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Questions and Answers
What is a potential cause of blood pressure depression during anesthesia?
What is a potential cause of blood pressure depression during anesthesia?
Which complication is characterized by a sudden loss of pulse in carotid and femoral arteries?
Which complication is characterized by a sudden loss of pulse in carotid and femoral arteries?
What is the main cause of cerebral edema?
What is the main cause of cerebral edema?
Which of the following can lead to cardiac rhythm disturbances during anesthesia?
Which of the following can lead to cardiac rhythm disturbances during anesthesia?
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Which treatment is NOT mentioned for cerebral edema?
Which treatment is NOT mentioned for cerebral edema?
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What characterizes non-depolarizing myorelaxants?
What characterizes non-depolarizing myorelaxants?
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What clinical sign is NOT usually associated with cardiac arrest?
What clinical sign is NOT usually associated with cardiac arrest?
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What is a primary reason for myocardial ischemia during anesthesia?
What is a primary reason for myocardial ischemia during anesthesia?
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Which of the following myorelaxants has the shortest duration of action?
Which of the following myorelaxants has the shortest duration of action?
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Which of these is a sign of cardiac arrest?
Which of these is a sign of cardiac arrest?
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Which of the following statements about Curare is correct?
Which of the following statements about Curare is correct?
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What is the mechanism of action for depolarizing myorelaxants?
What is the mechanism of action for depolarizing myorelaxants?
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What should be done immediately in case of cardiac arrest due to narcotic drug overdosage?
What should be done immediately in case of cardiac arrest due to narcotic drug overdosage?
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Which of the following conditions is least likely to cause cardiac arrhythmias?
Which of the following conditions is least likely to cause cardiac arrhythmias?
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Which of the following is an advantage of using muscular relaxants?
Which of the following is an advantage of using muscular relaxants?
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Which inhalational anesthetic has a pungent odor and irritates the airways?
Which inhalational anesthetic has a pungent odor and irritates the airways?
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What is the primary benefit of non-depolarizing myorelaxants during surgery?
What is the primary benefit of non-depolarizing myorelaxants during surgery?
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What is a characteristic of Nitrous oxide?
What is a characteristic of Nitrous oxide?
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Which anesthetic is known for having nephrotoxicity?
Which anesthetic is known for having nephrotoxicity?
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What is the third stage of ether narcosis according to P. Guedel's classification?
What is the third stage of ether narcosis according to P. Guedel's classification?
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Which inhalational anesthetic has a rapid onset and recovery and is suitable for induction of anesthesia?
Which inhalational anesthetic has a rapid onset and recovery and is suitable for induction of anesthesia?
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Which anesthetic is considered hepatotoxic?
Which anesthetic is considered hepatotoxic?
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What is the typical ether concentration for the first stage of analgesia?
What is the typical ether concentration for the first stage of analgesia?
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Which of the following anesthetics is known to be proconvulsive?
Which of the following anesthetics is known to be proconvulsive?
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What is the primary initial pathogenetic factor of hemorrhagic shock?
What is the primary initial pathogenetic factor of hemorrhagic shock?
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Which phase of shock is characterized by excitement and elevated blood pressure?
Which phase of shock is characterized by excitement and elevated blood pressure?
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What is a common factor that can promote the development of shock?
What is a common factor that can promote the development of shock?
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Which shock degree is characterized by a decreased systolic blood pressure of 90-70 mmHg?
Which shock degree is characterized by a decreased systolic blood pressure of 90-70 mmHg?
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According to the theories of etiology, which type of shock theory emphasizes neuro-reflex actions?
According to the theories of etiology, which type of shock theory emphasizes neuro-reflex actions?
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In the assessment of shock, which symptom is NOT characteristic of shock of I degree?
In the assessment of shock, which symptom is NOT characteristic of shock of I degree?
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What effect does severe shock have on capillary circulation?
What effect does severe shock have on capillary circulation?
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What is typically observed during the torpid phase of shock?
What is typically observed during the torpid phase of shock?
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Which type of shock is characterized by tachycardia and acute cardiac insufficiency?
Which type of shock is characterized by tachycardia and acute cardiac insufficiency?
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What is the preferable method for administering preparations to correct hypovolemia?
