Pharmacology of Anesthesia Types

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Questions and Answers

What is the primary aim of Phase 2 metabolism in drug processing?

  • To increase the solubility of the metabolized drug (correct)
  • To excrete drugs unchanged from the body
  • To convert drugs into their active forms
  • To decrease the solubility of the metabolized drug

Which combination of gases is primarily used for analgesia during procedures?

  • 25% nitrous oxide and 75% oxygen
  • 100% oxygen mixed with nitrous oxide
  • 70% oxygen and 30% nitrous oxide
  • 50% nitrous oxide and 50% oxygen (correct)

What are common adverse effects of prolonged administration of certain anesthetics?

  • Diarrhea and renal failure
  • Megaloblastic anemia and nausea (correct)
  • Cardiovascular disease and headache
  • Respiratory depression and convulsions

Which of the following is NOT a contraindication for the use of nitrous oxide?

<p>Hypersensitivity to barbiturates (D)</p> Signup and view all the answers

What is the acceptable concentration of oxygen in inspired anesthetic gases?

<p>No less than 21% (C)</p> Signup and view all the answers

What potential effect does administering oxygen above 80% have?

<p>Promotes pulmonary congestion (B)</p> Signup and view all the answers

What is the recommended dosage of premedication for adults before surgery via subcutaneous or intramuscular injection?

<p>150–200 mcg/kg (C)</p> Signup and view all the answers

Which of the following may result from inhalational anesthetic practice?

<p>Acute myocardial infarction (C)</p> Signup and view all the answers

What is the first step in the WHO recommendations for hand hygiene during patient care?

<p>Before touching a patient (C)</p> Signup and view all the answers

Which of the following is NOT included in the protocols to minimize infection risk associated with invasive devices?

<p>Overusing single-use equipment (A)</p> Signup and view all the answers

What is the recommended intubating dose of pancuronium?

<p>0.5 mg/kg (B)</p> Signup and view all the answers

Which muscle relaxant has a faster onset for rapid sequence intubation?

<p>Rocuronium (D)</p> Signup and view all the answers

What should be done after body fluid exposure or risk according to the hand hygiene recommendations?

<p>Wash hands thoroughly (A)</p> Signup and view all the answers

What is a common adverse effect associated with atracurium use?

<p>Histamine release (C)</p> Signup and view all the answers

Which of the following techniques is suggested for reprocessing single-use equipment?

<p>Following national guidelines (B)</p> Signup and view all the answers

Which of the following is a contraindication for the use of rocuronium?

<p>Hypersensitivity to rocuronium (A)</p> Signup and view all the answers

When should clean/aseptic procedures be conducted during patient care?

<p>Before, after, and during patient interaction (B)</p> Signup and view all the answers

Which step in proper hand hygiene involves rubbing fingers in a circular motion?

<p>Step 7 (C)</p> Signup and view all the answers

What precaution should be taken when administering cisatracurium?

<p>Use with caution in patients with bronchial asthma (A)</p> Signup and view all the answers

After interacting with which of the following should hands be washed?

<p>A patient’s surroundings (C)</p> Signup and view all the answers

What is the maintenance dose for rocuronium?

<p>0.03 mg/kg (A)</p> Signup and view all the answers

What class of muscle relaxant is cisatracurium considered?

<p>Intermediate-acting non-depolarizing (C)</p> Signup and view all the answers

What should be the frequency of reviewing the condition of an indwelling invasive device?

<p>Daily or as needed (D)</p> Signup and view all the answers

Which of the following doses is appropriate for intubation using cisatracurium?

<p>0.6-1.2 mg/kg (B)</p> Signup and view all the answers

What characteristic distinguishes biphasic defibrillation from monophasic defibrillation?

<p>Biphasic defibrillation has a voltage that rises, then reverses direction. (C)</p> Signup and view all the answers

Which of the following is a potential complication during intubation?

<p>Airway trauma (C)</p> Signup and view all the answers

Why is a biphasic defibrillator considered more practical than a monophasic one?

<p>It is easier to transport and cheaper. (C)</p> Signup and view all the answers

What can be a consequence of inadequate anaesthesia during intubation?

