Anesthesia Lectures – Flashcards

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analgesia
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absence of pain
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anesthesia
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absence of sensation
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amnesia
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absence of memory of procedure
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anxiolysis
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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
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delivery methods of general anesthesia
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-endotracheal tube (ETT) -laryngeal mask (LMA) -simple mask
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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
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local anesthesia
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-anesthetizing at the level of surrounding nerve trunks/roots -don't require anesthesia provider
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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
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-tip of uvula -soft and hard palate visible
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class 2 mallampatti classification
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-base of uvula -soft and hard palate visible
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class 3 mallampatti classification
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-perhaps base of uvula -soft and hard palate visible
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class 4 mallampatti classification
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hard palate visible
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red flag predictors of cardiac risk
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-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
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short hand method for standardizing and categorizing anesthesia risk
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class 1 ASA
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normal healthy patient
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class 2 ASA
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patient w/ mild systemic disease
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class 3 ASA
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patient w/ moderate to severe systemic disease
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who are the NPO guidelines not applicable to
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patients w/ delayed gastric emptying
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what medications are usually held prior to surgery
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-aspirin (7-14 days prior) -warfarin (4-5 days prior) -plavix (7 days prior) -NSAIDs (7-14 days prior) -oral hypoglycemics -MAO inhibitors
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differences between procedural sedation and monitored anesthesia care
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-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)
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mild sedation (1)
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largely aware of surroundings, mildly sleepy and relaxed
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moderate sedation (2)
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-slightly aware of surroundings -somnolent but easily aroused with verbal or tactile stimulation -airway maintained
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deep sedation (3)
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-unaware of surroundings -ventilation likely impaired -responds only to painful stimulation -may require anesthesia provider
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opioids
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used to reduce pain and have some sedative qualities
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benzodiazepines
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used to produce sedation, anxiolysis and amnesia and don't provide analgesia
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narcotics for procedural sedation and MAC
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-fentanyl -morphine -meperidine
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benzos for procedural sedation and MAC
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-midazolam (versed) -diazepam (valium)
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what drug reverses narcotics
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naloxone (narcan)
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what drug reverses sedatives
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flumazinil (romazicon)
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commonly used drugs for procedural sedation and MAC
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-narcotics -benzos -propofol -ketamine -reversal agents
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does ketamine provide sedation or analgesia
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both
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MOA of benzos
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bind to GABA receptors in brain
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who should use ketamine
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those w/ hospital privileges in deep sedation
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how are dreams and delirium from ketamine minimized
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co-administering small doses of benzos like midazolam
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what is the reversal agent for ketamine
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there is none
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miscellaneous info about ketamine
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-produces heavy secretions (consider co-administration of atropine or glycopylorrate as a drying agent) -can be given IM or IV -causes increased intracranial pressure
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what is the reversal agent for propofol
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there is none
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does propofol produce analgesia or sedation and amnesia
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sedation and amnesia
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what is optimal position to prevent airway obstruction
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sniffing position
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what should be done when oversedation or airway obstruction are suspected
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-assess patients level of consciousness -pts responding only to painful stimulation are deeply sedated and at risk for airway compromise -consider administering reversal agents
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what causes MAC to become GA
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-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
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stage 1 GA
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amnesia and analgesia
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stage 2 GA
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excitement or delirium
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stage 3 GA
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surgical anesthesia divided into 4 planes
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at what plane do you stop at in GA
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planes 3 & 4
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at what stage of GA should a patient not be stimulated
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stage 2 (excitement or delirium)
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what drug can be used to suppress the cough reflex and blunt the sympathetic response to intubation
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narcotics
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what induction drug maintains BP and tends to increase HR
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ketamine
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why are muscle relaxants needed to facilitate intubation
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to relax vocal cords and muscles of jaw and neck
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2 types of muscle relaxants
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-depolarizing -nondepolarizing
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depolarizing muscle relaxants
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-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
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nondepolarizing muscle relaxants
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-slower onset, longer duration -rocuronium, vecuronium, pancuronium -not good for short surgical cases -reversible w/ meds
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when do you NOT use succinylcholine
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-pts w/ history of malignant hyperthermia -hyperkalemia -neuromuscular disease -recent CVA -paraplegia -routine use in children
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PROS of GA w/ endotracheal tube
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gold standard for securing airway and protecting against aspiration
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CONS of GA w/ endotracheal tube
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-inability to intubate -airway instrumentation can be traumatic -results in increased anesthetic requirement -possibility of laryngospasm after extubation
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what drug treats vagally induced bradycardia
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atropine and glycopyrolate
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what drug treats drops in BP when HR is normal or slow
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ephedrine
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what drug treats drops in BP when HR is rapid
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phenylepherine
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malignant hyperthermia
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rare genetic condition characterized by a severe hypermetabolic state and rigidity of the skeletal muscles which is triggered by certain anesthetic agents
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malignant hyperthermia (MH) symptoms
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-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
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MH treatment
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-treat early -call MH hotline -turn off triggering agents and used high oxygen flows -administer dantrolene -treat hypermetabolic activity
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meds for post-op nausea and vomiting (PONV)
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-decadron -metoclopromide -ondansetron -dolasetron
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indications for regional anesthesia
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-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
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relative contraindications of regional anesthesia
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-chronic back pain -hypovolemia -preexisting neurologic disorders -local infection near regional site -ASA, NSAID, coumadin use -uncooperative patient
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absolute contraindications of regional anesthesia
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-patient refusal -infection at puncture site -generalized sepsis -severe coagulation abnormalities -raised ICP
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onset of spinal and epidural anesthesia
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-sympathetic and sensory fibers blocked first -motor fibers blocked last
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what dermatomes need to be blocked for lower leg tourniquet use
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L4, L5, S1, S2
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what dermatomes need to be blocked for thigh tourniquet use
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L2, L3
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