question

analgesia

answer

absence of pain

question

anesthesia

answer

absence of sensation

question

amnesia

answer

absence of memory of procedure

question

anxiolysis

answer

absence of anxiety

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areflexia

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absence of reflexes

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antiemesis

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absence of nausea and vomiting

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muscle relaxation

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absence of muscle tone

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regional anesthesia

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anesthetizing a larger section of the body via the placement of local anesthesia in the area of a nerve plexus, larger nerve, or spinal canal

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general anesthesia

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-rendering patient unconscious and insensitive to pain -voluntary and reflex motor responses are diminished or absent

question

delivery methods of general anesthesia

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-endotracheal tube (ETT) -laryngeal mask (LMA) -simple mask

question

combined regional/general anesthesia

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usually a GA for the surgery and a long acting or continuous regional block for post op pain control

question

local anesthesia

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-anesthetizing at the level of surrounding nerve trunks/roots -don't require anesthesia provider

question

procedural sedation of monitored anesthesia care (MAC)

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-administration of IV drugs and O2, all w/ standard patient monitoring -airway reflexes should remain intact (trachea not intubated) -lower doses of same anesthetic drugs that are used in general anesthesia

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class 1 mallampatti classification

answer

-tip of uvula -soft and hard palate visible

question

class 2 mallampatti classification

answer

-base of uvula -soft and hard palate visible

question

class 3 mallampatti classification

answer

-perhaps base of uvula -soft and hard palate visible

question

class 4 mallampatti classification

answer

hard palate visible

question

red flag predictors of cardiac risk

answer

-hx of MI in last 6 months -cardiac surgery/stents w/in 12 months -angina in last 30 days -CHF in last 30 days prior to surgery -new onset a-fib

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ASA physical status classification

answer

short hand method for standardizing and categorizing anesthesia risk

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class 1 ASA

answer

normal healthy patient

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class 2 ASA

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patient w/ mild systemic disease

question

class 3 ASA

answer

patient w/ moderate to severe systemic disease

question

who are the NPO guidelines not applicable to

answer

patients w/ delayed gastric emptying

question

what medications are usually held prior to surgery

answer

-aspirin (7-14 days prior) -warfarin (4-5 days prior) -plavix (7 days prior) -NSAIDs (7-14 days prior) -oral hypoglycemics -MAO inhibitors

question

differences between procedural sedation and monitored anesthesia care

answer

-who's pushing the drugs -where is it being done -what's the backup plan

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levels of sedation

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-mild sedation (1) -moderate sedation (2) -deep sedation (3)

question

mild sedation (1)

answer

largely aware of surroundings, mildly sleepy and relaxed

question

moderate sedation (2)

answer

-slightly aware of surroundings -somnolent but easily aroused with verbal or tactile stimulation -airway maintained

question

deep sedation (3)

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-unaware of surroundings -ventilation likely impaired -responds only to painful stimulation -may require anesthesia provider

question

opioids

answer

used to reduce pain and have some sedative qualities

question

benzodiazepines

answer

used to produce sedation, anxiolysis and amnesia and don't provide analgesia

question

narcotics for procedural sedation and MAC

answer

-fentanyl -morphine -meperidine

question

benzos for procedural sedation and MAC

answer

-midazolam (versed) -diazepam (valium)

question

what drug reverses narcotics

answer

naloxone (narcan)

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what drug reverses sedatives

answer

flumazinil (romazicon)

question

commonly used drugs for procedural sedation and MAC

answer

-narcotics -benzos -propofol -ketamine -reversal agents

question

does ketamine provide sedation or analgesia

answer

both

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MOA of benzos

answer

bind to GABA receptors in brain

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who should use ketamine

answer

those w/ hospital privileges in deep sedation

question

how are dreams and delirium from ketamine minimized

answer

co-administering small doses of benzos like midazolam

question

what is the reversal agent for ketamine

answer

there is none

question

miscellaneous info about ketamine

answer

-produces heavy secretions (consider co-administration of atropine or glycopylorrate as a drying agent) -can be given IM or IV -causes increased intracranial pressure