<p>Increased risk of coughing or bronchospasm. (A)</p> Signup and view all the answers

What is the purpose of using high flow nasal oxygen (HFNO) during intubation?

<p>To prevent oxygen desaturation. (D)</p> Signup and view all the answers

Which feature of new intubation devices enhances the process of visualization?

<p>Integrated LED light source (D)</p> Signup and view all the answers

What is one of the main benefits of the integrated high-resolution monitor in new intubation devices?

<p>It allows for real-time patient monitoring. (C)</p> Signup and view all the answers

What is a disadvantage of using a scope during a bronchoscopy procedure?

<p>Barotrauma. (C)</p> Signup and view all the answers

What is the recommended temperature range for wetting hands during handwashing?

<p>35–45 °C (A)</p> Signup and view all the answers

How long should the duration be for handwashing with plain soap according to JCI recommendations?

<p>40–60 seconds (A)</p> Signup and view all the answers

What is advised regarding the handling of gloves during hand hygiene practices?

<p>Always remove gloves before hand hygiene. (C)</p> Signup and view all the answers

Which of the following is NOT part of the maximal sterile barrier recommended for the anesthesia provider?

<p>Non-sterile gown (D)</p> Signup and view all the answers

When should the operation theatre be cleaned according to local protocols?

<p>After each patient (C)</p> Signup and view all the answers

What is a misconception about gloved hands during procedures?

<p>Gloved hands are always clean. (D)</p> Signup and view all the answers

What is the recommended duration for hand rub with alcohol-based hand rub (ABHR)?

<p>20–30 seconds (A)</p> Signup and view all the answers

Which procedure must always be followed when placing peripheral arterial lines?

<p>Using a cap, mask, sterile gloves, and a small sterile fenestrated drape (B)</p> Signup and view all the answers

What is the primary purpose of weekly maintenance checks for anesthesia equipment?

<p>To guarantee patient safety during anesthesia (D)</p> Signup and view all the answers

Which system is classified as a semi-open breathing system?

<p>Mapleson C system (A)</p> Signup and view all the answers

What is a significant risk associated with improper handling of oxygen cylinders?

<p>Explosions and burns from oxygen misuse (A)</p> Signup and view all the answers

How often should connections to oxygen delivery devices be checked for leakage?

<p>Monthly (A)</p> Signup and view all the answers

Which of the following is NOT a characteristic of open systems in anesthesia?

<p>Rebreathing of exhaled gases (D)</p> Signup and view all the answers

What is a disadvantage of semi-closed breathing systems?

<p>Greater complexity and larger size (A)</p> Signup and view all the answers

Which of the following actions is included in the pre-anesthetic checkout procedure as per the American Society of Anesthesiologists?

<p>Documenting completion of checkout procedures (A)</p> Signup and view all the answers

What characteristic distinguishes semi-closed breathing systems from open systems?

<p>They allow for rebreathing of exhaled gases (A)</p> Signup and view all the answers

Flashcards

Phase 2 metabolism (Synthetic Phase)

Phase of drug metabolism where the drug is modified by the body, usually making it easier to excrete.

Intravenous (IV) administration

A common method of drug administration that involves injecting medication into a vein.

Intramuscular (IM) administration

A common method of drug administration that involves injecting medication into a muscle.

Anesthesia

A procedure aimed at reducing pain perception, often used during surgery.

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Analgesic

A type of drug that reduces pain.

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Nitrous oxide

A type of anesthetic gas that can be used to induce anesthesia.

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Nausea and vomiting

A common symptom that can occur after drug administration.

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Morphine

A type of opioid drug used for pain relief.

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Pancuronium

A long-acting non-depolarizing muscle relaxant used for intubation and muscle relaxation during surgery. It is administered intravenously.

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Cisatracurium

An intermediate-acting non-depolarizing muscle relaxant that can be used for intubation and muscle relaxation during surgery or mechanical ventilation. It's metabolized by the body, so it's suitable for patients with kidney and liver issues.

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Rocuronium

A non-depolarizing muscle relaxant with a faster onset compared to others. It's used for rapid sequence intubation and muscle relaxation during surgery.

