Pharmacology for Surgical Technician Chapter 14 & 15 – Flashcards
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Who have published standards of care regarding patient monitoring?
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ASA (American Society of Anesthesiologists) and AANA (American Association of Nurse Anesthetists)
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What literally means "without sensation"?
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anesthesia
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What are the four major types of anesthetic techniques?
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Local, regional, sedation/monitored anesthesia care (MAC), and general
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Who is monitoring direct observation of the patient?
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anesthesia provider
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Circulation is monitored by?
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electrocardiography and blood pressure
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The patient's oxygen saturation is monitored by?
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direct observation and by the use of the pulse oximeter
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What is the process of recording the electrical impulses of the heart?
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electrocardiography
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What is the ECG of an adult resting?
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60-100 bpm
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What is the ECG of children one to ten years old?
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70-130 bpm
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What is the ECG of infants (1-11 months)?
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80-120 bpm
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What is the ECG of Newborns (0- 30 days)?
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70-190 bpm
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Oxygen saturation should be above 95% in health patients
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Pulse oximetry function
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Less than 120 mm Hg systolic and less than 80 mm Hg diastolic
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Blood pressure function
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37 C or 98 F
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Temperature function
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Sustained carbon dioxide waveform greater than 30 mm Hg indicates correct placement of endotracheal tube
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Capnometry function
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A scaled number between 45 and 60 indicates an appropriate depth of general anesthesia
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Consciousness function
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Zero of the four twitches indicates complete muscle relaxation
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Neuromuscular function
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Establish patient baseline waveform and monitor changes; digital values range 90-140/60-90 mm Hg
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Arterial pressure function
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Establish patient baseline waveform and monitor changes; digital values are inconsistent and less reliable than waveform analysis?
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Central venous pressure function
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Establish patient baseline waveform and monitor changes; digital values range 15-25/8-15 mm Hg but are less reliable than waveform
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Pulmonary artery pressure function
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The surgical technologist in the circulating role may assist the anesthesia provider in placing the electrodes, which should be securely adhered to areas of clean, dry skin.
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True
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In what system are electrodes placed on each shoulder, each hip, and in the fifth intercostal space near the left anterior axillary line?
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five lead system
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What is the ECG supplemented by?
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auscultation with a precordial stethoscope
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What is listening to the sounds of the chest, e.g., the heart rate, rhythm, and pulmonary sounds called?
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Auscultation
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What is also used to assess respiratory rate and lungs sounds as well as verify placement of airway devices used in general anesthesia?
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Auscultation
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What is a noninvasive measure of the oxygen saturation of blood?
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Pulse oximetry
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Where is the two-sided sensory probe attached? (pulse oximetry)
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finger, toe, or earlobe
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What can affect readiings of pulse oximetry?
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intravenous dyes (methylene blue)
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Vasoconstriction due to hypothermia can affect reading when using a finger sensor
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True
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An audible signal reflects?
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pulse rate
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The signal tone indicates?
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saturation
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What must be loud enough to be heard by all members of the operating room team?
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audible signal
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What is the measure of the force of blood against the vessel wall?
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Blood pressure
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Where is blood pressure typically measured?
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Brachial artery
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The point at which the pulse is first detected is?
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systolic pressure
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The point at which the pulse can no longer be detected is?
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diastolic pressure
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Temperature may be assessed from any number of locations, including?
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skin, axilla, bladder, esophagus, and ear
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Core temperatures lower than 36 degrees C indicate?
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hypothermia
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What alters several normal body functions and it is associated with an increased risk of surgical site infections?
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hypothermia
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What patients are particularly vulnerable to a drop in temperature?
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Pediatric and geriatric
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What is measurement of carbon dioxide (CO2) exhaled by the patient, called end-tidal CO2?
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Capnometry
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What is used to verify adequate ventilation whenever the patient is under heavy sedation or general anesthesia?
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Capnometry
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An adapter is connected to the breathing circuit and a small diameter piece of tubing extends from the adapter to the analyzer in? (Capnometry)
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In general anesthesia
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An oxygen cannula with a CO2 sampling tube is available to monitor the?
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sedated patient
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The concentration of expired CO2 is measured and displayed as a continuous graph and in numerical value.
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True
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Capnometry is an extremely valuable tool in the assessment of respiratory function and can serve a critical role in early detection of problems such as?
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Esophageal intubation, compromised ventilation, or malignant hyperthermia
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What is not frequently used in current practice?
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SARA (system for anesthetic and respiratory analysis)
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What is also used to assess the extent to which muscle relaxants are wearing off and the patient is becoming ready to breathe on his o her own after surgery?
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peripheral nerve stimulation
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Arterial catheterization and pressure monitoring, central venous catheterization and pressure monitoring, and pulmonary artery catheterization are examples of what techniques?
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Advanced monitoring
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What is usually placed in the radial artery and connected to a transducer that records continuous, immediate, and highly accurate measurement of blood pressure?
