Neuroanatomy and pathways
This specific type of nerve fiber is myelinated, handles well-localized "fast" sharp pain, and conducts signals at a velocity of 5–15 m/s
What is an A-delta fiber?
This specific side effect of neuraxial opioids is considered the most common, and can be reversed using a mu antagonist like nalbuphine
What is pruritus (itching)
The acronym "TORA BORAB" is a clinical tool used to remember when to avoid or reduce NSAID dosing. The letters "B", "R", and "A" stand for these three distinct medical contraindications
What are Bleeding, Renal disease, and Asthma?
Awakening following a single bolus of propofol, etomidate, or sodium thiopental is driven by this pharmacokinetic process rather than immediate drug elimination
What is redistribution?
This drug is chosen as the gold standard induction agent for Electroconvulsive Therapy (ECT) because it preserves necessary therapeutic seizure duration
What is methohexital (Brevital)?
This tract in the anterolateral system is often referred to as the indirect or paleospinothalamic pathway, and it mediates the emotional "suffering" and arousal components of pain
What is the spinoreticular tract?
Opioids produce this change in a patient's CO2 response curve, requiring a higher-than-normal partial pressure of carbon dioxide to stimulate breathing
What is a shift to the right?
This anti-epileptic drug reduces baseline opioid requirements by 16% to 67% by blocking voltage-gated calcium channels in the central nervous system
What is gabapentin?
Propofol, etomidate, barbiturates, and benzodiazepines all primarily act by enhancing the conductance of this specific ion through the GABA-A receptor channel
What is chloride
Why do anesthesia providers choose etomidate for patients with severe dehydration, trauma, or cardiac instability?
What are stable hemodynamics?
Axons carrying pain and temperature enter the spinal column and travel up or down one to two spinal segments in this posterolateral structure before penetrating the gray matter
What is the Tract of Lissauer?
Intravenous administration of morphine, meperidine, or codeine can drop a patient's blood pressure via this non-receptor-mediated mechanism
What is histamine release?
Unlike morphine, this commonly used moderate-duration opioid has no active metabolites and does not release histamine, making it highly advantageous for renal failure patients
What is hydromorphone (Dilaudid)?
To prevent bacterial growth supported by its soy and egg lipid emulsion, a vial of drawn-up propofol must be entirely discarded after this many hours
What is 6 hours?
For a patient presenting with an active severe asthma exacerbation, this specific induction agent is highly preferred for its powerful, direct bronchodilatory properties
What is ketamine (or propofol)?
According to the Gate Control Theory, this anatomical region of the dorsal horn (specifically Rexed's Lamina II) acts as the physical "gate" modulating incoming pain impulses
What is the substantia gelatinosa?
While oral and IV opioids primary rely on Mu-1 receptors to alter a patient's emotional response to pain via the brain, spinal analgesia is predominantly mediated by this receptor subtype
What is the Mu-2 receptor?
This metabolite can build up to toxic, seizure-inducing levels in patients with liver or kidney failure who are repeatedly given meperidine
What is normeperidine?
This unique sedative agent achieves its effects by decreasing neuronal activity in the brainstem locus coeruleus as an alpha-2 adrenergic agonist
What is dexmedetomidine (Precedex)
Ketamine must be avoided in neurosurgical cases with elevated intracranial pressure (ICP) because it causes a 60% to 80% increase in this parameter
What is Cerebral Blood Flow (CBF)?
This chemical mediator acts natively within the spinal cord to decrease the release of Substance P, effectively acting as the chemical "gate" in Gate Control Theory
What is enkephalin?
High doses of rapid IV opioids can cause chest wall rigidity, causing difficult bag mask ventilation which can only be treated using this class of medications
What are NMBAs
This drug is a weak natural opioid that relies on a genetic conversion rate of about 10% into morphine to yield its primary analgesic effects
What is codeine?
This clinical syndrome is marked by metabolic acidosis (base deficit > 10), rhabdomyolysis, hyperlipidemia, and bradycardia progressing to asystole
What is Propofol Infusion Syndrome (PRIS)?
Anesthetists avoid etomidate or barbiturates in a patient with known congenital heme biosynthesis defects because it can trigger a severe crisis of this metabolic disease
What is porphyria?