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Reversal of Neuromuscular Blockade

A medication that reverses the effects of non-depolarizing muscle relaxants, allowing the patient to regain muscle function after surgery.

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Adverse effects of Pancuronium

A reaction that can occur with pancuronium, involving increased histamine levels, leading to skin flushing, low blood pressure, and rapid heart rate.

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Adverse effects of Atracurium/Cisatracurium

A reaction that can occur with atracurium or cisatracurium. It can cause prolonged paralysis in patients with kidney issues.

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Rapid sequence intubation (RSI)

A common use for rocuronium is for rapid sequence intubation. This technique allows for quick and efficient intubation, often used in emergency situations.

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Tracheal intubation

The process of placing a tube into the windpipe (trachea) to help a person breathe.

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Infection Prevention

Procedures that are performed during patient care to minimize the transmission of harmful organisms, primarily through hand hygiene, but also environmental disinfection, PPE, and other strategies.

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Hand Hygiene

The practice of cleaning hands to remove microbes and reduce the risk of spreading infections.

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WHO's 5 Moments for Hand Hygiene

WHO's 5 moments for hand hygiene are key times during patient care when hand cleaning is essential to prevent infection transmission.

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Moment 1: Before Touching a Patient

The first of the 5 moments for hand hygiene, before touching a patient.

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Moment 2: Before a Clean/Aseptic Procedure

The second of the 5 moments for hand hygiene, before a clean/aseptic procedure like inserting a catheter.

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Moment 3: After a Procedure or Body Fluid Exposure Risk

The third of the 5 moments for hand hygiene, after a procedure or exposure to body fluids.

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Moment 4: After Touching a Patient

The fourth of the 5 moments for hand hygiene, after touching a patient.

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Moment 5: After Touching a Patient's Surroundings

The fifth of the 5 moments for hand hygiene, after touching a patient's surroundings.

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Biphasic defibrillation

A defibrillation that delivers a shock with two phases: one positive and one negative. The direction of current flow reverses during the shock.

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Monophasic defibrillation

A defibrillation that delivers a shock with a single phase of current. Simple and effective, but generally delivers higher energy.

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Video Laryngoscope

A specialized medical device used for intubation and basic bronchoscopy procedures. It features a video camera and integrated lighting for visualization of the airway.

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Airway trauma

A potential complication of video laryngoscope use, especially in inexperienced providers. It can occur when the patient coughs or experiences bronchospasm.

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Bronchoscope damage

A potential complication of video laryngoscope use. It can occur when the patient bites the scope, potentially causing damage to the device.

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High-flow Nasal Oxygen

Delivering high-flow oxygen through the nose to prevent oxygen desaturation during procedures, particularly in fragile patients.

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Double Lumen Tube (DLT) placement

A technique that involves positioning a device called a double lumen tube (DLT) during endotracheal intubation, providing ventilation to both lungs simultaneously.

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Bronchoscopy

A procedure that involves inserting a bronchoscope into the airways for visual examination, sampling of fluids, or other diagnostic purposes.

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Handwashing

The process of cleaning hands with soap and water to remove germs. This is an essential practice in healthcare settings to prevent the spread of infections.

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Alcohol-based hand rub (ABHR)

A type of hand hygiene using a gel or foam containing alcohol to quickly disinfect hands. It's faster than handwashing but only effective against certain germs.

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Recommended Handwashing Duration with Soap

The recommended duration for handwashing with plain soap, as per Joint Commission International (JCI).

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Recommended Hand Rub Duration with ABHR

The recommended duration for hand hygiene with alcohol-based hand rub (ABHR), according to Joint Commission International (JCI).

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Gloves Removal Before HH

The practice of removing gloves before performing hand hygiene, as recommended by CDC and WHO guidelines.

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Cleaning of the Operating Theatre

The process of thoroughly disinfecting the operating room after every surgery to prevent infections.

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Full Maximal Sterile Barrier

A recommended set of protective equipment used by anesthesia providers during surgeries, including face mask, cap, gown, and sterile gloves.