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Arterial pressure-monitoring catheter
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Placement of an arterial line is indicated for a number of reasons, including potential for rapid changes in blood pressure, frequent sampling of arterial blood for blood gas analysis (ABGs), or when routine blood pressure measurement is inaccurate.
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True
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What is positioned in the superior vena cava and is used to assess the volume of blood returning to the heart?
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CVP line (Central venous pressure-monitoring catheter)
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What is also used to assess the need for fluid replacement and to prevent fluid overload?
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CVP line
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What is guided through the heart into a branch of the pulmonary artery to obtain measurements of central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac output?
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Pulmonary artery catheter (such as a SwanGanz catheter)
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What are most frequently used in adult patients during cardiac surgery, lung transplantation, and liver transplantation?
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Pulmonary artery catheter
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During heart surgery, ________ may be used to assess cardiac function.
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TEE (transesophageal echocardiography)
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What can be used to observe cardiac wall motion and valve function, assess intravascular fluid volume, and to identify the presence of air in the heart?
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TEE (transesophageal echocardiography)
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What is the administration of an anesthetic agent to nerve endings in the surgical site?
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Local anesthesia
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What is accomplished by the administration o f the same type of agents, but at a group of nerves called a plexus?
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Regional anesthesia
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What interferes with the brain's ability to interpret pain impulses coming from anywhere in the body?
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General anesthesia
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What is administered to the immediate surgical site?
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Local anesthetic
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What interferes with sensory nerve endings in the operative area; thus, they block transmission of pain impulses to the brain?
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Local anesthetic (such as Lidocaine)
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When local anesthesia is used without an anesthesia provider present who is assigned to monitor the patient's vitals during the surgical procedure?
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Registered nurse
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Who may administer sedatives as ordered by the surgeon?
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Registered nurse
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Only physically healthy and psychologically stable patients undergoing brief, uncomplicated surgical procedures are appropriate candidates for local anesthesia without monitoring by an anesthesia provider.
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True
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What is a specialized type of local infiltration called?
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tumescent anesthesia
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What type of anesthesia is widely used in aesthetic surgery such as liposuction?
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Tumescent anesthesia
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What is used in plastic surgery for limited facial procedures, such as excision of lesions or minor scar revisions?
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Local anesthesia
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In urology, cystoscopy may be performed with?
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Topical anesthetic agent
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What blocks sensory nerve impulses only at the site of injection or application, the patient cannot feel pain in that area but is still able to move muscles and feel pressure?
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Local anesthesia
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Local anesthetics agents are chemically classified as either?
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aminoesters or aminoamides
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Topical cocaine and injectable procaine (Novocain) are what?
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aminoesters (local anesthesia agents)
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What is a powerful vasoconstrictor, meaning that is reduces bleeding and helps shrink mucous membranes?
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Cocaine
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What are adverse effects of this that are primarily seen in the central nervous system that include excitement, depression, and may lead to respiratory arrest?
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Cocaine
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Injection of lidocaine (Xylocaine) and the topical application or either phenylephrine (Neo-Synephrine) or the nasal spray oxymetazoline (Afrin) to shrink mucous membranes are more commonly used for?
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Nasal local anesthesia (instead of cocaine)
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Benzocaine is?
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aminoesters (local anesthesia agent)
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What is a topical agent with rapid onset and a duration of 30 to 60 minutes?
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Benzocaine (Local anesthesia agent)
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What is applied prior to bronchoscopy or fiberoptic endotracheal intubation?
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Benzocaine
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What is Tetracaine (Pontocaine)?
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aminoesters (local anesthesia agent)
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What is a potent and long acting local anesthetic?
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Tetracaine (Pontocaine)
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What may be used for topical anesthesia prior to cataract surgery, spinal anesthesia, a type of regional anesthesia, because it provides rapid onset and excellent motor and sensory block lasting 90 to 120 minutes?
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Tetracaine (Pontocaine)
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Lidocaine (Xylocaine), bupivacaine (Marcaine), Ropivacaine (Naropin) are?
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The most commonly used aminoamides (local anesthetic agents)
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Mepivacaine (Carbocaine) is?
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Aminoamides less commonly used
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All of local anesthetic agents (aminoamides), except what may be combined with dilute epinephrine?
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Ropivacaine (Naropin)
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What cause some vasodilation, which speeds absorption?
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Most local anesthetics (except ropivacaine)
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What is a potent vasoconstrictor?
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epinephrine
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When ___ is combined with a local anesthetic agent it causes local vasoconstriction, slowing the absorption of the agent into the circulatory system? This action keeps the local anesthetic in the surgical site longer, thus increasing the duration of effect.
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epinephrine
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Where shouldn't epinephrine go?
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fingers, toes, ears, nose, or penis
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local anesthetics with epinephrine are labeled?
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Red
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Local anesthetics without epinephrine are labeled?
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Blue
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What is the most common local anesthetic agent use today?
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Lidocaine
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What is fast acting and rapidly metabolized?
