Anesthesia Adjuncts and Balanced Anesthesia

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Questions and Answers

What is the main use of Neuromuscular blocking drugs (NMBDs) during surgical procedures?

To maintain controlled ventilation (correct)

To reduce blood pressure

To relieve pain

To induce general anesthesia

What is the mechanism of action of nondepolarizing NMBDs?

They bind to acetylcholine receptors and block the usual action of acetylcholine (correct)

They bind to muscarinic receptors and stimulate muscle contraction

They bind to autonomic ganglia and stimulate muscle contraction

They bind to acetylcholine receptors and stimulate muscle contraction

Which of the following is an indication for the use of succinylcholine?

To reduce muscle contraction in an area that needs surgery

During long surgical procedures

To facilitate endotracheal intubation (correct)

As a diagnostic drug for myasthenia gravis

What is the primary adverse effect of pancuronium?

Hypotension due to blockade of autonomic ganglia Signup and view all the answers

What is the difference between depolarizing and nondepolarizing NMBDs?

Depolarizing NMBDs are competitive agonists, while nondepolarizing NMBDs are competitive antagonists Signup and view all the answers

Which of the following is a short-acting nondepolarizing NMBD?

Mivacurium Signup and view all the answers

Why does succinylcholine cause flaccid muscle paralysis?

Because it is metabolized slowly Signup and view all the answers

What is the primary use of pancuronium?

For long surgical procedures that require prolonged muscle paralysis Signup and view all the answers

Which type of regional anesthesia involves injecting an anesthetic solution into the epidural space, without penetrating the dura?

Epidural anesthesia Signup and view all the answers

What is the primary mechanism of action for local anesthetics?

Interfering with nerve transmission by blocking ion channels Signup and view all the answers

Which of the following statements is TRUE about local anesthetic administration?

Adverse effects are more likely with large quantities of anesthetic. Signup and view all the answers

Which of the following is a common application of lidocaine?

Relieving pain during dental procedures Signup and view all the answers

What is a potential systemic adverse effect of local anesthesia?

All of the above Signup and view all the answers

What is the term used to describe the simultaneous use of general anesthetics and adjunct drugs?

Balanced anesthesia Signup and view all the answers

What is the main purpose of using adjunct anesthetics?

To improve patient comfort and management during anesthesia Signup and view all the answers

Which of the following is NOT an example of an adjunct anesthetic?

Nitrous oxide Signup and view all the answers

What is the primary mechanism of action of general anesthetics?

Depressing the central nervous system Signup and view all the answers

How do fat-soluble drugs differ from water-soluble drugs in terms of their anesthetic properties?

Fat-soluble drugs are more potent and have a faster onset of action Signup and view all the answers

What is the main characteristic of malignant hyperthermia?

Uncontrollable muscle spasms and elevated body temperature Signup and view all the answers

Study Notes

Adjunct Anesthetics

Also known as "helper drugs" that complement the use of general anesthetics
Used simultaneously with general anesthetics for:
- Anesthesia induction
- Sedation
- Reduction of anxiety
- Amnesia

Types of Adjunct Anesthetics

Neuromuscular blocking agents
Sedative hypnotics or anxiolytics
- Propofol, benzodiazepines, barbiturates, hydroxyzine, and promethazine
Opioid analgesics
Anticholinergics (atropine)
Antiemetics (ondansetron)

Mechanism of Action and Drug Effects

Fat-soluble drugs are stronger anesthetics than water-soluble drugs
General anesthetics produce a progressive reduction of sensory and motor CNS functions
The degree and speed of this process vary with the anesthetics and adjuncts used along with their dosages and routes of administration

Adverse Effects

Sites primarily affected:
- Heart (myocardial depression)
- Peripheral circulation
- Liver
- Kidneys
- Respiratory tract
Malignant hyperthermia is an uncommon, but potentially fatal, adverse effect

Neuromuscular Blocking Drugs (NMBDs)

Prevent nerve transmission in skeletal and smooth muscles, leading to paralysis
Often used as adjuncts with general anesthetics
Classified into two groups based on mechanism of action:
- Depolarizing (e.g., succinylcholine)
- Non-depolarizing (e.g., mivacurium, atracurium, rocuronium, vecuronium)

Indications for NMBDs

Maintaining controlled ventilation during surgical procedures
Endotracheal intubation (short-acting)
Reducing muscle contraction in an area that needs surgery
Diagnostic drugs for myasthenia gravis

Adverse Effects of NMBDs

May cause:
- Hypotension (blockade of autonomic ganglia)
- Tachycardia (blockade of muscarinic receptors)
- Hypotension (release of histamine)

Specific NMBDs

Succinylcholine:
- Metabolized more slowly than Ach
- Most commonly used to facilitate endotracheal intubation
Pancuronium:
- Long-acting non-depolarizing NMBD
- Most commonly employed for long surgical procedures that require prolonged muscle paralysis

Types of Local Anesthesia

Central:
- Spinal or intraspinal anesthesia
- Intrathecal anesthesia: involves injection of anesthesia into the subarachnoid space
- Epidural anesthesia: involves injection of anesthesia via a small catheter into the epidural space without puncturing the dura
Peripheral:
- Infiltration: small amounts of anesthetic solution are injected into the tissue that surrounds the operative site
- Nerve block: anesthetic solution is injected at the site where the nerve innervates a specific area
- Topical anesthesia: the anesthetic drug is applied directly onto the surface of the skin, eye, or any mucous membrane to relieve pain or prevent it from being sensed

Mechanism of Action and Drug Effects of Local Anesthetics

Local anesthetics work by rendering a specific portion of the body insensitive to pain by interfering with nerve transmission in that area
They block the generation and conduction of impulses through all types of nerve fibers by blocking the movement of certain ions important to this process

Adverse Effects of Local Anesthetics

Possible systemic effects of the administration of local anesthetics include effects on circulatory and respiratory function
The systemic adverse effects depend on where and how the drug is administered
Such adverse effects are somewhat unlikely unless large quantities of a drug are administered

Specific Local Anesthetics

Lidocaine:
- One of the most commonly used local anesthetics
- Available in several strengths, both alone and in different concentrations with epinephrine, and is used for both infiltration and nerve block anesthesia
- Also available in topical form
- Parenteral lidocaine is also used to treat certain cardiac dysrhythmias

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Description

This quiz covers the use of adjunct anesthetics, also known as 'helper drugs', to complement general anesthetics in anesthesia induction, sedation, anxiety reduction, and amnesia. It explores the different types of adjuncts, including neuromuscular blocking agents, sedative hypnotics, opioids, and anticholinergics.