Anesthesia Overview and Safety

Study Notes

General Anesthesia

Anesthesia response (AR) includes decreased heart rate (HR), blood pressure (BP), respiratory rate (RR), and gastrointestinal (GI) activity (nausea/vomiting).
Emergency airway equipment must be readily available.
Vital signs (vs) should be closely monitored.
Safety measures include siderails and continuous monitoring until patient recovery.

Moderate Sedation

Commonly used for minor surgical procedures (e.g., EGD, cardioversion, colonoscopy).
AR involves decreased HR, BP, and RR; patients may be unable to protect their airway.
Midazolam (Benzodiazepine) is administered via IV push, induces amnesia, has rapid onset, and can cause respiratory depression requiring resuscitative equipment.
Etomidate, an IV anesthetic, has a quick onset (1 min) and rapid recovery (3-5 min), used for acute situations like rapid intubation; may cause seizure-like activity and nausea/vomiting.
Ketamine increases HR and BP, beneficial in cardiac depression scenarios; acts quickly (30 seconds onset) with 45 min recovery, enhances effects of paralytics.
Propofol has a rapid onset (30-60 seconds) and is used for short procedures or maintenance of sedation; must be used correctly to avoid infection, has associated risks such as localized burning.

Continuous Sedation

Primarily used for long-term sedation in ICU settings.
AR includes decreased RR, HR, BP, and skin breakdown due to immobility.
Propofol is effective for quick sedation but also raises triglycerides; requires tube changes every 12 hours to reduce infection risk; can cause green urine.
Midazolam may be used alongside low blood pressure scenarios.
Fentanyl functions as an analgesic and sedative; assessed with the FLACC scale; has risks like respiratory depression and constipation; Narcan is available for overdose.
Precedex, anxiolytic/hypnotic, alleviates anxiety; can either decrease or increase HR and BP depending on patient response.

Neuromuscular Blocking Agents

Indicated for paralysis; must provide sedative prior to administration.
AR encompasses paralysis and apnea (100% inability to breathe independently).
Succinylcholine has rapid onset and short duration, used before intubation; prepare for potential respiratory depression.
Vecuronium, Rocuronium, and Pancuronium are slower to act, necessitating monitoring for prolonged paralysis risks like pressure ulcers.

Analgesics

Opioid agonists treat moderate to severe pain.
Opioid antagonists (e.g., Naloxone) reverse respiratory and CNS depression without analgesic effects.
ARs include respiratory depression, orthostatic hypotension, nausea/vomiting, constipation, lightheadedness, dizziness, and pupil constriction.
Assessments involve evaluating bowel sounds, liver and kidney function, and fall risks; documentation must happen within 30 min post IV administration or 1 hour for oral dosing.
Fentanyl is used perioperatively and in transdermal patches for chronic pain management.
Hydromorphone effectively treats moderate to severe pain.
Meperidine is an alternative for patients allergic to morphine, but it has side effects of potential hypotension and nausea/vomiting.
Morphine is applicable for moderate to severe pain, both acute and chronic.
Naloxone is critical in managing opioid overdose situations, with attention to possible withdrawal symptoms.

Cardiac Medications

Cardiac medications may have inotropic (increase contraction), chronotropic (increase heart rate), and dromotropic (increase conduction) effects.
Nitroglycerin is administered sublingually (1 tab every 5 min up to 3 times); dosage is titrated in 5 mg increments for effective pain management; adverse reactions include hypotension, headaches, dizziness, and weakness; caution when used with PDE5 inhibitors like Viagra.
Digoxin, a cardiac glycoside, is used to control heart rate in atrial fibrillation (A-Fib) and heart failure scenarios.

Description

This quiz covers essential topics related to general anesthesia and moderate sedation, including vital signs, emergency protocols, and safety measures during procedures. It highlights the importance of monitoring and equipment readiness to ensure patient safety during anesthesia. Test your knowledge on these critical aspects of anesthetic practices.