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Lidocaine
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Novocain is the trade name for?
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Procaine
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What causes more allergic reactions?
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Aminoester
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What is the generic name of Marcaine, Sensorcaine?
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Bupivacaine
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What is an aminoamide anesthetic, which is about four times more potent than lidocaine and has a longer duration from four to eight hours?
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Bupivacaine
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What is no longer used for obstetric surgery because of increased risk for cardiotoxicity?
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Bupivacaine 0.75%
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What is also contraindicated for intravenouse regional anesthesia because of toxicity?
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Bupivacaine 0.75%
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What is the generic name for Naropin?
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Ropivacaine
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What is an aminoamide local anesthetic agent release for used in 1996? It is similar in duration to bupicacaine, but is generally less cardiotoxic.
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Ropivacaine (Naropin)
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What is the generic name of Carbocaine and Polocaine?
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Mepivacaine
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What is another aminoamide anesthetic that has a simliar potency to lidocaine, with slightly longer duration (40-90 minutes)? But is used less often because it doesn't have a significant advantage over lidocaine?
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Mepivacaine (Carbocaine, Polocaine)
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The names of all local anesthetic agents end in?
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-caine
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Solutions Available: 0.25%, 0.5%, 0.75% with a duration of 4-8 hours, what local anesthetic agent is this?
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Bupivacaine (Marcaine, Sensorcaine)
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Solutions available are: 4% and 10% with a duration of 0.5-2 hours, what local anesthetic agent is this?
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Cocaine
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Solutions available are: 0.5%, 1%, 1.5%, 2% with a duration of 0.5-1.5 hours, what local anesthetic agent is this?
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lidocaine with epinephrine (Xylocaine)
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Solutions available are: 1%, 1.5%, 2%, 3% with a duration of 0.75-1.5 hours, what local anesthetic agent is this?
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Mepivacaine (Carboncaine, Polocaine)
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Solutions available are: 0.2%, 0.5%, 1%, with a duration of 2-6 hours is what local anesthetic agent is this?
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Ropivacaine (Naropin)
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The letter "i" occurs in amide and in the first part of the name of each amide agent: l"i"docaine, bup"i"vacaine, rop"i"vacaine, and mep"i"vacaine what agents is it?
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aminoamides
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______ of local anesthetics is most commonly due to inadvertent intravascular injection during peripheral nerve infiltration.
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System toxicity
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What blocks nerves (not just nerve endings) at specific locations; thus, it provides a larger anesthetized area?
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Regional anesthesia
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What involves injecting a local anesthetic into the nerves that supply the operative region?
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Regional anesthesia
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What can affect sympathetic, sensory, and motor nerve supply, so an anesthetized limb may be immobile as well as numb?
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Regional blocks
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What are the most commonly used regional blocks?
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spinal and epidural (collectively referred to as central neuraxial blockade CNB)
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What takes more time to administer than general anesthesia?
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Regional blocks
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What are agents injected intrathecally, that is, through the dura mater into the subarachnoid space and cerebrospinal fluid in the lumbar area of the spine?
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Spinal Anesthesia
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What is injected at the end of spinal cord, usually not higher than L3 or L4?
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Spinal Anesthesia
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What anesthetizes the entire lower body?
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spinal anesthesia
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Who commonly assists the anesthesia provider during injection of a spinal anesthetic by helping the patient to get into optimum position?
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circulator
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Skin around the injection site area is prepped with an?
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antiseptic agent and a small fenestrated sterile drape (is placed over the area)
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What is injected through skin and subcutaneous tissue prior to insertion of a spinal needle through the ligaments and dura?
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Local anesthesia
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What is used to reconfirm placement of spinal anesthesia?
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CSF (cerebral spinal fluid)
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What is another technique that is commonly used to assess the level of spinal anesthesia?
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pinprick
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What is it when the patient feels a sharp ____ on an unblocked area of skin and a dull sensation on a blocked area?
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pinprick
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What is usually quicker to administer than an epidural and provides more intense sensory and motor blockade?
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spinal anesthesia
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Proper needle placement is clearly verified by the appearance of?
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CSF (cerebral spinal fluid)
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What are the most common local anesthetic agents used for anesthesia?
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tetracaine and bupivacaine (both lasting 90-120 minutes)
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What may be added to prolong blockade, but it may also delay postoperative urination during recovery. (it is also less frequently used for out patient surgery)
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Epinephrine
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Instead of using epinephrine what may be added to prolong duration of spinal anesthesia without prolonging recovery time?
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Opioid such as fentanyl (10-25 mcg) or sufentanil (10mcg)
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What is used for procedures of the lower abdomen, perineum, and lower extremities?
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Spinal anesthesia
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It is often used for transurethral resection of the prostate gland or bladder tumors, for lower leg vascular procedures such as embolectomy, for select orthopedic procedures such as total knee arthroplasty, and for cesarean sections?
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Spinal anesthesia
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Why will there be a drop in blood pressure with administration of a spinal or epidural anesthetic?
