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Pharm II > (2-22-17) General Anesthesia > Flashcards

(2-22-17) General Anesthesia Flashcards

1
Q

According to Dr. Manton what are the 3 components of being a doctor?

A
  1. Legal
  2. Practical
  3. Psychological
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2
Q

What are the two principle classes of general anesthesia?

A
  1. Intravenous

2. Inhalation

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3
Q

What is historically considered the first anesthetic?

A

Nitrous Oxide

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4
Q

If a patient inhales normal atmospheric air what percentage of O2 is present?

A

21%

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5
Q

If a patient inhales normal atmospheric air what percentage of N2 is present?

A

79%

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6
Q

Why do you Pre-oxygenate a patient?

A

To ensure that the patients functional residual capacity (about 2.5 L) has the maximum amount of O2 present while you intubate (thus giving you more time in case you don’t get the intubation on the first try).

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7
Q

What are the 4 A’s of General Anesthesia?

A
  1. Amnesia
  2. Analgesia
  3. Akinesia
  4. Autonomic and sensory areflexia
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8
Q

Type of General Anesthesia achieved with several agents

A

Balanced Anesthesia

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9
Q

Type of Local Anesthesia used to anesthetize a body region

A

Regional Anesthesia

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10
Q

Regional Anesthesia plus “light” General Anesthesia

A

Combined technique

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11
Q

IV agents for analgesia/ anxiolysis maintaining consciousness

A

Conscious Sedation

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12
Q

T/F: In terms of anesthesia, we usually use a combined technique or balanced anesthesia

A

True

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13
Q

What stage of anesthesia occurs without amnesia, impaired judgement, vertigo/ataxia, increased respiration, blood pressure, heart rate

A

Stage 1 (Stage of Analgesia)

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14
Q

What stage of anesthesia is the patient delirious, excited, amnestic, irregular respirations, struggling, retching and vomiting

A

Stage 2 (Stage of Excitement)

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15
Q

What stage of anesthesia will the patient experience recurrence of regular respiration–>cessation, loss of corneal, swallowing, eyelid reflexes, skeletal muscle relaxation, and decreased blood pressure

A

Stage 3 (Stage of Surgical Anesthesia)

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16
Q

What stage of anesthesia begins at cessation of spontaneous respiration–> severe depression of vasomotor and respiratory centre –> and can result in death without support

A

Stage 4 (Stage of Medullary Depression)

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17
Q

T/F: Nitrous Oxide is the ideal anesthetic drug for all cases

A

FALSE: No such thing as one ideal anesthetic.

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18
Q

What are the two main ways IV anesthetics act by?

A

A. Potentiating the action of an inhibitory ionophore (the GABAa receptor)
B. Blocking the action of excitatory ionophores (Nicotinic Ach & NMDA receptors in spinal chord)

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19
Q

What are the advantages and disadvantages of IV anesthetics?

A

Advantages: Rapid onset, controlled dosage, ease of administration
Disadvantages: Overdose not readily corrected, no antagonists or antidotes, prolonged after effects (hangover).

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20
Q

Dr. Manton used the drug_____ as an example for dissociative anesthetics. This drug can be administered in what ways?

A

Ketamine;

Intramuscularly or Intravenously

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21
Q

What class of drug is ketamine?

A

Cyclohexylamine (similar to angel dust or PCP)

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22
Q

How does Ketamine work? What is its main action on the body?

A

Blocks both nicotinic ACh and NMDA (glutamic acid) receptor channels; main action is cardiovascular stimulation

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23
Q

T/F: Dissociative anesthesia produces catatonia, amnesia, analgesia, and true surgical anesthesia

A

FALSE: It does not produce true surgical anesthesia

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24
Q

When are cyclohexylamines indicated?

A

Mainly in outpatient procedures, children, and burn dressings

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25
Q

If a patient is having an adverse (emergence) reaction to ketamine what drug is given to counteract the drug?

A

Diazepam or Versed

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26
Q

Are Benzodiazepines used mainly preoperatively, during the procedure, or post operatively?

A

Preoperatively

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27
Q

T/F: Benzodiazepines are primarily used for anxiolytic/ amnestic effects

A

True

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28
Q

What is the specific antagonist for benzodiazepines?

A

Flumazenil

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29
Q 
Which of the following serves as the main analgesic agents intravenously?
A. Barbiturates
B. Benzodiazepines
C. Opioids
D. Dissociative Anesthetics
A

C. Opioids

30
Q

T/F: Opioids do little to affect the CV system (CV stability) and have dose dependent respiratory depression

A

True

31
Q

Propofol is what type of drug?

A

Alkylphenol

32
Q

Why are alkyl phenols contraindicated for sedation in children?

A

Possible acidosis and neurological sequelae

33
Q

What class of drug discussed by Dr. Manton produces a significant but transient fall in blood pressure and a rise in heart rate?

A

Alkylphenols (propofol)

34
Q

Is ALPHA half-life synonymous with the redistribution half life or the excretion half life?

A

Redistribution

35
Q

Is BETA half-life synonymous with the redistribution half life or the excretion half life?

A

Excretion

36
Q

The most popular ambulatory surgery induction agent with the least residual sedation is….

A

Propofol

37
Q

An ULTRA SHORT ACTING, class of drugs that induces anesthesia (hypnosis) in 1 circulation time and is very lipid soluble

A

Barbiturates

38
Q

Barbiturates redistribution occurs at a rate proportional to blood supply. Rank the following structures in the order of Barbiturates action: Lean tissues, Fat, Brain.

