Shared Flashcard Set

Details

Fundies test 4
Anesthesia
48
Dentistry
Graduate
12/09/2013

Additional Dentistry Flashcards

 


 

Cards

Term
What type of anesthesia offers anxiolysis (decrease anxiety) and can be moderate or deep?
Definition
Sedation
Term
What type of anesthesia is it when you can't recall anything going on around you; in a state of artificially induced coma?
Definition
General anesthesia
Term
What are local anesthesia, regional anesthesia, and neuraxial anesthesia all considered?
Definition
Nerve blockade

Regional anesthesia (nerve or plexus blocks)
Neuraxial anesthesia (spinal or epidural)
Term
What are the 3 goals of anesthesia
Definition
Amnesia (can't recall anything)
Analgesia (pain relief-important)
Neuromuscular blockade (paralysis)
Term
What are the different roles of the anesthesiologist?
Definition
• Preoperative Risk Assessment
• Intraoperative Care
• Anesthesia Recovery / Postoperative Care
• Critical Care Medicine
• Pain Medicine
• Anesthesia for Labor and Delivery
• Medical Emergency Services (MET Team)
Term
What intravenous anesthetic helps with sleep and anxiety (anxiolysis)
Definition
benzodiazepines
Term
What intravenous anesthetic can be used for long cases, cheap, and always of shortage because it's rarely produced?

Which is the more expensive drug, better recovery, and shorter effect?
Definition
barbiturates

propofol
Term
What intravenous anesthetic is used for patients with cardiac problems because it depresses the vasculature less
Definition
etomidate
Term
What intravenous anesthetic is raises the heart rate and blood pressure?
Definition
ketamine
Term
What inhalational anesthetics is used to maintain anesthesia, put in vaporizers
Definition
volatile anesthetics (contains nitrous oxide, xenon)
Term
What is used for pain relief?
Definition
opioids
Term
What intravenous opioid is potent but doesn't cause much effect on alertness so is useful for procedures that you expect a lot of pain but want them awake in the end?
Definition
sufentanil
Term
What intravenous opioid is longer acting and used for postoperative pain relief?
Definition
morphine
Term
What intravenous opioid is short acting?
Definition
alfentanil
Term
What intravenous opioid is frequently used, even seen in dental procedure?
Definition
fentanyl
Term
What intravenous opioid is potent, doesn't have short elimination half-life, broken down by plasma esterases into non-active metabolites quickly. It is very predictable and short time of acting, given as infusion and effect goes away in 5 minutes when stop infusion
Definition
remifentanil
Term
What intravenous opioid has a metabolite that when given a lot and repeatedly it can cause seizure but is good for bowel surgery?
Definition
meperidine
Term
Identify whether the following muscle relaxants is short, intermediate, long acting

Atracurium
Pancuronium
Mivacuirium
Rapacuronium
Cisatracurium
Rocuronium
Definition
Atracurium - intermediate
Pancuronium - long
Mivacuirium - short
Rapacuronium - short
Cisatracurium - intermediate (not renally excreted)
Rocuronium - intermediate (used mostly)
Term
What drug is used as muscle relaxant because it depolarizes the muscle and causes paralysis because it depletes all of the acetylcholine?
Definition
succinylcholine
Term
What is a state resembling sleep marked by a level of awareness other than the conscious state?
Definition
hypnosis
Term
What is the condition that involves complete or near-complete lack of responsiveness to people and other environmental stimuli?
Definition
unconsciousness (condition of being not conscious)
Term
What is a state of unconsciousness lasting more than 6 hours, in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep wake cycle and does not initiate voluntary actions
Definition
coma
Term
Some people consider anesthesia as a drug induced _____.
Definition
coma
Term
What do people test in order measure how deep anesthesia is?
Definition
they try to elicit recall (by playing words during anesthesia)
Term
What is the test used in animal literature for consciousness?
Definition
mirror test (dot placed on forehead to see if animal tries to remove the dot)
Term
In this theory, conscious depend on?
Definition
patterns of coherent neuronal activity in the thalamus, which in turn are modulated by the ascending arousal system
Term
When monitoring conscious, if the EEG frequency faster or slower when you're awake versus when you are in deep sedation?
Definition
EEG frequency is faster when you're awake (smaller waves) and slower when you're asleep (large waves; larger waves when in deep sedation)
Term
In PET imaging, do you see more or less cortical activity when you are awake?
Definition
more cortical activity when awake
Term
What are the 2 proposed mechanism of actions for inhaled anesthetics and which one is more specific?
Definition
Lipid theory (Anesthetics bind to lipids in
the membrane of neurons and disrupt
neurotransmission - global shut down)