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because of vasodilation
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Who has a higher risk for significant bradycardia under spinal anesthesia?
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Younger, more athletic patients (with lower resting heart rates)
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What is another complication of spinal anesthesia?
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postdural puncture headache
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What can be severe and is thought to be associated with the creation of a persistent tear or slit in the dura?
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postdural puncture headache
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Severe postdural puncture headaches may be treated by administration of a?
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blood patch
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What is an injection of 10 to 15 mL of the patient;s blood at the original spinal injection site?
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blood patch
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An extreme manifestation of neurotoxicity attributed to the use of 5% lidocaine in spinal anesthesia is?
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Cauda equina syndrome
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What is a paralysis of nerves resulting in lower extremity muscle weakness and impaired bowel and bladder function?
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cauda equina syndrome
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What is not used in spinal anesthesia because of the potential for neurotoxicity?
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Lidocaine (in high concentrations 5%)
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What are used to deliver analgesics to patients with various types of chronic pain. But these devices are not used for surgical anesthesia, but may be palced in the surgical setting as part of the patient's treatment for chronic pain issues?
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Intrathecal catheters and pumps
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What is an anesthesia agent injected into the space surrounding the dura mater?
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epidural anesthesia
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A single injection may be administered or a catheter may be placed for continuous infusion or repeated injections is?
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Epidural
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Sedation may be given to help relieve discomfort of injection and catheter placement (except in pregnant because sedation would also affect the baby)?
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Epidural
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When indicated for use in pediatric patients, an epidural is placed after?
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general anesthesia is induced
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In an epidural the correct placement is verified when?
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CSF does not enter the syringe
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Common agents used for epidural anesthesia include?
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lidocaine, bupivacaine, and ropivacaine
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What may be added to prolong duration and small doses of opioids may be used to reduce the concentration of the local anesthetic agent?
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Dilute epinephrine (1:200,000)
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What is an excellent choice for obstetric epidural anesthesia?
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Bupivacaine (0.25% and 0.5%)
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In obstetric anesthesia, concentration of 0.125% plus very low doses of fentanyl are used to provide?
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walking epidurals (sensory block without motor block)
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What may be used as an adjunct to general anesthesia in select patients to minimize the amount of agents needed; they may also be used for postoperative pain control after such procedures as thoracotomy?
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epidural blocks
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Epidural anesthesia has some advantages over spinal anesthesia including?
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reduced risk of hypotension and less incidence of postdural puncture headache (because the dura is not intentionally punctured)
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What may be administered at levels about L3 to L4?
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epidural anesthesia
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What requires greater volume of agent (typically 20 mL) than spinal (typically 1-2 mL) and has a longer onset of action?
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Epidural anesthesia
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What is preferred over spinal anesthesia when the surgical procedure duration is variable or extended or when prolonged postoperative analgesia is necessary?
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epidural
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What is a type of epidural block injected into the epidural space via the sacral canal?
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Caudal anesthesia
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What may also be used in conjunction with general anesthesia for urologic and lower-extremity surgical procedures in children and for postoperative pain management?
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Caudal blocks
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What are injected behind the eye into the muscle cone to block branches of the oculomotor nerve?
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Retrobulbar blocks
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Retrobulbar blocks may be administered by?
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ophthalmologist or an anesthesia provider
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These blocks may be used for procedures requiring a motionless, anesthetized eye.
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Retrobulbar blocks
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A typical injection is made up of equal parts or 0.5% to 0.75% bupivacaine and 2% lidocaine with 150 units of hyaluronidase is what?
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Retrobulbar blocks
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Extremity block is also called?
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peripheral nerve block
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These types of blocks may be used for procedures on distal arms and legs, and the hand and fingers, and foot and toes?
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Extremity block
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What are more frequently blocked? The upper or lower extremities?
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upper extremities (arm, hand, fingers)
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The arm may be blocked at several locations including?
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brachial plexus, median radial, and ulnar nerves
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The leg may be blocked at the?
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femoral, obturator, or sciatic nerves
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Preoperative preparation for extremity block includes premedication with ____ and ___ to lessen discomfort during administration of the block?
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anxiolytics and analesics
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1% to 1.5% lidocaine, which provides onset in ten to twenty minutes and a block lasting two to three hours?
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extremity blocks
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Ropivacaine (0.5%) and bupivacaine (0.375%-0.5%) have a slower onset but last six to eight hours?
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extremity blocks
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The nerves to be blocked are identified with?
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nerve stimulator or ultrasound probe
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What may be used for procedures on the hand, forearm, or elbow?
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Brachial plexus
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What is one of the most common extremity blocks is?
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IVRA (intravenous regional anesthesia)
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Intravenous regional anesthesia is also called?
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Bier block
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What is the most common agent used for IVRA?
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Lidocaine
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What is faster and easier to administer than brachial plexus block and onset is immediate?
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IVRA (intravenous regional anesthesia)
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What is particularly useful for soft tissue procedures lasting one hour or less such as release of carpal tunnel, trigger finger, or moderate dupuytren contracture?
