Exam 1 Review A
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Questions and Answers

What is the primary characteristic of neuromuscular blockers that exhibit a ceiling effect?

  • No increase in potency beyond a certain dose (correct)
  • Increased potency with increased dose
  • Reversal by anticholinesterases
  • Spontaneous degradation in plasma

    • Which inhalation agent is favored in pediatric cases due to its sweet smell?

  • Nitrous oxide
  • Sevoflurane (correct)
  • Desflurane
  • Isoflurane

    • What is the primary mechanism of Hoffman degradation?

  • Enhanced metabolism of inhalation agents
  • Enzymatic degradation of neuromuscular blockers
  • Spontaneous degradation of non-depolarizing neuromuscular blockers in plasma (correct)
  • Reversal of neuromuscular blockers by anticholinesterases

    • What is the primary contraindication for the use of nitrous oxide?

    <p>Pneumothorax</p> Signup and view all the answers

    What is the primary characteristic of opioids that exhibit a ceiling effect?

    <p>No increase in potency beyond a certain dose</p> Signup and view all the answers

    What stage of anesthesia is characterized by a deeply unconscious patient with increasing muscle relaxation and absence of protective airway reflexes?

    <p>Stage 3 Surgical</p> Signup and view all the answers

    What occurs during emergence when discontinuing N2O administration?

    <p>Rapid diffusion of N2O from bloodstream into alveolus</p> Signup and view all the answers

    What is an absolute contraindication to regional anesthesia?

    <p>Pt refusal</p> Signup and view all the answers

    What is the mechanism of action of local anesthetics?

    <p>Block generation and conduction of afferent nerve impulses</p> Signup and view all the answers

    What is a relative contraindication to regional anesthesia?

    <p>Hypovolemia</p> Signup and view all the answers

    What is the effect of local anesthetics on the resting transmembrane potential?

    <p>It has no effect on the resting transmembrane potential</p> Signup and view all the answers

    What is the binding characteristic of local anesthetics to open and inactivated channels?

    <p>High affinity</p> Signup and view all the answers

    Which characteristic does not make an inhaled anesthetic ideal for use in all patient populations, including pregnancy?

    <p>High blood and tissue solubility</p> Signup and view all the answers

    What does a lower MAC indicate about an inhaled anesthetic’s potency?

    <p>The agent has a higher potency</p> Signup and view all the answers

    Which phase of general anesthesia involves administration of a hypnotic agent and confirmation of loss of consciousness?

    <p>Induction</p> Signup and view all the answers

    What occurs during the MAC bar stage?

    <p>Inhibition of adrenergic and CV response to incision</p> Signup and view all the answers

    How does nitrous oxide (N2O) affect the cardiovascular system?

    <p>Causes myocardial depression and diffusion hypoxia</p> Signup and view all the answers

    What is measured to determine the potency of inhaled anesthetic agents?

    <p>Minimum alveolar concentration (MAC)</p> Signup and view all the answers

    Which of the following is a common result of rapid administration of desflurane?

    <p>Increased blood pressure and heart rate</p> Signup and view all the answers

    During which stage of general inhalational anesthesia is amnesia typically provided?

    <p>Stage 1</p> Signup and view all the answers

    Which property of total intravenous anesthesia (TIVA) is considered advantageous?

    <p>decreased cardiac depression</p> Signup and view all the answers

    Which of the following sedative-related effects is specific to Etomidate?

    <p>decreased cerebral blood flow</p> Signup and view all the answers

    What is a primary pulmonary effect of Propofol?

    <p>respiratory depression and bronchodilation</p> Signup and view all the answers

    Which phenomenon is a disadvantage of the N2O-narcotic technique?

    <p>potential for intraoperative awareness</p> Signup and view all the answers

    Which general anesthesia technique is characterized by a higher risk of opioid-induced hyperalgesia?

    <p>TIVA</p> Signup and view all the answers

    Which sedative should be avoided in patients with advanced cardiovascular disease?

    <p>Ketamine</p> Signup and view all the answers

    Which anesthetic drug is known for causing pain on injection and carries a high incidence of nausea and vomiting?

    <p>Etomidate</p> Signup and view all the answers

    What type of sedation is characterized by a reversible state of unconsciousness?

    <p>General anesthesia</p> Signup and view all the answers

    Which component of general anesthesia involves sensory blockade?

    <p>analgesia</p> Signup and view all the answers

    What is the blood gas coefficient?

    <p>the ratio of the amount of anesthetic in blood and gas when the two phases are of equal volume and pressure and in equilibrium at 37°C</p> Signup and view all the answers

    What is the relationship between blood gas coefficient, solubility in blood, and rate of onset?

    <p>Directly proportional to solubility and inversely proportional to rate of onset</p> Signup and view all the answers

    What are the 4 stages of general inhalational anesthesia?

    <p>Disorientation, Delirium, Surgical, and Medullary Depression</p> Signup and view all the answers

    Where is the local anesthetic (LA) placed in a spinal block?

    <p>Into the subarachnoid space L3-L5</p> Signup and view all the answers

    What medications can be used in a spinal block?

