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DAANCE: Module III
DAANCE: Module III Anesthetic Drugs & Techniques
| Question | Answer |
|---|---|
| What are four goals of IV anestesia? | Analgesia, amnesia, relaxation and immobility, and hypnosis |
| What are the basic requisites of an anesthetic agent? | Lack toxicity, be nonflammable, possess minimal allergenicity, and preferably be nonaddictive |
| Pharmacokinetics can be defined as: | The effect that the body has on drugs or what the body does to the drug |
| Where does metabolism usually occur? | The liver, and sometimes in the plasma |
| The effect that a drug has on the body involving primary and secondary effects is known as: | Pharmacodynamics |
| Secondary effects from a drug is known as a: | "Side effect" |
| What is "balanced anesthesia?" | Several different drugs combined that have effects that compliment each other |
| What are the 9 routes of administration? | By mouth (PO), intravenous (IV), intramuscular (IM), inhalation, intraoral transdermal, transdermal, rectal transmucosal, subcutaneous (SQ or subQ), and intranasal transmucosal |
| What is the purpose of local anesthesia? | Eliminate sensation (pain) |
| What are the 6 levels of sedation? | Local anesthesia, local with NO2, minimal sedation, moderate sedation, deep sedation, and general anesthesia |
| Which ASA classifications are considered low risk? | Class I and Class II |
| What are the monitoring requirements for deep sedation? | Pulse oximeter, capnograph, EKG, BP, a method to access temperature, and a time-oriented anesthesia record |
| For IV deep sedation and general anesthesia, what is the minimum number of individuals participating in the procedure? | Minimum of 3 - the surgeon, a surgical assistant, and a trained member recording/monitoring vitals |
| During the post-operative assessment, the first stage of recovery protocol involves what? | Observation and monitoring by a staff member that usually doesn't include patient's escort. The IV line maintained, airway support, supplemental oxygen, and monitoring devices continued/recorded until patient awakened |
| During the post-operative assessment, the second stage of recovery protocol involves what? | Reunite the escort to the patient until ready for discharge |
| In a 1% solution, how many grams are in 100mL of fluid? | 1 gram (1 gram/100 mL, 1000 mg/100 mL, or 10 mg/1 mL) |
| What is the maximum number of lidocaine (Xylacaine) carpules for a healthy adult patient? | 10-11 carpules |
| What is the maximum number of mepivacaine (Carbocaine) carpules for a healthy adult patient? | 7-8 carpules |
| Bupivacaine (Marcaine) is what kind of local anesthetic? | Long-acting |
| Lidocaine (Xylacaine) is what kind of local anesthetic? | Short-acting, or intermediate-acting when combined with epinephrine |
| Articaine (Septocaine) is what kind of local anesthetic? | Intermediate-acting |
| Prilocaine (Citanest) is what kind of local anesthetic? | Short-acting |
| Bupivocaine Liposomal (Exparel) is what kind of local anesthetic? | Long-acting |
| What is the most common vasoconstrictor added to local anesthetics? | Epinephrine |
| The adjacent tissue to the surgical site may do what when injecting local anesthetic? | Blanch |
| What would a patient experience if an inadvertent intravascular injection occured? | Tachycardia, hypertension, and a sense of the heart pounding in the chest |
| What is the maximum dose of epinephrine in a healthy adult patient? | 0.2 mg, which equates to 11.7 total carpules |
| What is the maximum dose of epinephrine in a cardiovascular compromised patient? | 0.04 mg, which equates to 2.3 carpules |
| What is the purpose of a topical local anesthetic? | Used to desensitize the mucosa prior to injection of local anesthetic |
| What are the two most commonly used topical anesthetics? | Benzocaine and lidocaine |
| For topical anesthetics to be effective, how long should it be applied prior to injection? | 2-3 minutes |
| What is a benzodiazepine? | A dose-dependent CNS depressant classified as an anxiolytic sedative producing retrograde amnesia |
| Where are benzodiazepines metabolized? | The liver |
| What is another name for Ketelar? | Ketamine |
| What is a significant benefit of benzodiazepines? | The availability of a competitive antagonist flumazenil (Romazicon) |
| What is another name for Midazolam? | Versed |
| Versed has a reduced potential for prolonged sedation which avoids: | The "hangover" effect |
| Injecting diazepam (Valium) results in injection pain and increases the risk for: | Thrombophlebitis |
| Administering IV diazepam results in longer sedation time and has an increased potential of" | The "hangover" effect |
| What is another name for Diprivan? | Propofol |
| What kind of a drug is propofol? | It is a sedative/hypnotic with rapid onset and short duration of acting |
| How does propofol effect a patient? | Decreases BP, hypotention, antiemetic, may reduce respiration rate, doesn't promote laryngospasms or bronchospasms, and the patient awakens with a feeling of well-being |