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IVRA
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What is not generally used for IVRA because of the risk of cardiotoxicity?
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Bupivacaine
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Epinephrine is not used with lidocaine to prolong effect because IVRA duration is dependent upon tourniquet time rather than an agent's particular duration?
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True
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The most significant risk of IVRA is?
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tourniquet failure
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Another contraindication to IVRA is?
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traumatic laceration
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What could cause a toxic volume of anesthetic agent to rapidly enter systemic circulation?
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tourniquet failure
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What may allow uncontrolled release of the agent from the limb?
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traumatic laceration
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Who defined the term monitored anesthesia care (MAC)?
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ASA (American Society of Anesthesiologists)
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A specific anesthesia service for a diagnostic or therapeutic procedure that includes all aspects of anesthesia care before, during, and after the procedure?
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MAC (monitored anesthesia care)
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Agents that may be administered during MAC include? (monitored anesthesia care) 2
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Midazolam (Versed)
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Agents that may be administered during MAC include? (monitored care anesthesia)
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Midazolam (Versed), Fentanyl (Sublimaze), Alfentanil (Alfenta), Meperidine (Demerol), and Propofol (diprivan)
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Agents that may be administered during MAC include? (monitored anesthesia care)
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Midazolam (Versed), Fentanyl (Sublimaze), Alfentanil (Alfenta), Meperidine (Demerol), and propofol (diprivan)
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Agents that may be administered during MAC include?
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meperidine (Demerol)
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Agents that may be administered during MAC include? (monitored anesthesia care) 1
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propofol (Diprivan)
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colonoscopy, cataract extraction, pacemaker insertion, venous access port or catheter insertion, or placement of a dialysis access graft are?
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common procedures for MAC
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What is a systemic state of anesthesia, rather than anesthesia in a large area (regional) or specific site (local)?
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General anesthesia
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What is defined as a drug induced temporary loss of consciousness during which patients are not arousable, even by painful stimulation?
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General anesthesia
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The decision to use general anesthetic is based both on the requirements of the?
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surgical procedure being performed and patient
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Thoracic or abdominal cavities use what type of anesthesia?
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General anesthesia
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What is used when there are multiple operative sites or for a procedure on an area that is difficult to block regionally?
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General anesthesia
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Examples of surgical procedures on multiple locations include?
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skin grafts, breast reconstruction, and autologous bone grafts
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Surgical procedures that require an absolutely motionless field, such as retinal surgery, are also performed under?
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General anesthesia
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Patient age, cognitive ability, mental or emotional state, and (when possible) patient preference are what?
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patient factors that influence the selection of general anesthesia
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Who are almost never candidates for regional or local anesthesia, regardless of the surgical procedure being performed?
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children
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1. patient remains unconscious 2. Is pain free 3. retains non memory of the event 4. is immobile 5. maintains normal cardiovascular function are what?
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The desired result of general anesthesia
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Drugs used to produce an unconscious state affect the reticular activating system in the?
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brain stem
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Agents used to produce analgesia (opioids) bind with receptors on cell membranes in the brain and spinal cord, altering the transmission of?
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pain signals
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What works at the neuromuscular junction of skeletal muscles?
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muscle relaxants
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In most situations, the goal is to have patients awake, alert, and breathing on their own before transport to the?
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PACU (post-anesthesia care unit)
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Ventilation system, breathing circuits, oxygen and nitrous oxide (N2O) central pipeline hoses and backup tanks, vaporizers (for volatile gases), pressure regulators and gas-mixing components, and gas-scavenging systems are all?
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components of anesthesia workstation
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What are the four major goals of general anesthesia?
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unconsciousness, analgesia (painlessness), amnesia, and muscle relaxation
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Two methods, or routes, are used to administer general anesthetic agents, which are?
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inhalation and intravenous injection
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What is the technique that uses a combination of inhalation and intravenous agents to accomplish general anesthesia?
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balanced anesthesia
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What is another technique that is less common, is useful for select patients undergoing major vascular procedures because it decreases the amount of general anesthetic agents required, helping to maintain cardiovascular stability, and provides an effective means of postoperative pain control?
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regional blocks
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What are the five phases of general anesthesia?
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preinduction, induction, maintenance, emergence, and recovery
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The intraoperative phases of general anesthesia are?
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induction, maintenance, and emergence
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What is the postoperative phase?
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Recovery
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What includes preoperative assessment and preparation of the patient, both physically and psychologically?
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preinduction
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What classification systems are used to categorize the patient;s risk for difficult airway management?
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Mallampati and Cormack-Lehane scores
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What begins as the patient is admitted to the preoperative holding area and continues up to the point of administration of anesthetic agents?
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preinduction phase
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Who secures the safety belt over the patient;s thighs and obtains warm blankets for patient comfort?
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circulator
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What begins when medications are administered to initiate general anesthesia and concludes when an adequate depth of anesthesia is reached and the patient's airway is secured?