    <p>All of the above</p> Signup and view all the answers

    What are some potential complications of neuroaxial blocks?

    <p>All of the above</p> Signup and view all the answers

    What are fascial plane blocks?

    <p>A type of regional anesthesia that targets specific fascial planes</p> Signup and view all the answers

    What are common sites of fascial plane blocks?

    <p>All of the above</p> Signup and view all the answers

    What is a Bier block?

    <p>A type of nerve block used to anesthetize a limb</p> Signup and view all the answers

    How is a Bier block performed?

    <p>By injecting a small amount of local anesthetic and applying a tourniquet to the extremity</p> Signup and view all the answers

    Which is a component of general anesthesia?

    <p>all of the above</p> Signup and view all the answers

    What is the most cardiostable sedative?

    <p>Etomidate</p> Signup and view all the answers

    What complication can etomidate cause?

    <p>Adrenal insufficiency</p> Signup and view all the answers

    What is neostigmine used for?

    <p>Reversing non-depolarizing neuromuscular blockers</p> Signup and view all the answers

    What are examples of non-depolarizing neuromuscular blockers?

    <p>Rocuronium, vecuronium, and atracurium</p> Signup and view all the answers

    What is the least potent inhalation agent?

    <p>Nitrous oxide</p> Signup and view all the answers

    Which inhalation agent can prolong QT?

    <p>Sevoflurane</p> Signup and view all the answers

    What does minimum alveolar concentration (MAC) mean?

    <p>The lowest concentration of a drug that is required to prevent 50% of pts from moving in response to painful stimuli</p> Signup and view all the answers

    What is the effect of inhaled anesthetics on blood pressure?

    <p>Decrease blood pressure</p> Signup and view all the answers

    How long should a procedure using a Bier block last?

    <p>30-60 minutes</p> Signup and view all the answers

    What is the effect of a higher blood-gas partition coefficient on the rate of induction of anesthesia?

    <p>It increases the rate of induction i.e. slows the rate</p> Signup and view all the answers

    Which of the following anesthetic agents is likely to have a faster onset of anesthetic action due to its lower blood-gas partition coefficient?

    <p>Desflurane</p> Signup and view all the answers

    What is the relationship between the partial pressure of a volatile anesthetic agent and its blood-gas partition coefficient?

    <p>A lower blood-gas partition coefficient results in a higher partial pressure</p> Signup and view all the answers

    Why do newer anesthetic agents tend to have a faster onset of anesthetic action compared to older agents?

    <p>Because they have a lower blood-gas partition coefficient</p> Signup and view all the answers

    What happens when more anesthetic is taken into the blood, resulting in a higher BGC?

    <p>The blood acts as a reservoir for the anesthetic, reducing the alveolar concentration</p> Signup and view all the answers

    What is anesthesia?

    <p>A type of medication that induces a loss of sensation in all or part of the body with or without loss of consciousness</p> Signup and view all the answers

    What is the balanced anesthesia technique?

    <p>A combination of sedatives, analgesics, and muscle relaxants</p> Signup and view all the answers

    What is the goal of inhalational anesthesia?

    <p>To have a constant brain partial pressure of anesthetic</p> Signup and view all the answers

    Alveolar partial pressure mirrors the brain partial pressure

    <p>True</p> Signup and view all the answers

    Which of the following inhalational anesthetics are known to cause airway irritation?

    <p>Desflurane and isoflurane</p> Signup and view all the answers

    What is ataraxia?

    <p>A state of freedom from mental or bodily pain</p> Signup and view all the answers

    What is the mechanism of action of propofol?

    <p>Activation of GABA receptors</p> Signup and view all the answers

    What is the drug class of etomidate?

    <p>Imidazole sedative</p> Signup and view all the answers

    What is a complication of etomidate?

    <p>Myoclonic activity</p> Signup and view all the answers

    What is the mechanism of action for ketamine?

    <p>N-methyl-D-aspartate (NMDA) receptor antagonist</p> Signup and view all the answers

    What is the mechanism of action of midazolam?

    <p>Potentiating the activity of GABA by binding to benzodiazepine receptors</p> Signup and view all the answers

    What is a pulmonary complication of midazolam?

    <p>Prolonged respiratory depression when combined with other agents , especially opioids</p> Signup and view all the answers

    What is a renal complication of sevoflurane administration?

    <p>Formation of nephrotoxic compound A</p> Signup and view all the answers

    What are bispectral index (BIS) monitors used for?

    <p>Measuring the depth of anesthesia</p> Signup and view all the answers

    What level of anesthesia is conscious sedation?

    <p>Moderate Sedation</p> Signup and view all the answers

    What characteristics do patients in deep sedation have?

    <p>Depressed consciousness with purposeful responses to stimulation</p> Signup and view all the answers

    What medications are used in a Bier block?

    <p>Lidocaine without epinephrine</p> Signup and view all the answers

    What local anesthetics are commonly used in peripheral nerve blocks?

    <p>All of the above</p> Signup and view all the answers

    Order these inhalational anesthetics from the least to the most potent: nitrous oxide, sevoflurane, isoflurane, desflurane

    <p>Nitrous oxide, desflurane, sevoflurane, isoflurane</p> Signup and view all the answers

    What is a common characteristic of inhalation anesthetics?

