
Suction

Monitor
Airway equipment
IV poles
Drugs
Special equipment

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7
Q

MS MAID
(Machine)

A

Machine check and backup supplies (Ambu!)

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8
Q

MS MAIDS
(Suction)

A

Suction is on and working, at head of bead for easy access

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9
Q

MS MAIDS
(Monitor)

A

Have all monitors for appropriate case
-BP
-Tele
-O2
-ETCO2

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10
Q

MS MAIDS
(airway equipment)

A

Tubes, blades, various airways:
-ETT w/ or w/o stylet
-Oral airway
-LMA

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11
Q

MS MAIDS
(Drugs)

A

table top and case specific drugs ready
labeled if drawn up

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12
Q

MS MAIDS
(Special equipment)

A

Two drape clips, bair hugger, fluid warmer, OG tube, IV pumps, swa ganz/CVP monitor, shoulder roll, pillows

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13
Q

Anesthesia Stages

A
  1. Pre- induction
  2. induction
  3. Maintenance
  4. Emergence
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14
Q

Induction stage, must

A

Ensure adequate oxygenation and airexchange with bag valve mask

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15
Q

Maintenance stage

A

Sustain surgical anesthesia

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16
Q

Emergence Stage

A

Discontinuation of anesthesia–>return to consciousness and protective physiologic reflexes are regained

reversals for muscle relaxants are given

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17
Q

Depth of Anesthesia

A

Degree to which CNS is depressed

Useful parameter for individualizing anesthesia

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18
Q

Stage 1 depth of anesthesia

A

Analgesia - amnesia and reduced awareness

Pt progresses to drowsy, poor coordination

VS and pupils UNCHANGED

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19
Q

Stage II depth of anesthesia

A

Increased SNS activity = Excitement - delirium and possibly combative behavior

Larygospasm can occur
Pupils are dilated

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20
Q

Stage III anesthesia depth

A

Adequately anesthetized for procedure

eventual loss of spontaneous movement
Eyelid reflex disappears
gag reflex is obtunded

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21
Q

Stage IV anesthesia depth

A

Medullary paralysis

Too much, overdose, arrest

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22
Q

Pain is

A

Conscious perception of noxious stimuli

NOT absence of movement

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23
Q

Prys-Roberts theory

A

Anesthesia is a state which patient does not perceive or recall noxious stimuli

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24
Q

Modern thoughts on anesthesia depths

A

Drug-induced non response to stimulation
CALIBRATED
against strength of surgical stimulus and diffiiculty of suppressing the response

Depth depends on what is happing in procedure
(i.e. Toe bunion vs open heart surgery)

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25
Q

Theory of General Anesthesia

A

Loss of response and perception of all external stimuli

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26
Q

Where in CNS to anesthetics work?

A

Spinal chord to inhibit movement

Hippocampus and amygdala to cause amnesia

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27
Q

Most relevant site of anesthetic action

A

Synapse

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28
Q

Basic anesthetic MOA

A

Presynaptic inhibition of neurotransmitter release –> enhancement of inhibitory neurotransmitter effects–>inhibition of excitatory neurotransmitter effect

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29
Q

Anesthetics modulate:

A

Ligand-gated ion channels

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30
Q

Ligand-gated ion channel mediate

A

fast excitatory and inhibitory neurotransmission

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31
Q

3 Ligand activated ion channels in anesthetics and basic ligand function

A

5-HT3
Glycine
Nicotonic

Ligand channel activation inhibits fast excitatory synaptic transmission and/or facilitates fast inhibitory synaptic transmission

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32
Q

Anesthetics and Glycine

A

Anesthetics increase affinity of receptor for glycine (potentiate glycine activated currents)

possibly contributes to action of volatile and some parenteral anesthetics

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33
Q

5HT3 channels are affected by

A

Volatiles but NOT propofol

possible responsible for PONV

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34
Q

Nicotinic receptors and anesthesia

A

Inhibited

may contribute to amnesia

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35
Q

Why are ligand gated ion channels a logical target for anesthetics?