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induction phase
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Fentanyl, droperidol, and nitrous oxide are the agents used to produce?
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neurolepatanesthesia
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What was used in specific situations but is rarely used in current practices?
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neurolepatanesthesia
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The patient's airway may be manages with a mask for surgical procedures of short duration when muscle relaxation is not required, such as myringotomy with placement of pressure equalization (PE) tubes.
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True
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This is also known as a supraglottic airway and consists of a flexible shaft attached to a silicone mask that is inflated to seal the airway, what is it?
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LMA (laryngeal masked airway)
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is inserted and positioned in the laryngopharynx to cover the epiglottis and larynx.
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LMA (laryngeal masked airway)
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Procedures on the oral cavity, obesity, hiatal hernia, gastroesophageal reflux disease (GERD), and low pulmonary compliance are?
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contraindications to LMA
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Many patients are not appropriate candidates for masked or laryngeal masked airway and require more precise control of the airway. In addition, many surgical procedures are of longer duration, require deep muscle relaxation, or are preformed in a lateral or prone position, all of which require a more highly controlled airway.
answer
True
question
Respiration are controlled by mechanical ventilation through a tube placed into the patient's trachea called?
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ET (endotracheal tube)
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Are made of clear, flexible polyvinyl chloride (PVC) and are sized by internal diameter in 0.5-mm increments. External marking on the tube are in centimeters and are used to determine the length of tube insertion.
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ET (endotracheal tube)
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The placement of an endotracheal tube is called?
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intubation
question
What begins after induction agents and muscle relaxants are administered to render the patient unconscious and immobile?
answer
intubation
question
Who assist the anesthesia provider during intubation and should be present at the patient's head as soon as induction begins?
answer
circulator
question
What is an induction technique that may be used for patients who are at an increased risk for gastric reflux and pulmonary aspiration? Also is used for patients who have not been NPO (especially trauma patients), and those with a history of hiatal hernia, GERD, previous gastrointestinal surgery, diabetes, or obesity.
answer
RSI (rapid sequence induction)
question
What is used to secure and control the airway quickly?
answer
RSI (rapid sequence induction)
question
What is it call when you apply the thumb and index finger to the cricoid cartilage, gently compressing the esophagus downward against the cervical vertebrae, in an effort to prevent gastric contents from entering the trachea and lungs?
answer
cricoid pressure (also known as sellick maneuver)
question
Preparation for intubation prior to induction begins with administration of an ___ such as glycopyrrolate (Robinul) 0.2 mg IV approximately 30 minutes before intubation.
answer
antisialagogue (an agent to dry salivary secretions)
question
The patient's gag reflex may be suppressed with the use of a topical anesthetic agent such as?
answer
Cetacaine (a combination of benzocaine, tetracaine, and butamben)
question
What is a typical vasoconstrictor? (1)
answer
cocaine
question
What is a typical vasoconstrictor? 2
answer
oxymetazoline (Afrin)
question
What is a typical vasoconstrictor 3
answer
phenylephrine
question
The ET tube is secured in position, and an adequate depth of anesthesia is achieved to begin the surgical procedure, ____.
answer
concluding the induction phase of anesthesia
question
What begins as the patient's airway is established and secured and continues until the surgical procedure has been completed?
answer
maintenance phase
question
What requires a much deeper level of anesthesia than superficial procedures?
answer
Abdominal and thoracic
question
What are considerable indicators of pain respose?
answer
sweating and lacrimation (production of tears), increase in BP, or heart rate
question
Patients who are hemodynamically unstable (such as trauma patients) are also?
answer
at greater risk for awareness
question
WHat refers to ability to recall events. That is conscious recollection.
answer
explicit memory
question
What is the term used to describe subconscious processing of information by the brain, demonstrated by changes in the performance of tasks?
answer
implicit memory
question
Prevention measures include administration of ____ for amnesia (provides anterograde amnesia only) and avoidance of the use of neuromuscular blocking agents whenever possible.
answer
midazolam
question
When is the deepest muscle relaxant needed?
answer
abdominal procedures
question
When is the longest muscle relaxant administrated?
answer
maintenance phase
question
The depth of neuromuscular blockade is monitored with the use of?
answer
peripheral nerve stimulator
question
What administrates an electrical stimulus to a nerve muscle group and the motor response is assessed, indicating the extent of muscle blockade?
answer
peripheral nerve stimulator
question
A series of four electrical stimuli delivered approximately 0.5 seconds apart.
answer
TOF (TRAIN-OF-FOUR)
question
Presence of four of the four twitches indicates?
answer
no muscle relaxation (TOF)
question
Zero of the four twitches indicates
answer
complete muscle relaxation (TOF)
question
When do muscle relaxants wear off?
answer
superficial layers are closed
question
What begins, during which anesthetic agents are discontinued and allowed to wear off?
answer
emergence phase
question
The emergence phase ends when the patient is transported to the?