Ion channel specific effects (drug binds to channels - more specific)
Term
What drug prolongs channel opening and
increases postsynaptic inhibition
Definition
isoflurane
Term
What drug(s) opens the GABA receptor chloride channels?
Definition
Propofol and Etomidate
Term
What drug enhances GABA receptor action primarily through effects on the alpha subunit?
Definition
benzodiazepine
Term
*what is is a concept used to compare the strengths, or
potency, of volatile anesthetics.
It is the concentration in the lungs that is needed to prevent movement (motor response) in 50% of subjects in response to surgical (pain) stimulus
Definition
Minimum alveolar concentration (MAC) - we want to be above MAC
Term
Why is it that patients may go back to sleep after they have awoken?
Definition
We have different profusion of tissue (slowest is fatty tissue)
The anesthesia may still be in their tissues (muscles) that can come out later
Term
Do barbiturates decrease or enhance pain?
Definition
enhance pain
Term
In the study involving pain with heat, cold, and electrical, which did propofol increase pain in?
Definition
increased heat pain (reduced cold and electrical pain)
Term
Of the following local anesthesias, which was the first local anesthetic, which was then invented that had a longer duration of action/more potent, and which was then invented that was similar but less toxic?

bupivacaine
lidocaine
ropivacaine
Definition
• Lidocaine 1943
– first synthetic local anesthetic.
• Bupivacaine 1957
– duration of action
• Ropivacaine 1996
-less toxic
Term
What is the mechanism of action of local anesthetics?
Definition
They work through a sodium channel, so they block sodium channels and thereby decrease nerve conduction
Term
What are the 2 classes of local anesthetics and which one is more used?
Definition
Ester (hydrolyzed)
Amides (more used)
Term
Identify if the follow local anesthetic is an ester or amide

Benzocaine
Procaine
Bupivacaine
Lidocaine
Ropivacaine
Tetracaine
Mepivacaine
Cocaine
Chloroprocaine
Definition
Benzocaine - ester
Procaine - ester
Bupivacaine -amide (longer lasting bc protein bound)
Lidocaine -amide
Ropivacaine-amide
Tetracaine-ester
Mepivacaine-amide
Cocaine-ester
Chloroprocaine-ester (very safe)
Term
what appears to be the most significant
property of local anesthetic molecules in determining
anesthetic potency
Definition
lipid solubility
Term
What determines the duration of conduction block of a local anesthetic?
Definition
protein binding
Term
*Allergic reactions from local anesthesia is due to what?
Definition
metabolites of ester-linked local anesthesia (namely PABA or compounds similar to PABA used as preservatives)
Term
*Tachycardia from local anesthesia is due to what?
Definition
epinephrine containing solutions
Term
If a patient has ringing in their ears or a funny taste in their mouth after receiving lidocaine than what is that a sign of?
Definition
systemic or CNS toxicity
Term
Which comes first: CNS or cardiac toxicity?
Definition
CNS toxicity occurs at lower concentration than cardiac toxicity
Term
Benzocaine and a metabolite of prilocaine can
cause clinically significant____________
Definition
methemoglobinemia (treat with methylene blue)
Term
The muscle relaxant Mivacurium is (short or long acting)?

Pancuronium?

What is the biggest danger with muscle relaxants?
Definition
mivacaurium (short)
pancuronium (long)

being unable to intubate or ventilate the patient
Supporting users have an ad free experience!