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39 Cards in this Set

  • Front
  • Back
What is general anesthesia?
General anesthesia is a pharmacologically-induced reversible state of unconsciousness which is maintained despite the presence of noxious stimuli.
What are the four goals of general anesthesia.
The four As:

1) Lack of Awareness
2) Analgesia
3) Amnesia
4) Akinesia
What is TIVA?
Total intravenous anesthesia

TIVA is the achievement of the goals of general anesthesia (lack of awareness, analgesia, amnesia, and akinesia) with the use of intravenous agents alone.

IV agents used to achieve TIVA: propofol, remifentanil
What are the four phases of general anesthesia?
Induction (followed by muscle relaxation)
Maintenance
Emergence
Recovery
Which two broad classes of drugs are employed during the induction phase of general anesthesia?
Inducing agents

Muscle relaxants
Name 3 inducing agents
Propofol
Ketamine
Thiopental
What a cataleptic state?
Catalepsy is a nervous condition characterized by muscular rigidity and fixity of posture regardless of external stimuli, as well as decreased sensitivity to pain
What is often performed directly after induction during the induction phase of general anesthesia?
Muscle relaxant given to allow for intubation
What is a "rapid sequence induction" and why is it performed?
Rapid sequence intubation is a rapid process designed to minimize the the time between anesthesia and securing the airway with a cuffed endotracheal tube.

This is the time when aspiration is most likely to occur. Rapid sequence induction is performed for those at increased risk of aspiration.
Name two states that predispose to aspiration.
1) Impaired gastric emptying
-diabetes, trauma, bowel obstruction, recent opioid administration

2) Decreased integrity of lower esophageal sphincter
-pregnancy, obesity
Name 4 conditions that lead to decreased gastric emptying and, as such, predispose to aspiration.
Diabetes
Trauma
Bowel obstruction
Recent opioid administration
Name 2 conditions that lead to loss of LES tone and thus predispose to aspiration.
Pregnancy
Obesity
Classically, what kind of muscle relaxant is employed in a rapid sequence induction?
Depolarizing muscle relaxant (e.g. succinylcholine)
Which kind of muscle relaxant is used in "modified' rapid sequence intubation?
Rapidly-acting non-depolarizing agent (e.g. rocuronium)
Name a depolarizing muscle relaxant.
Succinylcholine
Name a non-depolarizing muscle relaxant
Rocuronium
Is succinylcholine depolarizing or non-depolarizing?
Polarizing
Is rocuronium depolarizing or non-depolarizing?
Non-depolarizing
What three classes of agents are employed in the maintenance phase of general anesthesia?
Inhaled agents
Opiates
Non-depolarizing muscle relaxants
What is awareness?

What is the incidence of awareness with recall?
Awareness occurs when a patient who has received a general anesthetic becomes conscious of his or her environment during the surgical procedure.

The patient may or may not experience pain, and he may or may not recall the events post-operatively.

The incidence of awareness with recall is 0.2-1%
What is the relationship between the solubility of a gas in blood and its rate of onset/offset?
The more soluble a gas is in blood, the more delayed its onset.

This is because it will take longer for the gas to build up its MAC in the alveoli given that it is entering the blood so quickly.

Nitrous oxide, which is less soluble in blood, builds up its MAC quickly and thus has a very quick onset and offset.
How are inhaled agents eliminated from the body?
Exhalation from the lungs.

You just stop giving the drug and eventually the patient will blow them out.
Name three opioid analgesics employed by anesthesiologists for general anesthesia.
Fentanyl, remifentanil, sufentanil
Describe in general terms the administration of opioids in general anesthesia.
A bolus is usually given before i given as a loading dose prior to induction and intubation.

Because reminfentanil in particular is very short acting, infusion and supplementation usually follows to maintain its effects.
What is a NDMR?
Non-depolarizing muscle relaxant
Which type of muscle relaxant is typically used during the maintenance phase of general anesthesia?
NDMR
Which type of muscle relaxant is typically used during the induction phase of general anesthesia?
Nowadays rocuronium, a NDMR, is typically used, though historically succinylcholine was used.
How can the degree of muscular paralysis be monitored during general anesthesia?
Peripheral nerve stimulator
How is reversal of volatile gases achieved?
Cessation of administration, allowing the body to blow the gases out naturally through the respiratory tract
How is reversal of opioid analgesics achieved?
Cessation of administration, allowing the body to metabolize and eliminate the opioid through the liver and kidney.
How are NDMR agents reversed.
Both by cessation of administration and allowing the body to clear the drug to some degree and by the administration of anti-cholinesterase agents.
Name three anticholinesterases used as reversal agents.
Edrophonium
Neostigmine
Pyridostigmine
What are the 5 As of general anesthesia?
Lack of Awareness
Amnesia
Analgesia
Akinesia
Autonomic Stability
What are the 5 phases of general anesthesia?
Preparation
Induction
Maintenance
Emergence
Recovery
During which phase of general anesthesia does intubation occur?
Induction
What are the effects of inducing agents on airway reflexes and motor control?
Obtund airway reflexes and motor control, resulting in decreased airway protection and depressed ventilation.
What is minimum alveolar concentration MAC?
The minimum alveolar concentration (MAC) is the concentration (in volume %) of anesthetic agent in the alveoli that prevents 50% of people from moving in response to a standard surgical stimulus (incision).
What are the 5 As of general anesthesia?
1) Lack of Awareness
2) Amnesia
3) Analgesia
4) Akinesia
5) Autonomic stability
What does the term "balanced technique" refer to in the context of general anesthesia?
The practice of using combinations of agents, each for a specific purpose.