Intro to Clinical Anesthesia Final Exam Prep 2023 Update

Intro to Clinical Anesthesia Final Exam Prep 2023 Update Anesthesia - ANS-Local or general insensitivity to pain with or without the loss of consciousness, induced by an anesthetic agent What are the main components and goals of an anesthetic? - ANS-- Potential loss of consciousness that is reversible (INDUCTION) - Pain/sensation management (ANALGESIA) - Provision of optimal surgical conditions (PARALYSIS/MUSCLE RELAXANTS) - Monitor and manage vital signs - Amnesia What type of amnesia do we want during anesthesia? - ANS-Antegrade amnesia Anxiolysis - ANS-Relief of anxiety What are the roles of an Anesthesia Provider? - ANS-- Assess, consult and prepare patient for anesthesia - Analgesia (insensitivity to pain) - Monitor/restore homeostasis in peri-operative and critically ill patients What are the six main types of Anesthesia? - ANS-- General Anesthesia - Neuraxial blockade - Peripheral Nerve Block - Monitored Anesthesia Care (MAC or Sedation) - Conscious Sedation - Local Anesthesia What ultimately determines a general anesthetic plan? - ANS-When the patient has no response to a stimulus. Neuraxial Blockade - ANS-Signals are blocked from coming and going in the nerves but numbing the nerve roots of the lower extremities and lower abdomen with local anesthetics Which drugs do you use for Neuraxial Blockades? - ANS-Local anesthetics such a Lidocaine (all the -caines) Why is Epinephrine often used in conjunction with a neuraxial blockade? - ANS-To cause vasoconstriction - this increases the time of the blockade since more blood flow = more removal of the drugs Why are Opioids often used with a neuraxial blockade? - ANS-Pain control for after the surgery Indications for use of a Neuraxial Blockade? - ANS-- Obstetrics - Life threatening pulmonary disease (unlikely to wake up after coming down) - History of Malignant Hyperthermia - Pain Management - History of narcotic abuse Why would you chose to perform a neuraxial blockade for patients with a history of narcotic abuse? - ANS-Continued use of narcotics creates a tolerance to use of other Opioids - by using a block, you are managing pain through another means (aka blocking the signals from reaching the brain) Contraindications for use of a Neuraxial Blockade? - ANS-- Patient refusal - Infection at injection site - Coagulopathy/ blood thinners - Pre-existing neurological diseases (already has tingling in legs) - Cardiac disease of hypovolemia (cutting the path to increase blood pressure) - Extensive spinal or vertebral surgery Complications for use of a Neuraxial Blockade? - ANS-- Post-Dural-Puncture Headache - Infection - Hematoma - Nerve damage and paralysis - "High Spinal" (anesthetic goes too high) - "Total Spinal" (epidural anesthetic injected into CSF) Post-Dural-Puncture Headache - ANS-Caused by a leakage of CSF after spinal surgery. Increased pressure on the brain by a decrease of fluid surrounding your brain. More present when standing versus laying down What is achieved with neuraxial anesthesia? - ANS-- Motor blockade - Sensory blockade - Autonomic blockade What is another name for an autonomic blockade? - ANS-Sympathectomy What is the progression of functions blocked in a neuraxial blockade? - ANS-Autonomic (reduction in heart rate) -- Sensory (can feel a pinch) -- Motor (cannot move) What are the three types of neuraxial blockade? - ANS-- Spinal - Epidural - Caudal Spinal Anesthesia - ANS-- A regional anesthetic that is produced by an injection of local anesthetic directly into the subarachnoid space around the spinal cord. - Injected low along the spine to avoid damage to the spinal cord. Lumbar - One time shot - Small dosages, 1-2 mL Caudal Anesthesia - ANS-A type of regional anesthesia that is inserted into the lowest portion of the epidural system and is entered through the sacral hiatus. Useful in pediatric patients Epidural Anesthesia - ANS-- Regional anesthesia produced by injecting a local anesthetic into the epidural space of the spine. - Can be administered sacral, lumbar, thoracic or even cervical - Have more control on where you put it and how much to give - Continuous administration with a catheter - Larger dosages, 10-20 mL For example, in child delivery What is a bier block? - ANS-A type of a peripheral nerve block where an extremity is is isolated with a tourniquet and a local anesthetic is administered intravenously Peripheral Nerve Block - ANS-- When you are "blocking" the nerve endings - useful for surgeries on the extremities. For example, a hand surgery Why do peripheral nerve blocks typically last longer than neuraxial blockades? - ANSThere is less vasculature compared to the spine, up to 48 hours. (Helpful in post-operative management since pain signals are blocked for longer and less narcotics are needed.) What are the contraindications of peripheral nerve blocks? - ANS-- Patient refusal - Infections What are the complications of peripheral nerve blocks? - ANS-- Damaging of nerves - Intravascular injection (local anesthetic toxicity) Monitored Anesthesia Care (Sedation/Twilight or MAC) - ANS-The patient is unconscious but can be aroused when stimulated. "On the edge" Usually involves the use of a sedative such as F For example, a colonoscopy or carpal tunnel surgery What do you need to pay special attention to during MAC anesthesia? - ANS-Airway management since the airway is not secure (aka oral airway, nasal airway, jaw thrust, chin lift, etc) When might you want the patient to be sedated but not necessarily needs to be unconscious? - ANS-MAC anesthesia during a orthopedic surgery Volatiles are associated with what type of Anesthesia? - ANS-General Anesthesia What is frequently used with monitored anesthesia care? - ANS-Local anesthesia If you need a patient to be immobile, what type of Anesthetic plan would you chose? - ANS-General Anesthesia What is a disadvantage of monitored anesthesia care? - ANS-There is limited control of the airway since the patient is (typically) not intubated Conscious Sedation - ANS-Technically not an "Anesthetic" plan, When a patient is given enough non-anesthetic drugs (aka narcotics or benzos) to render them somewhat unconscious and to facilitate conditions for the procedure. This type of sedation is easily reversible. Nurses can provide this type of Anesthesia What drug reverses the effects of narcotics? - ANS-Nalaxone (aka Narcane) which is an Opioid Antagonist. STANDARD CONCENTRATION: 0.4 mg/mL IV DOSE: 1-4 mcg/kg Local Anesthesia - ANS-Injected or topically at the desired site causing loss of sensation used for minor procedures We are not required to be present for this type of Anesthesia, surgeon could provide. Which drug is typically used for local anesthesia? - ANS-Lidocaine (aka Xylocaine) which is an Amide Local Anesthetic STANDARD CONCENTRATION: 20 mg/mL IV DOSE: 0.5-1.0 mg/kg What type of Anesthetic is cocaine? - ANS-Local Anesthetic (hence the -caine in the name) Approximately how long has surgery been practiced? - ANS-Thousands of years How were coca leaves used for Anesthesia by the Incan Shamans? - ANS-The coca leaves were first chewed and then the "surgeons" would spit into the wounds - this was done even for surgeries of the skull In addition to analgesia, what is cocaine useful in the treatment of? - ANS-Bleeding as it is a good vasoconstrictor. ENT surgeons inject cocaine to minimize bleeding What type of drugs are derived from Opium? - ANS-Opiods (aka Narcotics, such as Morphine and Fentanyl) What is a common pain medication? - ANS-Fentanyl (aka Sublimaze) which is an opioid/narcotic. STANDARD CONCENTRATION: 50 mcg/mL IV DOSE: 0.5 - 2 mcg/kg Soporific Sponge - ANS-A "stew" derived from adding several natural analgesics such as opioids, mulberry, hemlock, and madragora. This liquid was then soaked into a sponge which was then dripped into the nasal passage. Which plant whose analgesic effects were originally described by Discorides to provide "anesthesia"? - ANS-Mandragora or Mandrake, which is part of the Solanum family (also includes Henbane, Datura, hemlock and mulberry). Compression Anesthesia - ANS-If you compress a nerve enough, you stop the nerve from signaling pain. Unfortunately, the compression itself is very painful up to that point. Refrigeration Anesthesia - ANS-By cooling the area down, you can induce analgesia. Ice as a topical anesthetic. Continues...