answer
PACU
question
If the patient has been intubated, particular care is used to assess the appropriate timing for removal of the endotracheal tube, a process called?
answer
extubation
question
Multiple agents are used to provide an unconscious state, analgesia, amnesia, and muscle relaxation.
answer
True
question
Intravenous induction agents, analgesics, inhalation agents, neuromuscular blocking agents, an reversal agents are?
answer
Major categories of anesthesia medications
question
What are administered to produce a rapid loss of consciousness?
answer
Intravenous induction agents
question
Is used for induction and is a sedative?
answer
Benzodiazepines
question
Hynotic agent? 1 (intravenous induction agent)
answer
barbiturates (thiopental and methohexital)
question
Hynotic agent? 2 (Intravenous induction agent)
answer
ketamine (Ketalar)
question
hynotic agent? 3 (Intravenous induction agent)
answer
etomidate (Amidate)
question
Hynotic agent (various chemical categories) include? (Intravenous induction agent)
answer
Ketamine (Ketalar), Etomidate (Amidate), and Propofol (Diprivan)
question
WHat can be used during maintenance of general anesthesia?
answer
hynotic agents
question
Benzodiazepines include? 1
answer
midazolam (Versed)
question
Benzodiazepines include? 2
answer
diazepam (Valium)
question
BEnzodiazepine includes?
answer
Midazolam (Versed), Diazepam (Valium), and Lorazepam (Ativan)
question
What is used to treat anxiety but not for induction and/or maintenance of anesthesia?
answer
Lorazepam (Ativan)
question
What may be administered for induction in a dose of 0.1 to 0.3 mg/kg IV, but it causes a greater drop in blood pressure than diazepam?
answer
Midazolam (Versed)
question
what are ultra-short acting hypnotic agents derived from barbituric acid?
answer
Barbiturates
question
What is ultra-short acting and is more often used for procedures that take place outside the operating room such as cardioversion? (Barbiturates)
answer
Methohexital (Brevital)
question
What takes only seconds to travel from the injection site to the brain; thus, it is rapidly taken up by the brain, but it is also rapidly eliminated? (Barbiturates)
answer
Thiopental (Pentohal)
question
What is a dissociative hypnotic agent used for induction of general anesthesia? Chemically related to the drug phencyclidine (PCP) or angel dust, it is a powerful amnestic and analgesic-- the only hypnotic agent with this property. (intravenous induction)
answer
Ketamine (Ketalar)
question
When this is used patients appear to be awake and their eyes may be open; however they are dissociated from their environment and they do not consciously recall surgical events? Can cause hallucinations and distorted visual, auditory, and tactile sensations.
answer
Ketamine (ketalar)
question
What is a hypnotic agent that produces an unconscious state in less than a minute but provides no analgesia and no muscle relaxation?
answer
Etomidate (Amidate)
question
What is hypnotic agent chemically unrelated to any other anesthetic agent?
answer
propofol (Diprivan)
question
Adverse effects include hypotension, bradycardia, and apnea, what is the agent?
answer
propofol (diprivan)
question
What are the intravenous induction agents sedative (benzodiazepines) used in general anesthesia?
answer
midazolam (versed) and diazepam (valium)
question
what are the intravenous induction agents, hypnotics (barbiturates) used in general anesthesia?
answer
thiopental (pentothal) and methohexital (brevital)
question
What are the intravenous induction agents, hypnotics (various chemical categories) used in general anesthesia?
answer
propofol (diprivan), ketamine (ketalar), and etomidate (amidate)
question
What are given during maintenance of general anesthesia to prevent pain during surgery?
answer
Analgesics
question
What are natural opioids?
answer
morphine and codeine
question
Synthetic opioids 1
answer
fentanyl (sublimaze)
question
synthetic opioids 2
answer
alfentanil (alfenta)
question
synthetic opioids 3
answer
sufentanil (sufenta)
question
synthetic opioids 4
answer
remifentanil (ultiva)
question
what is 100 more potent than morephine? this drug has a rapid onset, about 30 seconds with a duration of 20 to 40 minutes.
answer
Fentanyl (sublimaze)
question
Has one fourth the potency of fentanyl and its onset of action is rapid. Lasting just ten to fifteen minutes.
answer
Alfentanil (alfenta)
question
is five to ten times more potent than fentanyl, but it is more rapidly cleared from the body providing a very rapid recovery. Onset is rapid with effects lasting 20 to 45 minutes.
answer
Sufentanil (sufenta)
question
is the newest ultra short acting opioid and is 20 to 40 times more potent than alfentani. ONsent of effects occurs in one to three minutes, but duration is only 5 to 10 minutes.
answer
Remifentanil (ultiva)
question
The potency of inhalation agents is compared using a measurement called?
answer
minimum alveolar concentration
question
If the abbreviation MAC is used in referene to an inhalation agent (used in general, not local, anesthesia) is stands for?
answer
minimum alveolar concentration
question
If the abbreviation MAC is used in reference to an anesthesia method involving administration of sedation, anxiolysis, and/or analgesia and patient assessment provided by an anesthesia professional it stand for?
