Anesthesia

Question 1

Define Anesthesia.

Answer 1

‘sedation of a patient for the purposes of a medical procedure/intervention’

Question 2

4 Types of Anesthesia.

Answer 2

1. Local Anesthesia
2. Regional Anesthesia
3. General Anesthesia
4. Monitored Anesthesia Care

Question 3

Local Anesthesia

Answer 3

Localized loss of sensation in a specific area of the body. Used for minor procedures.

Question 4

Regional Anesthesia.

Answer 4

Loss of sensation in a region of the body (ex. arm)

Question 5

General Anesthesia.

Answer 5

Systemic Effect (giving via IV or inhalation) 
Complete loss of consciousness. Used for major, invasive procedures.

Question 6

Monitored Anesthesia Care.

Answer 6

Also known as conscious sedation. A type of low dose sedation that is administered through an IV to make the patient sleepy and calm during a procedure. The patient is awake, but groggy, and is able to follow instructions as needed. CNS depressant!

Question 7

What Drug Class are Local Anesthetics?

Answer 7

Sodium Channel Blockers
-The sodium influx into the neurons is blocked, inhibiting action potential. Therefore there is no cellular depolarization resulting in no communication of sensory information to the cerebral cortex.

Question 8

Which nervous system pathway is affected?

Answer 8

Efferent and Afferent!

Question 9

Kinetics of Local Anesthetics.

Answer 9

• Lipophilic
• Cleared via circulation and hepatic metabolism
• Does not cross the blood-brain barrier
• Onset of less than 2 minutes
• The duration must match the duration of the procedure

Question 10

Local Anesthetic Medications.

Answer 10

Prilocaine, Lidocaine, Bupivicaine, Ropivicaine

Question 11

Routes for Administrations for Local Anesthesia.

Answer 11

1. Topical: on the surface of the location
2. Infiltration: SC injection into the tissue
3. Nerve block: SC injection near a large nerve bundle
4. Epidural: Injection of an anesthetic into the epidural space
5. Spinal: Drug delivered directly into CSF (intrathecal space/subarachnoid space)

Question 12

Adjunct Medications paired with Local Anesthesia.

Answer 12

• Epinephrine (adrenalin): localized vasoconstriction, increases the duration of anesthetic
• Sodium Bicarbonate: Alkalinization of the tissue in case of bacterial infection
• Opioids: Analgesia

Question 13

Epidural Route: Local Anesthesia.

Answer 13

Injection of an anesthetic into the epidural space. Causes loss of sensation to the spinal nerves. Any level of the spinal column can be blocked (cervical, thoracic, lumbar).

• Onset: 20-30 minutes
• Continuous infusion via an indwelling catheter.
• DOSE IS HIGHER THAN FOR SPINAL ROUTE

Question 14

Spinal Route: Local Anesthesia.

Answer 14

Drug delivered directly into CSF (subarachnoid space). Spinal anesthesia is performed by placing a needle between the lumbar vertebrae and through the dura to inject the anesthetic medication.

• Quick Onset
• Most Common Procedures: Abdominal, Pelvic

Question 15

Nursing Considerations for Local Anesthesia.

Answer 15

• Monitor VS
• Test sensation and motor function
• Monitor for signs of hematoma
• Monitor for signs of infections
• Monitor Catheter Migration (epidural)
• Backache
• Monitor Signs of spinal cord injury.

Question 16

Three Stages of General Anesthesia.

Answer 16

1. Patient is calm, breathing slows down, drowsiness. Analgesics given.
2. Hypnosis, starting to enter a stage of unconsciousness
3. Loss of reflexes, muscles completely relax

Question 17

Analgesia Medications used during General Anesthesia.

Answer 17

Opioid analgesics

-Fentanyl, Morphine

Question 18

Inhaled General Anesthetics.

Answer 18

Decrease action potentials, increase GABA

-Nitrous Oxide, Halothane, Isoflurane

Question 19

Intravenous General Anesthetics.

Answer 19

Increases GABA

• Rapid onset of action
• VS monitored

Question 20

Neuromuscular Blocking Agents

Answer 20

Anticholinergic agents (paralytics). Inhibits acetylcholine from binding to nicotinic receptors causing muscle paralysis.

• No blood bairn barrier infiltration
• Rapid Onset
• Vecuronium, Rocuronium, Pancuronium