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14 Cards in this Set
- Front
- Back
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anesthesia triad and phases
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1. triad: amnesia, relaxation, analgesia
2. phases - induction, maintenance, emergence |
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types anethesia
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1. general - lost sensory perception of entire body
2. regional - loss sensory over specific part of body 3. local - loss sensory over small area of body |
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anestheisa side effects
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1. nausea
2. incomplete pain relief 3. nerve injury 4. malignant hyperthermia - all inhalation agents and succinycholine can cause this |
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Malignant hyperthermia
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1. caused by inhalation agents (halothane, sevoflurane, isoflurane, desflurane) and succinylcholie
2. AD hypermetabolic state where massive amount Ca released in SR due a drug administration 3. defect of ryanodine receptor (Ca release channel) 4. correct with Dantroline which inhibits SR Ca release w/out affecting reuptake 5. rapidly increased temp and extreme acidosis |
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multimodal targeted anesthesia
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1. advantages - reduce pain intensity, reduce opioid use
2. disadvantages - requires knowlege drug, may increase drug-drug interactions, requires specialized skill 3. combination analgesic modalities results better analgesia with concomitant reduction adverse SE 4. faster revocery adn earlier discharge |
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local anesthetic classes
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1. amino amides - lidocaine, etidocine, prilocaine, mepivacaine, ropivacaine, bupivacaine
2. amino esters - procaine, 20chloroprocaine, tetracaine |
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Local anesthetics MoA
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1. inhibit influx Na ions prevent conduction of nerve impulse
-bind specific receptor on inner portion channel -bind active Na channels, most effective firing neurons -3* amines cross uncharged, bind channels charged |
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MAC
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1. minimal alveolar concentration at which 50% of population is anesthetized
2. potency = 1/MAC |
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lipid solubility of LA
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1. determines anesthetic potency, more lipsoluble = more potent
2. all CNS drugs must be either lipid soluble actively transported |
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degree protein binding of LA
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1. determine duration of action, more bindings = longer duration
2. increased solubility in blood or less protein binding = more rapid induction and recovery time |
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pKa of LA
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1. all are weakly basic with pKa around 8
2. infected tissue is acidic and alkaline anesthetics will be charged and thus unable penetrate membrane - need more anesthetic |
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potency/duration of LA
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1. low - procaine, chloroprocaine (amino esters)
2. intermediate - lidocaine, mepivacaine, prilocaine 3. high - bupivacaine, ropivacaine, etidocaine, tetracaine -epi prolongs duration of LA by vasoconstricting |
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LA allergic reaction
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1. if allergic to ester may still give amides
2. small % population allergic via PABA release from esters 3. PABA liberated by metabolism of amino ester anesthetics |
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intercostal block
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1. associated with highest blood levels
2. intercostal > caudal > epidural 3. order nerve block small myelinated > small unmyelinated > large myelinated > large unmyelinated 4. order sensation loss pain - temp - touch - pressure 5. high plasma levels LA produce CNS and/or cardio toxicity including death |
