Term
| Which anesthetic agents can cause malignant hyperthermia? |
|
Definition
| all inhalational agents (halothane, sevoflurane, isoflurane, desflurane) and succhinylcholine |
|
|
Term
| What are the side effects of anesthesia? |
|
Definition
| nausea, incomplete pain relief, nerve injury, malignant hyperthermia |
|
|
Term
| What is malignant hyperthermia? |
|
Definition
| autosomal dominant inherited myopathy, defect of the ryanodyne receptor (calcium release channel), intracellular calcium increases 500-fold causing a hypermetabolic state with muscle rigidity and acute severe rhabdomyolysis after exposure to triggering agents |
|
|
Term
|
Definition
| dantrolene= works by inhibiting SR calcium release without affecting uptake (reduces mortality from 70% to less than 5%) |
|
|
Term
| What is the incidence of MH in children versus adults? |
|
Definition
| 1/15,000 in children versus 1/50,000 in adults |
|
|
Term
| What is multimodal (targeted) analgesia? |
|
Definition
| analgesic regimens that employ a variety of agents in small doses to block pain perception at different sites in the peripheral and central nervous system |
|
|
Term
| T/F Multimodal analgesia allows for faster recovery and earlier hospital discharge. |
|
Definition
|
|
Term
| Conduction blocking profile of local anesthetics depends on... |
|
Definition
| lipid solubility, degree of protein binding, and pKa |
|
|
Term
| Lipid solubility determines anesthetic ____. |
|
Definition
|
|
Term
| Degree of protein binding determines... |
|
Definition
|
|
Term
| How can you increase the uptake of local anesthetics? |
|
Definition
| additio of sodium bicarb to raise the pH closer to the pKa to drive more extracellular local anesthetic into the nonionized or base form |
|
|
Term
| What causes allergy to local anesthetics? |
|
Definition
| release of PABA (paraaminobutyric acid from amino esters) |
|
|
Term
| Name two of the more common local acting anesthetics. |
|
Definition
| bupivacaine and ropivicaine |
|
|
Term
| Which location of injection are associated with the highest blood levels of local anesthetics? |
|
Definition
| highest= intercostal block; 2nd highest= caudal block; 3rd highest= epidural |
|
|
Term
|
Definition
| long acting bupivicaine in tiny lipid based particles |
|
|
Term
| How long does exparel last? |
|
Definition
| 72 hours (rather than 8 hours) |
|
|
Term
| What instrument is used to ensure correct placement of a nerve block? |
|
Definition
|
|
Term
| What are the components of anesthesia? |
|
Definition
| analgesia, unconsciousness, amnesia, and muscular relaxation |
|
|
Term
| What are the components of aneshtesia at lower concentrations? |
|
Definition
| analgesia, unconsciousness, amnesia |
|
|
Term
| What are the effects of anesthesia at higher concentrations? |
|
Definition
|
|
Term
| What is the purpose of neuromuscular blockers? |
|
Definition
| facilitates intubation, provides muscular relaxation during surgery, fascilitates artificial ventilation |
|
|
Term
| How many vesicles of ACh are at the end of each nerve terminal? How many are exocytosed with each impulse? |
|
Definition
|
|
Term
| After it is released, ACh is rapidly hydrolyzed by... |
|
Definition
|
|
Term
| What are the nicotinic effects of ACh? |
|
Definition
| autonomic ganglia stimulation and skeletal muscle stimulation |
|
|
Term
| What are the two broad types of neuromuscular junction blocking drugs? |
|
Definition
| depolarizers and nondepolarizers |
|
|
Term
| What is the MOA of depolarizers? |
|
Definition
| ACh like so they stimulate the cholinergic receptor and depolarize the muscle cell |
|
|
Term
|
Definition
| succinylcholine (diactylcholine) |
|
|
Term
| T/F It is normal for the patient to have fasiculations after you give them succinylcholine. |
|
Definition
|
|
Term
| What are the side effects of succinylcholine? |
|
Definition
| increases intracranial pressure, increases intraocular pressure, increases serum potassium levels, leg and muscle pain (caused by fasciculation), triggering agent for malignant hyperthermia |
|
|
Term
| What is the MOA of nondepolarizers? |
|
Definition
| bind to the post-synaptic receptor of the motor endplate and competitively prevent acetylcholine from binding to that receptor |
|
|
Term
| Name some examples of nondepolarizers. |
|
Definition
| vecuronium, pancuronium, rocuronium |
|
|
Term
| How do you reverse the action of nondepolarizers? |
|
Definition
| acetylcholinesterase inhibitor (e.g. neostigmine) in combination with an antimuscarinic agent (atropine or glycopyrolate) |
|
|
Term
| How do you select which muscle relaxant to use? |
|
Definition
| duration of action, cardiovascular effects, class of muscle relaxant |
|
|
Term
| T/F Rocuronium has a lot of cardiovascular side effects. |
|
Definition
|
|
Term