What is the preferable method for administering preparations to correct hypovolemia?
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Which glucocorticoid hormones are useful for restoring blood vessel tonus?
Which glucocorticoid hormones are useful for restoring blood vessel tonus?
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Which of the following drugs is NOT a narcotic analgesic used for anesthesia?
Which of the following drugs is NOT a narcotic analgesic used for anesthesia?
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Which solution is recommended for the removal of acidosis during hypovolemia correction?
Which solution is recommended for the removal of acidosis during hypovolemia correction?
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Which type of anaphylactic shock is indicated by symptoms such as cyanosis and dyspnea?
Which type of anaphylactic shock is indicated by symptoms such as cyanosis and dyspnea?
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For which condition is good transport immobilization and local anesthesia a prophylaxis?
For which condition is good transport immobilization and local anesthesia a prophylaxis?
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What kind of circulation is often damaged in cases of hypovolemia?
What kind of circulation is often damaged in cases of hypovolemia?
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Study Notes
Inhalational Anesthetics
- Most commonly used inhalational anesthetics: Desflurane, Sevoflurane, Isoflurane, Nitrous oxide
- Nitrous oxide can cause gas expansion in cavities and is typically used in combination with other anesthetics.
- Desflurane has a rapid onset and recovery, pungent odor, and can irritate airways.
- Sevoflurane has a rapid onset and recovery and is non-pungent, making it suitable for induction of anesthesia.
- Isoflurane has a relatively slow onset and recovery and a pungent odor.
Ether-Oxygen Anesthesia
- No longer in use
- P. Guedel described four stages of ether narcosis:
- Analgesia
- Delirium
- Surgical
- Respiratory arrest, Medullary paralysis
Cardiovascular Complications of Anesthesia
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Blood pressure depression (arterial hypotension) can occur during the anesthesia and may be caused by:
- Overdosage of anesthetic
- Low circulating blood volume
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Cardiac rhythm disturbance (cardiac arrhythmia) can be caused by:
- Oxygen insufficiency (hypoxia) and hypercapnia during intubation
- Overdosage of narcotic drugs
- Introduction of epinephrine after using fluothane, which increases sensitivity to catecholamines
- Myocardial ischemia and infarction
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Cardiac arrest, heart failure (syncope) is a serious complication. Symptoms include:
- Absence of carotid and femoral pulse
- Absence of heart sounds
- Respiratory arrest (apnea)
- Cyanosis
- Dilated pupils
- Muscle relaxation
- Cessation of wound bleeding
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Cerebral edema is a result of deep hypoxia. Treatment includes:
- Dehydration
- Hyperventilation
- Local hypothermia
Myorelaxation, Muscular Relaxants, Drugs, and Curare
- Curare was a South American Indian poison traditionally used in arrow poisoning
- Curare paralyzes muscles and causes asphyxia
- Modern myorelaxants act on the neuromuscular impulse transmission unit (synapse) and are divided into two groups:
- Nondepolarizing myorelaxants block the synapse, preventing acetylcholine from acting.
- Depolarizing myorelaxants mimic acetylcholine, causing prolonged depolarization and prevent repolarization.
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Advantages of using muscular relaxants:
- Reduces the dose of basic anesthesia
- Allows artificial ventilation when spontaneous breathing is impaired
- Prevents cramps in cases of tetanus
- Facilitates repositioning of dislocations and fractures
- Enhances the anesthetic and antishock action of drugs.
Antidepolarizing (nondepolarizing) Muscle Relaxants
-
Mivacurium is a short-acting non-depolarizing neuromuscular blocking agent.
- Onset of action: 2-4 minutes
- Duration of action: 15-25 minutes
- Used for tracheal intubation and skeletal muscle relaxation
-
Rocuronium is a non-depolarizing neuromuscular blocker.
- Onset of action: 1-3 minutes
- Duration of action: 60-90 minutes
- Used for tracheal intubation and skeletal muscle relaxation during surgery.
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Atracurium is a non-depolarizing neuromuscular blocker.
- Onset of action: 2-3 minutes
- Duration of action: 45-60 minutes
- Used for tracheal intubation and skeletal muscle relaxation.
