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28 Cards in this Set
- Front
- Back
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Define general anesthesia |
State of unconsciousness and alleviation of pain and suffering. |
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2 types of general anesthesia |
inhalation intravenous |
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Define balanced anesthesia |
Produce a balance of deep CNS depression, freedom from anxiety, control of secretions, and neuromuscular blockade. |
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List in order in which different parts of the brain are affected by general anesthetics |
1. Reticular activating system (RAS) - arousal mechanisms blocked unconsiousness occurs 2. General sensory and motor areas of cerebrum - sensory awareness and motor activity blocked 3. Cerebral cortex - general depression 4. Medulla - vital centers blocked |
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4 stages of inhalation anesthesia |
1. Amnesia and analgesia 2. Excitement 3. Surgical anesthesia and planes 4. Medullary paralysis |
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Describe the four planes of surgical anesthesia |
Plane 1—Light anesthesia. Most reflexes (pedal, corneal, palpebral) are still present. Plane 2 – Medium anesthesia. Most surgeries are conducted at this level. Muscles are relaxed. Most reflexes (pedal, palpebral, corneal) are absent. Plane 3—Deep anesthesia. Intercostal muscles are relaxed; ability to maintain respiration is endangered. Pupillary light reflex may be slow or absent. Plane 4—Too Deep. All muscles, including diaphragm & intercostal muscles, are paralyzed. |
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Discuss the uptake of inhalation anesthetics by describing the movement between compartments |
Intravenous are carried rapidly in bloodstream to perfused organs(brain) Inhalational reach brain indirectly. First diluted by gas for delivery to the lungs, leave the alveoli to circulation. Then leave circulatory system to enter brain. |
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Discuss the distribution of inhalation anesthetics by describing the movement between compartments |
Once reached the vascular compartment, distribution is affect by pharmacokinetic principles. Highly perfused tissues (brain, heart) are exposed to higher amounts. |
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Discuss the elimination of inhalation anesthetics by describing the movement between compartments |
pulmonary ventilation, perfusion, solubility, flow rate of administered anesthetic. the amount of anesthetic present in the tissues begins to decrease once the delivery of anesthetic is terminated. |
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adjunct; adjunctive agent |
Drugs used in association with a general anesthetic, used to achieve the goals of balance anesthesia. |
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inducing agents |
used as adjuncts to general anesthetics because the inducing agents have a rapid onset of action coupled with a short duration of action |
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induction |
Voluntary excitement |
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Explain the concept of procedural sedation and anesthesia |
Sensory input -> RAS (arousing system) filtering ----> Minimal blocking = fully alert ---> Moderate blocking = sedation ---> Maximal blocking = hypnosis |
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Effects produced during moderate sedation in dentistry |
Nitrous oxide with oxygen to produce conscious sedation for short-term analgesia 30% N20 70% O2 -numbness around the mouth -analgesia -mild sedation -euphoria -mild dissociation -mild interference with hearing |
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Describe the adverse reaction to anesthesia known as malignant hyperthermia (MH) |
rare and unusual, rapid rise in core temp that can be fatal Ca ions from skeletal cells trigger muscle contractions Muscle cell + ATP transport CA ion back to storage therefore increase in metabolic activity which then increases temperature |
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Nitrous Oxide |
Entonox Incomplete anesthetic Strong analgesic but weak anesthetic Not potent so stage 3 (deep surgical anesthesia) cannot be attained with just N20 without causing oxygen deprivation leading to hypoxic hypoxia not metabolized and eliminated within a few minutes compatible with all drugs and no side effects Indication: used as inducing agent in balance anesthesia |
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Halothane |
Fluothane Indication: used for maintenance of anesthesia Contra: where general anesthesia is contra Precautions: Alveolar ventilation decreased (assisted ventilation necessary) Adverse reactions: Hepatotoxicity |
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Isoflurane |
Forane Good skeletal muscle relaxation, low systemic toxicity Indication: Maintenance of anesthesia Contra: where general anesthesia is contra Precautions: peripheral vasodilation; dec blood pressure and inc heart rate Adverse Reaction: Ventilatory depression is greater than halothane and cardiovascular depression is less |
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Desflurane |
Suprane Nonflammable halogenated ether with high volatility. Low solubility in blood, rapid uptake and induction of anesthesia. Indications: Maintenance of anethesia Contra: where general anesthesia is contra Precautions: dec in ventilation, depressant on medullary respiratory centers. Hypotension Adverse effects: hypotensions, arrythmias, resp dep, apnea |
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Sevoflurane |
Sevarane Halogenated ether with low solubility and rapid induction. Rapid uptake and elimination Contra: where general anesthesia is contra Precautions: dec in ventilation, depressant on medullary respiratory centers. Hypotension Adverse effects: hypotension, arrythmias, respiratory depression and apnea |
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Describe the technique known as total intravenous anesthesia (TIVA) |
is an anesthetic state induced and maintained entirely with intravenous agents. |
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HYPNOTIC - propofol |
Diprivan Short acting intravenous hypnotic rapidly distributed, metabolized and cleared Indication: versatile agent. Used for both induction and maintenance of anesthesia Contra: where general anesthesia is contra. Hypersensitivity |
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BENZO - Midazolam |
Versed most versatile drugs. Short acting, shorter half life and greater potency. Water soluble. produces hypnotic, sedative, amnestic and anxiety relieving effects Indications: preoperative medicatio, hypnotic, adjunct to intravenous sedation Precautions: reduces requirement for analgesic and inhalational agents during anesthesia. Adverse reaction: apnea and hypotension. can be reserved antagonist flumazenil (mazicon) |
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OPIOD - Fentanyl |
Sublimaze Fails to provide complete amnesia |
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OPIOD - Alfentanil |
Alfenta less potent then fentanyl. short duration of action, rapid onset and produces complete amnesia |
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OPIOD - Sufentanil |
Sulfenta several times more potent then fentanyl produces complete amnesia longer lasting analgesic effects |
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BENZO REVERSAL AGENT - Flumazenil |
Mazicon competes at benzo binding sites with benzo, but the action is useful in balanced anesthesia should reversal be necessary |
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NARCOTIC REVERSAL AGENT - Naloxone |
Narcan competes with narcotic drug for available narcotic receptors. |