question

what is the reversal agent for propofol

answer

there is none

question

does propofol produce analgesia or sedation and amnesia

answer

sedation and amnesia

question

what is optimal position to prevent airway obstruction

answer

sniffing position

question

what should be done when oversedation or airway obstruction are suspected

answer

-assess patients level of consciousness -pts responding only to painful stimulation are deeply sedated and at risk for airway compromise -consider administering reversal agents

question

what causes MAC to become GA

answer

-inadequate localization -paradoxical effects from sedation -prolonged surgery or expanded scope -airway obstruction leading to need for GA -painful body position or body part and pt can't lie still

question

stage 1 GA

answer

amnesia and analgesia

question

stage 2 GA

answer

excitement or delirium

question

stage 3 GA

answer

surgical anesthesia divided into 4 planes

question

at what plane do you stop at in GA

answer

planes 3 & 4

question

at what stage of GA should a patient not be stimulated

answer

stage 2 (excitement or delirium)

question

what drug can be used to suppress the cough reflex and blunt the sympathetic response to intubation

answer

narcotics

question

what induction drug maintains BP and tends to increase HR

answer

ketamine

question

why are muscle relaxants needed to facilitate intubation

answer

to relax vocal cords and muscles of jaw and neck

question

2 types of muscle relaxants

answer

-depolarizing -nondepolarizing

question

depolarizing muscle relaxants

answer

-fast onset, short duration -succinylcholine used for securing the airway in an emergency or for pt considered at risk for aspiration of stomach contents -not reversible

question

nondepolarizing muscle relaxants

answer

-slower onset, longer duration -rocuronium, vecuronium, pancuronium -not good for short surgical cases -reversible w/ meds

question

when do you NOT use succinylcholine

answer

-pts w/ history of malignant hyperthermia -hyperkalemia -neuromuscular disease -recent CVA -paraplegia -routine use in children

question

PROS of GA w/ endotracheal tube

answer

gold standard for securing airway and protecting against aspiration

question

CONS of GA w/ endotracheal tube

answer

-inability to intubate -airway instrumentation can be traumatic -results in increased anesthetic requirement -possibility of laryngospasm after extubation

question

what drug treats vagally induced bradycardia

answer

atropine and glycopyrolate

question

what drug treats drops in BP when HR is normal or slow

answer

ephedrine

question

what drug treats drops in BP when HR is rapid

answer

phenylepherine

question

malignant hyperthermia

answer

rare genetic condition characterized by a severe hypermetabolic state and rigidity of the skeletal muscles which is triggered by certain anesthetic agents

question

malignant hyperthermia (MH) symptoms

answer

-masseter muscle rigidity -unexplained tachycardia and arrythmias -tachypnea if pt is breathing spontaneously -hypercarbia -core temp increase (late sign) -metabolic acidosis -skin changes -renal function altered

question

MH treatment

answer

-treat early -call MH hotline -turn off triggering agents and used high oxygen flows -administer dantrolene -treat hypermetabolic activity

question

meds for post-op nausea and vomiting (PONV)

answer

-decadron -metoclopromide -ondansetron -dolasetron

question

indications for regional anesthesia

answer

-no absolute indication -may improve outcome in selected situations -blunts stress response to surgical stimulation -lowers incidence of postop thromboembolic events in lower limb surgery -extends analgesia into postop period

question

relative contraindications of regional anesthesia

answer

-chronic back pain -hypovolemia -preexisting neurologic disorders -local infection near regional site -ASA, NSAID, coumadin use -uncooperative patient

question

absolute contraindications of regional anesthesia

answer

-patient refusal -infection at puncture site -generalized sepsis -severe coagulation abnormalities -raised ICP

question

onset of spinal and epidural anesthesia

answer

-sympathetic and sensory fibers blocked first -motor fibers blocked last

question

what dermatomes need to be blocked for lower leg tourniquet use

answer

L4, L5, S1, S2

question

what dermatomes need to be blocked for thigh tourniquet use

answer

L2, L3

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