answer
monitored anesthesia care
question
The first inhalation anesthetics used were?
answer
ether, chloroform, nitrous oxide, and cyclopropane
question
Of these inhalation agents only what is used currently?
answer
nitrous oxide
question
The disadvantage of inhalation agents include an increased potential for?
answer
cardiovascular depression and lack of postoperative analgesia
question
WHat are the most common inhalation agents in use today?
answer
nitrous oxide (gas)
question
What are the most common inhalation agents in use today that are volatile liquid (vapor)?
answer
isoflurane (forane), desflurane (suprane), and sevoflurane (ultane)
question
If the name of an agent ends in -ane it is probably an?
answer
inhalation anesthetic
question
Inhalation anesthetic agents (except for nitrous oxide) either alone or in combination with succinylcholine (anectine, quelicin) have been identified as triggering agents of a rare but life threatening condition called?
answer
malignant hyperthermia
question
What are administered to relax skeletal muscles for intubation and surgery?
answer
neuromuscular blockers
question
There are three types of muscle tissue?
answer
cardiac, smooth, and skeletal
question
what is an area where the motor nerve axon is very near the muscle fiber?
answer
neuromuscular junction
question
The space between an axon and a muscle fiber is called?
answer
synapse
question
The neurotransmitter at the neuromuscular junction is?
answer
ACh (acetylcholine)
question
When ___ is released from the axon, it diffuses across the synapse (synaptic cleft) and binds to receptor sites on the cell membrane of the muscle fiber (the sarcolemma).
answer
ACh (acetylcholine)
question
ACh causes a wave of depolarization to spread across the muscle fiber to T-tubules, which conduct the wave of depolarization deep into the muscle fibers.
answer
True
question
As a result of the spreading wave of depolarization, __ is released from its storage sites within the sarcoplasmic reticulum.
answer
calcium
question
The presence of calcium ions allows the contractile elements of the muscle, actin and myosin, to engage resulting in muscle contraction
answer
True
question
THere are two basic types of muscle relaxants classified according to their action on the motor end-plate, they are?
answer
depolarizing and nondepolarizing
question
Is the only depolarizing muscle relaxant used.
answer
Succinylcholine (Anectine, Quelicin)
question
Effects are seen in 30 to 60 seconds. Duration of effects is also short, usually only 5 to 10 minutes.
answer
Succinylcholine (Anectine, Quelicin)
question
What has been identified as a triggering agent for malignant hyperthermia?
answer
succinylcholine (anectine, quelicin)
question
Nondepolarizing muscle relaxant? 1
answer
pancuronium bromide (pavulon)
question
nondepolarizing muscle relaxant 2
answer
atracurium besylate (Tracrium)
question
nondepolarizing muscle relaxant 3
answer
vecuronium bromide (norcuron)
question
nondepolarizing muscle relaxant 4
answer
cisatracurium (nimbex)
question
nondepolarizing muscle relaxant 5
answer
rocuronium bromide (zemuron)
question
nondepolarizing muscle relaxant 1
answer
mivacurium chloride (mivacron)
question
nondepolarizing muscle relaxant 7
answer
tubocurarine chloride (curare)
question
Prevent muscle contractions by binding to cholinergic receptors, preventing ACh from binding to the receptor sites.
answer
nondepolarizing muscle relaxant
question
What does not cause fasciculations?
answer
nondepolarizing
question
is small involuntary muscle twitches just under the skin
answer
fasciculation
question
Nondepolarizing muscle relaxants may be reversed if necessary with an antagonist such as?
answer
neostigmine (prostigmine) and Edrophonium (Tensilon)
question
Nondepolarizing muscle relaxant reversal agent for anesthetics?
answer
edrophonium (tensilon)
question
Opioid analgesic reversal agent? 1
answer
naloxone (narcan)
question
Opioid analgesic reversal agent? 2
answer
nalmefene (revex)
question
Opioid analgesic reversal agent? 3
answer
naltrexone (ReVia, trexan)
question
Benzodiazepines reversal agent?
answer
flumazenil (mazicon)
question
Is a depolarizing agent with a duration of 4 to 6 minutes?
answer
succinylcholine (anectine)
question
is a nondepolarizing agent with a duration of 6 to 10 minutes?
answer
mivacurium chloride (mivacron)
question
is a nondepolarizing agent with a duration of 20 to 35 minutes?
answer
atracurium besylate (tracrium)
question
is a nondepolarizing agent with a duration of 25 to 30 minutes?
answer
vecuronium bromide (norcuron)
question
is a nondepolarizing agent with a duration of 45 to 75 minutes?
answer
cisatracurium besylate (nimbex)
question
is a nondepolarizing agent with a duration of 15 to 85 minutes?
answer
rocuronium bromide (zemuron)
question
is a nondepolarizing agent with a duration of 40 to 65 minutes?
answer
pancuronium bromide (pavulon)