    <p>CO preserved but myocardial depression can occur</p> Signup and view all the answers

    Where can local anesthetic be placed in an epidural?

    <p>In the epidural space of thoracic, lumbar, and sacrum</p> Signup and view all the answers

    Epidural blocks can be adjusted

    <p>True</p> Signup and view all the answers

    Patient must be able to maintain their airway in monitored anesthesia care

    <p>True</p> Signup and view all the answers

    What are the indications for a combined spinal/epidural block?

    <p>rapid analgesia/anesthesia followed by extended postop analgesia</p> Signup and view all the answers

    Study Notes

    Phases of General Anesthesia

    • Pre-operative anesthesia evaluation: transport from holding area to PACU
    • Pre-induction: baseline vitals, preoxygenation/denitrogenation, administration of a hypnotic agent, confirmation of LOC, attempt PPV, administration of muscle relaxant, intubation, confirmation of intubation
    • Induction: GA induction steps
    • Maintenance
    • Emergence: post-operative anesthesia evaluation, transport from OR to PACU

    Potency of Inhaled Agents

    • Measured via MAC (minimum alveolar concentration), blood gas coefficient, or bispectral index monitors (BIS)
    • MAC: minimum alveolar concentration of inhaled anesthetic required to prevent 50% of patients from moving in response to painful stimuli
    • Lower the MAC, the more potent the agent is
    • Variations of MAC:
      • MAC awake: allowing of eye opening on verbal command (seen during emergence and induction)
      • MAC asleep: loss of consciousness and recall
      • MAC bar: MAC to prevent adrenergic and CV response to incision
      • MAC intubation: MAC to inhibit movement and coughing during intubation
      • MAC incision: MAC to prevent movement during initial incision

    Characteristics of Ideal Inhaled Anesthetics

    • Potent
    • Low blood and tissue solubility
    • Resistant to physical and metabolic degradation
    • Stable (non-flammable or explosive)
    • Odorless and pleasant to inhale
    • Rapid onset and offset
    • Safe for all ages and in pregnancy

    Inhaled Anesthetics

    • Characteristics:
      • Provide amnesia and immobility
      • Decrease BP and SVR
      • CO preserved but myocardial depression can occur
      • Rapid administration of desflurane can increase BP and HR
    • Examples:
      • Nitrous oxide:
        • Blood gas coefficient: 0.47
        • MAC: 104 (least potent)
        • Has analgesic and anesthetic properties
        • Cautions: pneumothorax, dilated bowels, laparoscopic surgeries, cases with hollow organs
      • Isoflurane:
        • Blood gas coefficient: 1.4
        • MAC: 1.2
        • Cardiovascular: increased HR, hypotension, potent coronary artery vasodilator
      • Sevoflurane:
        • Blood gas coefficient: 0.65
        • MAC: 2
        • Favored in pediatric cases due to sweet smelling
        • Cautions: prolonged QT or other medications that can do the same
      • Desflurane:
        • Blood gas coefficient: 0.45
        • MAC: 6
        • CNS: quick induction and recovery
        • CV: increased HR and catecholamine production
        • Pulmonary: irritating
        • Cautions: pediatric pts or reactive airway disease

    Non-Depolarizing Neuromuscular Blockers

    • Benzylisoquinolinium Compounds:
      • Atracurium
      • Cisatracurium
      • Mivacurium
      • Doxacurium
    • Aminosteroid Compounds:
      • Pancuronium
      • Vecuronium
      • Rocuronium
      • Pipecuronium
    • Chlorofumarate diesters:
      • Gantacurium
    • Reversal agents:
      • Neostigmine
      • Sugammadex
      • Calabadion

    Stages of General Anesthesia

    • Stage 1: Disorientation, analgesia without amnesia
    • Stage 2: Delirium/excitement, pt is unconscious but responds reflexively and irrationally to stimuli
    • Stage 3: Surgical, ideal stage for surgery, characterized by a deeply unconscious pt with increasing degrees of muscle relaxation and absence of protective airway reflexes
    • Stage 4: Medullary depression, life-threatening condition characterized by cardiovascular and respiratory collapse due to depression of the associated centers in the brain

    Blood-Gas Partition Coefficient (BGC)

    • A higher BGC indicates greater solubility of the anesthetic in blood and tissues, which slows the rate of induction.
    • A higher BGC means more anesthetic is taken into the blood, acting as a reservoir for the agent, reducing the alveolar concentration.
    • Volatile agents with a lower BGC are less soluble and exert a higher partial pressure.
    • A lower BGC leads to a more rapid onset and offset of anesthetic action due to the higher partial pressure.
    • Newer anesthetics, such as desflurane, typically have smaller BGCs than older ones, such as ether.
    • A smaller BGC leads to a faster onset of anesthesia.

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    Description

    Identify and define the different levels of anesthesia and analgesia, including minimal sedation, moderate sedation, deep sedation, and general anesthesia. Learn about the differences between each type of anesthesia.

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