| What is the duration of action of succinylcholine? |
|
Definition
|
|
Term
| What's the difference between atracurium and cis-atracurium? |
|
Definition
| less side effects (reduction in histamine release and more cardiac stability) and slightly shorter acting |
|
|
Term
| Why is rocuronium the most popular nondepolarizers? |
|
Definition
| quick onset of approximately a minute and a half |
|
|
Term
| In what situations would you use atracurium? |
|
Definition
| if you have a patient with kidney failure and/or liver failure because atracurium doesn't require any organs for its metabolism and elimination and is therefore called "organ independent" |
|
|
Term
| Why was rapicuronium pulled from the market? |
|
Definition
| quicker onset and shorter duration; pulled from the market because it was associated with bronchospasm |
|
|
Term
| Besides AChE inhibitor/antimuscarinic, what else can you use to reverse nondepolarizers? |
|
Definition
|
|
Term
| Why might you want to use sugammadex over neostigmine/glycopyrrolate combo? |
|
Definition
| you avoid side effects such as PONV and heart rate changes |
|
|
Term
| Name some examples of antimuscarinics. |
|
Definition
| atropine or glycopyrolate |
|
|
Term
| Name some acetylcholinesterase inhibitors. |
|
Definition
| neostigmine or edrophonium |
|
|
Term
| What are the two methods by which you tell whether a patient is no longer paralyzed by NM blocking agents? |
|
Definition
| electrical twitch monitor and clinical signs |
|
|
Term
| What does it mean if a patient has an electrical twitch monitor of 0/4? |
|
Definition
| more than or equal to 95% of their receptors are blocked |
|
|
Term
| What does a 4/4 on electrical twitch monitor mean? |
|
Definition
| still have up to 2/3rds of receptors blocked |
|
|
Term
| What clinical signs are used to tell whether a person is paralyzed? |
|
Definition
| lift head for 5 seconds or give a firm hand grip |
|
|
Term
| If a patient can lift their head for five seconds or give a firm hand grip it means that... |
|
Definition
| no more than 1/3 of the neuromuscular receptors are blocked |
|
|
Term
| What are the brain wave monitors supposed to measure? |
|
Definition
| depth of consciousness and likelihood of recall |
|
|
Term
| Where do you want the patient's EEG score to be when putting them under anesthesia? |
|
Definition
|
|
Term
| What is the MOA of anesthetics? |
|
Definition
| largely unknown but probably the GABA(A) receptor is the primary target |
|
|
Term
| What are the important characteristics of general anesthetics? |
|
Definition
| controllability and non-specific action |
|
|
Term
| What is the mechanism of uptake for an anesthetic? |
|
Definition
| uptake=(lambdaxQx[Pa-Pv])/BP |
|
|
Term
|
Definition
| solubility (blood/gas partition coefficient which is directly related to solubility) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| rate of diffusion (alveolar minus venous partial pressure of an anesthetic or rate of diffusion) |
|
|
Term
|
Definition
|
|
Term
| Name the newest anesthetics and their unique characteristics? |
|
Definition
| desflurane and sevoflurane; very low solubility so quicker onset and quicker elimination |
|
|
Term
|
Definition
| the dose that prevents movement of a patient to painful stimuli 50% of the time |
|
|
Term
| What MAC dose will prevent movement of a patient 100% of the time to painful stimuli? |
|
Definition
|
|
Term
| When might you need higher levels of MAC? |
|
Definition
| if patient is young, chronic alcoholic, hypernatremic, or a cocaine user |
|
|
Term
| When would you need a lower level of MAC? |
|
Definition
| if a patient is pregnant, elderly, hyponatremic, anemic, or on lithium or clonidine |
|
|
Term
| What is the only gas currently being used to aid general anesthesia? |
|
Definition
|
|
Term
| What is the odor/taste of nitrous oxide? |
|
Definition
|
|
Term
| Why isn't nitrous oxide used very often? |
|
Definition
| because it is associated with nausea and vomiting |
|
|
Term
| What must you given in cominbation with nitrous oxide to achieve anesthesia? |
|
Definition
| one of the volatile halogenated hydrocarbons or an opioid analgesic |
|
|
Term
| What are the side effects of halothane? |
|
Definition
| hepatitis under hypoxic conditions d/t reductive metablism and production of flouride |
|
|
Term
| In what situation might you want to use isoflurane? |
|
Definition
| in a patient whom you knew was going to the ICU after surgery anyway and so there would be no need to have them woken up quicker becuaseisoflurane takes the longest but is also the cheapest |
|
|
Term
| In what situations is sevoflurane used? |
|
Definition
| pediatric inductions because it is not very pungent |
|
|
Term
| What physical properties of desflurane allow it to wear off quickly? |
|
Definition
|