-
Cisatracurium is a skeletal muscle relaxant.
- Used for tracheal intubation, muscle relaxation during surgery, and mechanical ventilation.
Etiopathogenesis of Shock
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Primary factors contributing to shock:
- Decreased circulating blood volume (hemorrhagic, hypovolemic shock)
- Vasodilation and blood redistribution (anaphylactic, septic shock)
- Cardiac dysfunction with decreased cardiac output
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These factors result in:
- Capillary circulation damage
- Hypoxia
- Metabolic disturbances in tissues and organs
-
Factors promoting shock development:
- Avitaminosis
- Tuberculosis
- Hypo- and dysproteinemia
- Cachexia
- Anemia
- Cold
- Nervous stress
- Incomplete transport immobilization
- Anesthesia during operation
- Ionizing radiation
Shock Theories
- Toxic (Quenu)
- Vasomotor (Crile)
- Acapnic (Henderson)
- Blood and plasma loss (Blelock)
- Sympathetic-adrenal depletion (H.Selye)
- Neuro-reflector (I.Pavlov)
Phases of Shock (according to N. Pirogov)
-
Erectile phase:
- Short, occurs immediately after trauma
- Characterized by sympathetic-adrenal system hypertonus (pale skin, rapid pulse, elevated blood pressure, excitement)
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Torpid phase:
- Depressed, low blood pressure, weak pulse
Degrees of Shock
-
Shock of degree I:
- Retained consciousness (slightly depressed)
- Systolic blood pressure decreased to 90 mmHg
- Rapid pulse
- Pale skin
- Muscle tremor
- Slow circulatory restoration after compression and decompression of the nail
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Shock of degree II:
- Depression
- Pallor
- Viscous sweat
- Marked cyanosis of the nails
- Very slow circulatory restoration
- Systolic blood pressure 90-70 mmHg
- Weak, rapid pulse (110-120 per minute)
- Decreased central venous pressure
- Shallow breathing
Shock Treatment
- Hypovolemia correction: use hemocorrectors (blood substitute liquids) with homodynamic (anti-shock) action, such as Macrodex, Rheomacrodex, Gelofusin, Crystalloid solutions, Trisamin, or 4% sodium bicarbonate for acidosis removal.
- Peripheral blood circulation damage: all preparations must be administered intravenously.
- Narcotic analgesics: morphine hydrochloride, Omnopon, Promedol, Phentanil, Pentazocin. Monitor respiration closely as these drugs can decrease respiratory center activity.
- Tranquilizers: Seduxen (diazepam) 0.5%- 1-2 ml.
- Airway tubes: Use if the patient is unconscious for adequate respiration.
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Prophylaxis of shock:
- Good transport immobilization
- Local anesthesia
- Novocain block (vago-sympathetic, paranephral, paravertebral, and intercostal)
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Blood vessel tonus restoration:
- Dopamine (Dobutrex) solution
- Glucocorticoid hormones (prednizollone, hydrocortisone)
Hemorrhagic Shock:
- Refer to "Bleeding"
Burns Shock:
- Refer to "Burns"
Anaphylactic Shock
- Immediate reaction to antigen-antibody, occurring in allergic individuals.
- Frequent after administration of protein-containing blood substitutes, immune drugs, antibiotics, and iodine-containing antiseptics in patients with bronchial asthma or drug-induced dermatitis.
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Types of anaphylactic shock:
- Cardiovascular type: tachycardia, cardiac arrhythmia, atrial/ventricular fibrillation, hypotension, acute cardiac insufficiency.
- Respiratory type: respiratory insufficiency, dyspnea, cyanosis, stridor, moist râles, lung/larynx/epiglottis swelling.
- Cerebral type: hypoxia, brain swelling, coma, local CNS alterations.
Stages of Anaphylactic Shock (based on severity)
- Stage 1
- Stage 2
- Stage 3
- Stage 4
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Description
This quiz covers the most commonly used inhalational anesthetics such as Desflurane, Sevoflurane, Isoflurane, and Nitrous oxide. It also discusses the historical context of ether-oxygen anesthesia and its four stages, as well as cardiovascular complications that can arise during anesthesia. Test your knowledge on these essential topics in anesthesiology.