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Central Intravenous Catheter (CVC)

A type of central catheter that is inserted into a large vein in the chest to deliver fluids, medications, or nutrition.

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Weekly Anesthesia Equipment Maintenance

A regular, scheduled maintenance procedure for anesthesia equipment, typically conducted weekly.

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Daily Anesthesia Equipment Checks

Daily checks are performed on anesthesia equipment to ensure proper function before each use.

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Pre-Anesthetic Checkout Procedure

A comprehensive checklist used before anesthesia is administered, ensuring all vital components are functioning correctly.

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Breathing System Pressure & Leak Testing

The process of verifying that the breathing system is properly connected and functioning correctly, allowing for safe gas delivery.

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Breathing Circuit Gas Flow Verification

Ensuring oxygen flows properly through the breathing circuit, vital for patient safety during anesthesia.

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Checking the Oxygen Cylinder

A critical step in anesthesia preparation where the oxygen cylinder is inspected for leaks and adequate pressure, ensuring a safe oxygen supply.

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Semi-Closed Breathing System

A type of breathing system used in anesthesia, where exhaled gases are partially re-breathed, allowing for greater efficiency.

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ANESTHESIA Time Out

A critical safety measure taken before anesthesia, where the anesthesiologist confirms the patient's identity, the planned procedure, and the anesthetic plan.

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Study Notes

Pharmacology of Anesthesia Types

  • General anesthesia (GA) is suitable for most major surgeries
  • Goals of Stage III surgical anesthesia: hypnosis/unconsciousness, amnesia, analgesia, muscle relaxation, and autonomic/sensory blockade

General Anesthesia Stages

  • Stage I (Analgesia): Pain loss, patient remains conscious and can converse.
  • Stage II (Excitement): Delirium, violence, decreased blood pressure, increased respiratory rate. Barbiturates often bypass this stage.
  • Stage III (Surgical Anesthesia): Skeletal muscle relaxation, regular breathing, slow/stopped eye movements. Surgery can begin at this stage.
  • Stage IV (Medullary Paralysis): Death can result if not revived; careful control of anesthetic amounts is crucial.

Induction

  • Induction may involve intravenous and/or inhalation agents.
  • Intravenous agents include sedative-hypnotics (e.g., Propofol, Etomidate, Ketamine) accompanied by adjuvant agents (e.g. opioids, benzodiazepines like Midazolam)) and a neuromuscular blocking agent (NMBA) for endotracheal intubation.

Maintenance

  • Total Intravenous Anesthesia (TIVA) or inhalation/IV combinations are used to sustain GA.
  • The aim is to reduce the total dose of any single agent.
  • NMBA (neuromuscular blocking agents) are used if complete muscle relaxation is required.

Emergence

  • GA emergence is the return to consciousness and movement after the surgery.
  • Residual NMBA effects are reversed.
  • Spontaneous ventilation usually enables extubation without assistance.

Main Types of Medication in Anesthesia

  • Induction agents (IV and volatile) to induce and maintain unconsciousness
  • Analgesics for pain relief
  • Muscle relaxants to induce muscle relaxation
  • Other medications frequently used in anesthesia include those that reduce memory loss/amnesia and vomiting, counteracting (antagonists) and stimulating sympathetic/parasympathetic responses

Essential Introduction to Pharmacology

  • Pharmacokinetics (PK) studies how the body affects a drug (absorption, distribution, metabolism, excretion).
  • Pharmacodynamics (PD) studies the effect of a drug on the body. This includes drug action in terms of physiochemical characteristics, receptor binding, and enzyme binding to inhibit or decrease activity.

Induction Medications

  • Generally, induction is done with intravenous agents or inhalation.
  • Intravenous induction medications include medications like thiopentone and propofol.

Intravenous Anesthetics

  • Thiopental sodium: Powder for solution injection, for induction and short duration anesthesia.

Metabolism

  • Drugs are metabolized through phases: Phase 1 (non-synthetic) involves processes like oxidation, reduction, and hydrolysis; phase 2 (synthetic) includes glucuronidation, sulfation, acetylation, methylation, and glycination. Metabolic processes aim to increase the solubility of drugs for excretion.

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