Preoperative evaluation
Name one medication that is OK to take before undergoing anesthesia
atenolol (beta blocker)
Pepcid, protonix (H2 blocker)
What does proper preoxygenation markedly delay?
desaturation
What's another name for regional anesthesia?
nerve blocks
In General anesthesia, there are 5 goals that start with the letter A, can you name at least one?
-Amnesia (pts don't remember)
-Awareness (pts don't respond to stimuli)
-Analgesia (pts don't feel pain)
-Akinesia (pts don't move)
-Autonomic stability (pts don't get hypertensive/tachycardic)
what is an example of a sedative hypnotic and when is it used?
-benzodiazepdines (versed/midazolam) is preferred due to it's rapid onset and short duration. Can also use valium/diazepam, ativan/lorazepam and xanax/alprazolam.
-used for preoperative anxiety for post-op agitation
-barbiturates can also be used but less common
Name one medication that is NOT OK to take before undergoing anesthesia
Losartan, enalapril (ACE/ARB)
Metformin, glyburide (biguanide, sulfonylureas)
When intubating a pt, which induction agents can be used?
propofol or etomidate
what is the purpose of a nerve block?
intraoperative and postoperative analgesia
What is the potency of anesthetic gasses measured in?
MAC (Minimal Alveolar Concentration)
-one MAC is the alveolar concentration of anesthetic gas at which 50% of pts don't move with surgical incision.
-0.3 MAC = pt awakens from anesthesia
-0.7 MAC = amnesia reliably present
-1.0 MAC = 50% pts don't move w/ incision
-1.3 MAC = 95% pts don't move w/ incision
-1.5 MAC = blunts HTN/tachy on incision
->2.0 MAC = some muscular relaxation
What is an example of an induction agent and what is it used for?
-propofol
-pentothal, brevital
-ketamine
-etomidate
-these are intramuscular or oral medications(IV meds) used to bring pts from an awake state to a state of general anesthesia
What can a patient drink until 2 hours before their procedure?
clear liquids (water, fruit juices w/ no pulp, carbonated beverages, clear tea, black coffee(no cream)
When intubating a pt, and after using induction agents, which paralytic agent can be used?
rocuronium or succinylcholine
What are some methods for guiding needle placement during a nerve block?
-landmarks
-nerve stimulation
-US
What are some characteristics of an ideal anesthetic gas?
-nonflammable, non pungent, non toxic, non emetogenic, doesn't cause malignant hyperthermia, doesn't cause respiratory or cardiac depression, bronchodilator, potent, fast onset/offset, cheap, plentiful, stable at room temp/pressure
explain the MOA and use of rocuronium in anesthesia
-MOA = competes for cholinergic receptors at motor end plate
-It's used in conjunction with general anesthesia medicine for intubation
-It's a paralytic(muscle relaxor)
What information do you want to gather during the preoperative interview?
-gather info on pt that may alter anesthetic management
-inform pt about anesthetic plan including options and risks
-alleviate anxiety about the procedure
What is one way to insert a LMA?
-use index finger and bend the tip while advancing it into pharynx
which analgesia is most commonly used for blocks and how long can the block last for?
-bupivacane. can last 5-26 hr
what are some examples of anesthetic gases?
-nitrous oxide
-halothane
-Isoflurane
-Sevoflurane
-Desflurane
What is the MOA of Edrophonium and neostigmine and what are they used for?
-MOA= anticholinesterase (ie. blocks enzyme acetylcholinesterase therefore prolonging action of acetylcholine action.
-reversal of neuromuscular blockade(caused by rocuronium) during the administration of anesthesia to patients undergoing surgery that require muscle relaxation. Therefore pts will regain their use of muscle/movements
-heart: high BP, heart attack, pain, pressure in chest, heart failure, surgeries, pacemaker, etc
-lungs: asthma, COPD, tobacco, inhaler, sleep apnea, CPAP use, etc
-GI: reflux, ulcers, NPO status
-GU: kidney problems, dialysis
-endocrine: diabetes, thyroid issues
-muscoloskeletal, HemOnc, allergies, medicines, surgical hx
During extubation, how should the pt look and feel prior to extubation?
pt should be warm, strong, awake and comfortable
what are some risks of regional anestheisa?
bleeding
infection
damage
When do you use rocuronium over succinylcholine and why?
-Rocuronium is longer acting and has a reversal agent. Succinylcholine is shorter acting, making a reversal agent less often helpful. Some clinicians opt for rocuronium to avoid adverse reactions (e.g. hyperkalemia), and to have the option of reversal of the agent.