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risks assocated with anesthesia
poor airway management, neuro deficits, preexisitng CAD, administaration at atypical locations (cant be saved fast), not enough pre-testing in hospital
drug introduced through sacral hiatus above the coccyx, useful for perineal and rectal procedures
what is the purpose of vasoconstrictor use with ocal anestetics
increases anesthesia time in area; reduces systemic toxicity; increases duration of action
ideal local anestetic =
low systemic toxicity, quick onset of action, solubility in H2O, reversibility
what are ideal properties of general anesthetics
1.Rapid loss of consciousness 2. block the reflex reactions to pain; 3.Minimal ADRs 4.Relaxation of skeletal muscle to facilitate endotracheal intubation; 5.not flammable /explosive; 6. Prompt patient recovery
what are stages of depth of anesthesia
stage 1-4: analgesia, excitement, surgical anestheisa, medullary paralysis
what happens in stage 3 - surgical anestheisa
Begins w/ regular respiration and extends to complete cessation of spontaneous respiration; 4 planes: BEST STAGE
what is the worst stage?
stage 4: pt cant breathe; cardio-respiratory arrest; usually die in operating room
what is the MOA of general anesthetics
unitary theory: ALL oanesthetics have interactions with lipophilic membranes; cause neuronal failure
what are IV anesthetics
Ultra-Short Acting Barbiturates; Benzodiazepines; Etomidate (Amidate); Propofol (Diprivan); Ketamine ; Opiods; alpha 2 agonists
what are indications of ultra-short acting barbituates
maintenance hypnotics for short surgical procedures; keeps pt out of it
what are indications of benzodiazepines
preferred in CARDIAC surgery (no effect on cardio or respiratory); makes pt groggy, feels no pain;
out pt surgery; work quick, short recovery; antiemetic properties (less N,V side effects)
why can alpha 2 adrenergic agonists not be used alone?
inadequate anesthetic depth, bradycardia, hypotension
what is good about inhalation anesthetics?
even though it is acheived slower, there is QUICKER RECOVERY (bc elimnated of lungs)
minimun alveolar concentraction (MAC)
smallest amount you can give to open alveolus is the amount you want to give
what are halogenated hydrocarbons
volatile liquids; potent; last agent; reduces dosage of other medications
example of balanced anesthesia
1. Induction with bolus intravenous anesthetic 2.Supplemental anesthetic (opiod or N20) 3.Neuromuscular blocker (induce paralysis) 4.Reduced concentration of halogenated hydrocarbon
produces neuromuscular block by OVER STIMULATION of nerve; short procedures; no antidote
what is the MOA of non depolarizing neuromuscular blockers
REVERSIBLE COMPETATIVE antagonists of ACH in skeletal muscles; relax muscles
selection of pre-op drugs
Relieve anxiety, provide sedation; Induce amnesia; Decrease secretion of saliva and gastric juices; Increase gastric pH; Prevent allergic reactions to anesthetic drugs
selection of anesthesia depends on:
Site of surgery; Positioning of patient on table; Concurrent disease; Elective vs emergency; surgery; Age; Patient preference; Need for pain management post-operatively
A 25 year old woman comes to your office w/ red & itchy dermatitis. She had a dental procedure earlier that day and was administered a local anesthetic. Which drug is the most likely cause of her allergic reaction?
procaine: (ester causes this reaction, used for dental procedures; may also be allergic to sunscreen)
A 77 year-old male is being admitted to the hospital for a coronary bypass. He has been taking Atenolol 100mg PO QD. His anesthetic regimen consisted of: (Propofol induction, Fentanyl IV infusion, Vecuronium muscle relaxant) During the procedure, his HR dropped to 38 and BP to 80/60. It was treated and reversed with atropine and epinephrine. What most likely contributed to this problem?
propofol (causes cardiovascular depression)
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