|
Term
| Which inhalation agent allows patients to recover quickest? |
|
Definition
|
|
Term
| What is the unitary hypothesis? |
|
Definition
| hypothesis that all inhalation agents share a common mechanism of action at the molecular level (namely the GABA[A] receptor) |
|
|
Term
| Name three inducing agents. |
|
Definition
| thiopental, methohexital, etomidate, or propofol (propofol has pretty much replaced thiopental or methohexital) |
|
|
Term
| Which anesthetic used to be given reectally to induce anesthesia in kids? |
|
Definition
|
|
Term
| What are the side effects of propofol? |
|
Definition
| burning at infusion site (so you put lidocaine in it), drops blood pressure |
|
|
Term
| How do you perofrm anesthesia in kids? |
|
Definition
| give them oral midazolam to calm them down and then give them sevoflurane to induce anesthesia |
|
|
Term
| What is it called when you do an entire procedure using only propofol? |
|
Definition
| TIVA (or total intravenous anesthetic |
|
|
Term
| T/F Propofol causes nausea/vomiting. |
|
Definition
| false, it actually has an anti-emetic effect |
|
|
Term
| When might you want to give a patient etomidate? |
|
Definition
| if they are elderly or have limited cardiac reserve; keeps all of your parameters within 10% of baseline |
|
|
Term
| What are the side effects of etomidate? |
|
Definition
|
|
Term
| What inducing agent should you give in the ICU? |
|
Definition
|
|
Term
| Why don't you give etomidate in teh ICU? |
|
Definition
| it interferes with adrenal cortical steroidogenesis by inhibiting the 11-beta-hydroxylase enzyme |
|
|
Term
| What are the side effects of ketamine? |
|
Definition
| increases your heart rate, blood pressure, and cardiac output |
|
|
Term
| What are the uses of ketamine? |
|
Definition
| several uses including an intense analgesic effect; OB |
|
|
Term
|
Definition
| an anesthetic adjuvant that is an alpha 2 agonist in the CNS to provide a sedating effect |
|
|
Term
| When might you use dexmedetomidine? |
|
Definition
| given IV in the operating room or in the ICU |
|
|
Term
| What is the most commonly given benzodiazepine in anesthesia? |
|
Definition
| midazolam because it has a short action (2-3 hours) |
|
|
Term
| Why aren't lorazepam and diazepam used before anesthesia? |
|
Definition
| lorazepam has a half life of 10-20 hrs; diazepam has a half life that is dependent on how old the patient is (1 hour for every year of life) |
|
|
Term
| Why is midazolam given first for a patient going into surgery? |
|
Definition
| given as an anxiolytic and as an amnestic (NOT a analgesic) |
|
|
Term
| What is given to the patient after midazolam? |
|
Definition
| propofol and a muscle relaxant (succinylcholine or rocuronium), then the patient is intubated and given an inhalation agen (desflurane or sevoflurane) |
|
|
Term
| How is analgesia reversed? |
|
Definition
| turn off the inhalation agent and then reverse the muscle relaxant with neostigmine and glycopyrrolate; then the anesthesiologist will make sure the patient can move |
|
|
Term
| How do you reverse the actio of benzodiazepines? |
|
Definition
|
|
Term
| What drug is used to reverse the action of opiates? |
|
Definition
|
|
Term
| What is the most commonly used opiate in anesthesia? |
|
Definition
|
|
Term
| What is the strength of fentanyl? |
|
Definition
| 80-100x as strong as morphine with better side effect profile |
|
|
Term
| Why is fentanyl better to use than morphine? |
|
Definition
| less histamine release than morphine; fewer side effects; also fentanyl is a lot stronger |
|
|
Term
| T/F The amount of fentanyl you give contributes to the MAC dose. |
|
Definition
|
|
Term
| What is the most commonly used opiate in the recovery room? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| In which patients should you never use morphine? |
|
Definition
| patients with renal injury |
|
|
Term
| What is the active form of morphine? |
|
Definition
|
|
Term
| What is the strength of meperidine? |
|
Definition
| 1/10th as strong as morphine |
|
|
Term
| Why is meperidine no longer used at UH? |
|
Definition
| side effect profile; increases heart rate and can cause serotonergic syndrome if the patient is also taking MAOIs or St. John's wort |
|
|
Term
| Describe the strength of sufantanil. |
|
Definition
| 1,000x as strong as morphine |
|
|
Term
| Which opioid doesn't require an organ to break it down? |
|
Definition
| remifentanil (derivative of fentanyl and metabolized rapidly by plasma enzymes) |
|
|
Term
| What opiate would you use for patients with severe organ failure and where rapid recovery would be of benefit? |
|
Definition
|
|
Term
| How can you alter a anesthetic regime to prevent nausea and vomiting? |
|
Definition
| use less fentanyl, use more propofol, stay away from nitrous oxide |
|
|