A

Selective effects on these channels could either
INHIBIT fast excitatory synaptic transmission and/or FACILITATE fast inhibitory synaptic transmission

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36
Q

Most important inhibitory neurotransmitter in CNS

A

GABA

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37
Q

GABA

A

inhibitory neurotransmitter

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38
Q

GABA receptor location

A

abundantly in CNS

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39
Q

GABA nuerotranmitter type

A

ligand gated Cl - channel

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40
Q

GABAa and anesthetics

A

Potentiated by many anesthetics
Probably target molecular target of anesthetics

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41
Q

Glutamate

A

Major excitatory neurotransmitter in CNS

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42
Q

Glutamate -activated ion channels

A

nonselective, involved in fast excitatory synaptic transmission

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43
Q

Categories of glutamate activated ion channel

A

-NMDA
-AMPA
-Kainate

44
Q

NMDA receptors and anesthesia

A

Volatile anesthetics may inhibit NMDA-activated currents

45
Q

NMDA - type glutamate receptors and ketamine

A

Ketamine is a potent and selective inhibitor of NMDA activated currents

46
Q

NMDA type glutamate receptors are

A

inhibited by Ketamine and N2o2 and xenon

47
Q

MAC

A

Minimum alveolar concentration

48
Q

One MAC =

A

alveolar partial pressure of a gas at which 50% of humans do not respond to surgical incision

ie.e sero 2% (2% is the MAC)

49
Q

MAC-awake

A

Min alveolar concentration of anesthetic that inhibits response to COMMAND in 505 OF PATIENTS

1/3 of MAC
i.e. sero 2%, MAC awake is 0.6%

50
Q

MAC-BAR

A

Min alveolar concentration of anesthetic that blunts autonomic response

1.6 x higher than MAC
i.e Sero 2%
MAC-BAR is 3.2%

51
Q

Disadvantages of MAC

A

Highly dependent on anesthetic end point (i.e. different stimuli require different MAC values)

52
Q

Factors that reduce MAC (need less)

A

-older age
-hypothermia
-Depressant meds
-A2 agonist
-Acute ethanol consumption
-Hypoxemia
-anemia (less than 3.4)
-Hypotension
-Pregnancy
-N2O, Ketamine, lidocaine, clonidne, alpha-methyldopa, reserpine, chronic amphetamine use, lithium

53
Q

Factors that increase MAC (need more)

A

any hypermetabolic state
-young age
-hyperthermia
-hypermetabolism
-chronic ETOH consumption
-Acute administration of amphetamine
-redheaded females

54
Q

Factors with no effect on MAC

A

Anesthesia duration
gender
hyper/hypocapnia
metabolic alkalosis
HTN
Neuromuscular blocking agents (muscle relaxants)
Hypyer/hypothyroidism

55
Q

Nitrous Oxide effects on body

A

Increase HR
Increases SVR
no significant BP change

56
Q

Isoflurane effects on body

A

respiratory irritant
mild Increases heart rate
Significant BP drop
Decreases SVR

57
Q

Desoflurane effects on body

A

Respiratory irritant
moderate Increase HR
Decrease BP
Decrease SVR

58
Q

Sevoflurane effects on body

A

Seizure activity
No HR change
decrease BP
Decrease SVR

59
Q

Gas with highest metabolism by liver

A

Sevo (5-8%)

59
Q

N20 Advantage

A

reduces MAC

60
Q

N20 disadvantages

A

expansion of closed air spaces
diffusion hypoxia

61
Q

Isoflurane disadvantage

A

Trigger for MH

62
Q

Diasdvantage of sevoflurane

A

Trigger for MH

63
Q

Thipental is a/an______ and contraindicated in _____

A

IV induction agent
patients with porphyria

64
Q

ASA clasification system purpose

A

Asses and communicate patients comorbidities for anesthesia planning and risk assessment

65
Q

ASA class 1

A

Normal, healthy patient

nonsmoking, minimal ETOH

66
Q

ASA class II

A

Mild systemic disease w/o substantial function limitations

i.e. smoker, social ETOH, pregnancy, obesity, well controlled DM/HTN/Lung disease

67
Q

ASA III

A

Severe systemic disease and substantial limitations

poorly controlled DM, HTN COPD, morbid obesity, ETOH dependence, pacemaker, moderately reduced EF, ESRD,
Greater than 3 months from stent/MI/Stroke/CAD

68
Q

ASA IV

A

Severe systemic disease CONSTANT THREAT TO LIFE

less than 3 motnhs MI, CVA, stents, CAD

ongoing cardiac ischemia or valve dyfxn

Severe EF reduction

Sepsis/DIC/ARDS/ESRD

69
Q

ASA V

A

Moribound, not expected to survive without procedure

i.e. ruptured aneurysm, massive trauma, intracranial bleed with mass effects, ischemic bowel with organ dysfunction

