week 3 Live discussion: Anesthesia

Question 1

MAC

Answer 1

Monitored Anesthesia Care (conscious sedation).

Question 2

Local Anesthesia

Answer 2

Local anesthetics are sodium channel blockers. They block sodium, therefore reducing excitability of neuron, preventing nerve depolarization.

Peripheral: topical application, nerve block

Central : epidural

Example: ends in “Caine” . lidocaine, cocaine

Question 3

NMBA (neuro muscular blocking agents)

Answer 3

Ex: succinylcholine

Act in the neuromuscular junction, mimics ACH (acetylcholine) to paralyze the muscle.

Indication: are paralytics to help achieve paralysis (example uses: intubation).

Question 4

General Anesthetics

Answer 4

Example: propofol (looks like milk).

Question 5

Depolarizing NMBA

Answer 5

Example: Succinylcholine “sucs” a depolarizing paralytic.

Question 6

Non- Depolarizing NMBA

Answer 6

Happens in the neuromuscular junction. They do not depolarize the muscle. Instead they bind to receptors that acetylcholine normally binds to, and block the effects of acetylcholine to the muscle. In other words, they are an acetylcholine antagonist.

These drugs end in - ium.

Examples : coronium, aronium, pancuronium,

Question 7

Malignant Hyperthermia

Answer 7

Genetic and hereditary. Life threatening emergency usually seen in the OR or PACU.

Main agent associated with this is succinylcholine “succs” . Other agents that can cause this are inhaled gases like nitrous oxide.

When exposed to these agents, it can stimulate calcium release into your muscle cells, making your muscles contract and become rigid. Increase in HR and CO2 .

Question 8

L A S T
Local Anesthetic Systemic Toxicity

Answer 8

When local anesthetic gets into blood circulation and start spreading throughout the entire body becoming systemic, it can cause toxicity which can lead to CNS and Cardiovascular complications.

Question 9

Spinal headache

Answer 9

Can occur after a lumbar puncture. Blood patch is a procedure that can help patch the area of the spine that is leaking out CSF. Best position for patient to lay is supine.

Question 10

Propofol

Answer 10

Causes relaxation and sleep during surgery.

Increases level of GABA. (When GABA is increased, it relaxes the body and puts you to sleep).

Question 11

Benzodiazepines
( - pam, - lam)

Answer 11

Used for sedation, anxiety , insomnia.

Antidote: flumazenil

Question 12

Non- Benzodiazepines

Answer 12

Used for patients with insomnia.

Example: ambien (zolpidem)

Question 13

Barbiturates
( - tal)

Answer 13

Used for sedation, seizures, insomnia.

*Carry more adverse effects

Ex: phenobarbital

Question 14

Muscle relaxants

Answer 14

Used for muscle spasms.

Ex: baclofen, cyclobenzaprine, dantrolene

Question 15

Dantrolene

Answer 15

Counteracts malignant hyperthermia by inhibiting calcium release to muscles.

Question 16

Muscle relaxant : Central

Answer 16

These meds interfere with muscle reflexes

Example: Baclofen (acts on Gaba B receptors to relax muscle).

Question 17

Muscle relaxant : Peripheral
(Dantrolene)

Answer 17

This medication blocks calcium from going to the muscles to reduce spasticity.

Also given for malignant hyperthermia due to excess calcium in the muscles.

Example: Dantrolene (which is the only peripheral acting muscle relaxant).

Question 18

Antiepileptics
(Broad & Narrow spectrum)

Answer 18

Used for: abnormal electrical discharge such as seizures .

How they work: they can increase Gaba or they can block sodium channels

1. Generalized seizure: electrical discharge happening on both sides of the brain.
2. Focal or Partial seizure: happening on one side of the brain

• Broad spectrum antiepileptics treat a variety of seizure types (benzos)
• Narrow spectrum antiepileptics only treat specific seizures types (gabapentin)

Question 19

CNS stimulants

Answer 19

C - compliance
N - No toxicity
S - seizure precautions

Question 20

Barbiturate OD treatment

Answer 20

No antidote.

Can administer activated charcoal.