| If a patient has an egg allergy, what drug can a patient not have administered or take? | Propofol |
| What is the condition that is rare, life-threatening, primarily seen in hospital settings, and associated with prolonged use (48+ hours) of propofol at higher doses? | Propofol Infusion Syndrome |
| What kind of a drug is ketamine? | An analgesic, dissociative anesthetic resulting in prevention of visual, auditory, and painful stimuli |
| How does ketamine effect a patient? | Increases BP and increases heart rate |
| Ketamine causes a patient's eyes to do what? | Have blank stare, glassy-eyed, and horizontal nystagmus |
| What are some side effects of using ketamine? | Post-operative nausea and vomiting, hypersalivation, and sometimes emergence delirium and hallucinations when benzodiazepines added |
| Where is ketamine metabolized? | The liver |
| When ketamine is administered IM, it is referred to as: | Ketamine dart |
| What is another name for Brevital? | Methoxital |
| What is methoxital? | An ultra-fast-acting barbiturate that was used prior to the use of propofol |
| What are some side effects of methohexital? | Injection pain, phlebitis, coughing, hiccups, laryngospasm, twitching, and tremors |
| How does methohexital effect a patient? | Decreases BP and increases heart rate |
| Ketamine should not be used for patients that are: | Pregnant, hypertensive, cardiac compromised, have glaucoma, have had closed head trauma, or are a poorly controlled psychiatric patient |
| What is a narcotic? | Provides some systemic pain control during sedation and general anesthesia augmenting the calming effects of benzodiazepines |
| All narcotics have the potential for what? | Addiction |
| What are some side effects of a narcotic? | Drowsiness (but not a loss of consciousness), euphoria, and hypotension |
| What medication is used to reverse effects of an overdose of a narcotic? | Naloxone (Narcan) |
| Fentanyl is how much more potent than morphine? | 100x |
| With higher doses of fentanyl, what may a patient experience during a surgical procedure? | Muscle or chest wall rigidity |
| What is another name for fentanyl? | Sublimaze |
| What drugs are fentanyl congeners? | Sufentanil, alfentanil, and remifentanil |
| What is the type of drug that counteracts cholinergic effects? | Anticholinergics |
| How do anticholinergics effect a patient? | Decreases secretions from salivary glands and increase heart rate |
| What drug is an anticholinergic and is also used as an ACLS to treat bradycardia? | Atropine |
| What drug has an excellent antisialagogue effect (decrease production of salivation) with a reduced cardiovascular risk compared to atropine? | Glycopyrrolate (Robinul) |
| What is an antiemetic drug? | Medication preventing post-operative nausea and vomiting, stomach irritation, dizziness, syncope, pain, anxiety, and unpleasant visual stimuli |
| What is another name for ondansetron? | Zofran |
| Zofran can be administered by: | IV, oral tablet, and orally dissolving tablet (ODT) |
| Other drugs that have antiemetic effects include: | Propofol, corticosteroids, antihistamines, and benzodiazepines |
| What is one way that corticosteroids help a patient, besides the additional benefit of being antiemetic? | Helps minimize surgical swelling |
| What are three corticosteroid drug names? | Dexamethasone (Decadron), methylprednisolone (Solu-Medrol), and hydrocortisone (Solu-Cortef) |
| What is a muscle relaxant? | A neuromuscular blocker that paralyzes the patient |
| What drug would be used to paralyze a patient during a laryngospasm and has the potential to trigger MH? | Succinylcholine (Anectine) |
| What muscle relaxant may be used to treat a patient experiencing a laryngospasm without the potential risk of MH? | Rocuronium |
| Both succinylcholine and Rocuronium must be stored by: | Refrigeration |
| How much room air consists of oxygen? | 21% |
| All patients that are receiving sedation or general anesthesia should receive: | Supplemental oxygen |
| Nitrous oxide is administered in concentrations of: | 30-70% titration |
| What type of gas is used to "mask down/breathe down" a patient via a facemask or endotracheal tube? | Halogenated hydrocarbons |
| All halogenated hydrocarbons can potentially trigger: | MH |
| Contraindicating medications with concurrent halogenated hydrocarbons are: | Ritalin or Concerta (medications for ADD/ADHD) |
| This gas has a sweet, slightly pungent fruity odor that doesn't irritate the airway, and has a decreased incidence of breath holding and laryngospasm during induction: | Sevoflurane (Ultane) |
| There are no reversal agents for these two drugs: | Ketamine and propofol |
| When anesthetic agents outlast the effects of a reversal agent, what may the patient experience? | Re-sedation |
| What is a reversal agent of benzodiazepines? | Flumazenil (Romazicon) |
Created by:
K_Wheeler94
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