70
Q

ASA VI

A

Brain dead, organs to be removed for donation

71
Q

ASA E

A

Emergency operation

72
Q

Benefits of beta blockers

A

-Restores oxygen supply/demand mismatch
-reduces perioperative ischemia
-Redistribute coronary blood flow to the sub endocardium
-stabilizes plaques
-increases ventricular fibrillation threshold

73
Q

Medications affecting perianesthesia

A

-ACE inhibiitors
-Beta blockers
-Calcium channel blockers
-Diuretics
-Antiarrythmics

74
Q

Airway assessment components

A
  1. Mallampati Classifcation
  2. Jaw protrusion
  3. Range of neck movement
  4. 3-3-2
75
Q

3-3-2

A

Mouth opening 3 fingers between incisors

Thyromental distance 3 fingers (distance from tip of mandible to anterior neck

Mentohyoid distance 2 fingers - between base of mandible and thyroid notch

76
Q

TM distance ratings

A

Good >7.5 cm
Moderate 6-7.5
Poor: <6cm

77
Q

Mouth opening score

A

Good >4cm
moderate: 3-4 cm
poor: <3cm

78
Q

Mallampati classes and general indication

A

Stage II-IV = 50% of people difficult to intubate

79
Q

Cormack and Lehane Grade

A

view of vocal chords

80
Q

Mandibular mobility test

A

jaw thrust forward

81
Q

Herbal supplement use key points

A

FDA does not regulate! Should be d/c’d 2 weeks prior if possible

82
Q

4 herbal Gs that increase bleeding

A

Garlic
Ginger
GInkgo
Ginseng

83
Q

BMI calculation

A

height squared (m)

84
Q

Action of metabolic equivalents

A

Measures functional capacity (cardiovascular assessment)

85
Q

METS and proceeding to surgery

A

> 4 METs can proceed even with risk factors if managed with statins and beta blockers

<4 METs should be further assessed to identify cardiac risk

86
Q

Cardiac risk assessment question (beyond history)

A
  1. Are you able to walk 2 blocks without stopping (regardless of limiting symptoms)
  2. Are you able to climb 2 flights of stairs without stopping (regardless of limiting symptoms)?
87
Q

one MET is defined as

A

The amount of oxygen consumed while sitting at rest

88
Q

One met is equal to

A

35 mL O2 per kg/min or 250 mL 02/min

89
Q

MET calculation

A

VO2 = oxygen consumtion

VO2 x 3.5 mLO2/kg/min

90
Q

Highest risk of perioperative MI

A

Unstable angina- surgery should be canceled until patient is stabilized

91
Q

CV symptoms to assess for

A

Syncope
Fatigue
Chest pain
Dyspnea

92
Q

If patient has BMS (bare mental state)

A

delay elective surgery for 30 days

93
Q

If patient has drug eluding stents

A

delay surgery for 6-12 months or more

94
Q

Thiopental

A

-Barbiturate
-contraindicated in patients with porphyria
-gaba-a agonist
-histamine release (no asthma)

95
Q

Propofol

A

DIRECT gaba-a agonist: inhibits neuronal cell excitation

antiemetic effect pain
on injection

96
Q

Etomidate

A

Gaba-a agonist
-suppresses adrenocortical function
-triggering agent for porphyria
-increases PONV
-minimal effects on CV system

97
Q

Ketamine

A

NMDA receptor ANtagonist
-increases ICP, cerebral blood flow, cerebral metabolic rate
-Bronchodilator
-Preserves airway reflexes
-increases secretions
-dissociatic anesthesia
-trigger to patient with porphyria
-Increases BP and pulse

-caution in pts with HTN, angina, CHF, psychiatric diseases, airway issues (silent aspiration)

98
Q

Benzodiasapine

A

gaba-agonist

Midazolam, lorazepam, diazapam

anterograde amnesia

Little effect on CV system unless hypovolemic

Causes cerebral vasoconstriction (decrease CBF and ICP)

99
Q

Dexmedetomidine (precedex)

A

Alpha-2 receptor agonist (prevents central sympathetic response)
-Bradycardia and hypotension
-does not cause resp depression

100
Q

Methohexital

A

Barbituate
-triggering for porphyria
-Gold standard for ECT

101
Q

unconciousness

A

reticular activating system

102
Q

amnesia

A

hippocampus and amygdala

103
Q

analgesia

A

spinothalmic tract

104
Q

immobility

A

ventral horn

Priniclpes Of Anesthesia (19 decks)

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