A

Brain–> Lean tissues–> Fat

39
Q

When using barbiturates, induction can be accompanied by laryngospasm, coughing, or sneezing. What drug do you give to prevent these?

A

Atropine or SCOPOLAMINE

40
Q

Barbiturate solutions are very Alkaline or Acidic?

A

ALKALINE

41
Q

T/F: Barbiturates cause a marked respiratory depression, and mechanical ventilation should be available.

A

TRUE

42
Q

This class of analgesics are used mainly for induction and short duration procedures with Minimal cardiovascular or respiratory effects.

A

Imidazole’s (Etomidate)

43
Q

T/F: Imidazoles have a rapid onset (seconds) and analgesia making it perfectly suited for some surgeries

A

FALSE: They do have a rapid onset, however they do not produce Analgesia (the patients reflexes are present).

44
Q

What percentage of people experience pain on injection with Imidazoles?

A

30%

45
Q

A single dose of Imidazoles causes what?

A

Inhibitory effects of steroidgenesis- adrenocortical suppression

46
Q

How are inhalation anesthetics administered?

A

Via facemask or endotracheal tube

47
Q

When two gases of different solubility exist together in the alveolus, the more soluble dissolves in the plasma first, leaving the less soluble as a bigger fraction of alveolar gas, thus allowing it to dissolve more rapidly than would otherwise be the case. This phenomenon is termed what?

A

Second Gas Effect

48
Q

The steady state minimum alveolar concentration (percent) of an inhalation agent that is required for immobility of 50% of the subjects exposed to a noxious stimulus (e.g., surgical incision)

A

Minimum Alveolar Concentration (MAC)

49
Q

1 MAC of Sevo is what percentage?

A

about 2%

50
Q

Pharmacokinetically, inhalation anesthetics achieve increased effect as the steady state concentration increases in what bodily structure?

A

Brain

51
Q

A low Blood: Gas coefficient @ 37 C (i.e. 0.47 :1) means what?

A

The drug is not very soluble in blood (i.e. has a higher affinity for air) and will thus be cleared quicker after cessation of administration.

52
Q

Which of the following anesthetics has a HIGHER Blood:Gas Coefficient?
Nitrous Oxide or Sevoflurane

A

Sevoflurane

53
Q

Which of the following anesthetics has a HIGHER Blood:Gas Coefficient?
Halothane or Sevoflurane

A

Halothane

54
Q

Which of the following anesthetics has a HIGHER Blood:Gas Coefficient?
Halothane or Nitrous Oxide?

A

Halothane

55
Q

Why do anesthesiologist use several multiples of the MAC value for an agent initially?

A

To increase the rate of induction (i.e. cause a more rapid onset) of the anesthetic, more rapidly achieving an adequate brain level of the agent to produce the desired affect

56
Q

The rate of rise of anesthetic in the blood is also determined by the minute ventilation of the patient. What is the formula for the minute ventilation?

A

MV=TV x RR

Minute ventilation= Tidal Volume x Respiratory Rate

57
Q

Increasing ventilation will generally _______ (increase/decrease) the speed of induction

A

INCREASE

58
Q

T/F: The smaller the partial pressure gradient between arterial and venous blood, the less time it takes to achieve equilibrium (i.e. the faster the anesthetic works)

A

TRUE

59
Q

Patients with low cardiac output would have a relatively _______ (quick/ slow) induction

A

QUICK; due to decreased pulmonary blood flow, the rate of rise of the arterial anesthetic gas tension would increase

60
Q

The major route of elimination for inhalation anesthetics occur through which organ? Inhalation agents with ____ (low/high) solubility are eliminated quickly.

A

Lungs; low

61
Q

What are the risks associated with Halothane?

A
  1. Malignant Hyperthermia
  2. 20% metabolism “toxic” products causing hepatic damage with repeated exposure
  3. Risk of spontaneous abortion in pregnant OR staff
62
Q

An isomer of enflurane

A

Isoflurane

63
Q

T/F: Isoflurane causes some CV or respiratory depression and upon induction BP will decrease, but the stimulation of surgery restores it.

A

TRUE

64
Q

After giving Isoflurane, how is cardiac output maintained?

A

Increase in HR

65
Q

T/F: Isoflurane contains a halogenated ether and #1 used inhalation anesthetic in U.S.

A

True

66
Q

This inhalation anesthetic has a risk of malignant hyperpyrexia.

A

Isoflurane

67
Q

This inhalation anesthetic is the least blood soluble (most rapid induction) and has virtually no metabolism (no liver toxicity, but is still a respiratory depressant).

A

Desflurane

68
Q

When is Desflurane contraindicated as the sole anesthetic agent?

A

In cases of coronary artery disease (CAD) or where rise in heart rate or blood pressure is undesirable

69
Q

What risks are associated with Desflurane?

A

Malignant hyperthermia, severe laryngospasm, secretion, apnea

70
Q

This inhalation anesthetic has no respiratory tract irritation, poor solubility, and few real problems (however, should be used in closed circulatory systems at low gas delivery rates (due to formation of toxic Compound A with soda lime))

A

Sevoflurane

71
Q

This inhalation anesthetic is commonly used but least potent. Really used as an analgesic attaining only stage 1, or as an adjuvant for the second gas effect. Also has a high risk of abuse in anesthetists, dentists, and nurses

A

Nitrous Oxide (Laughing gas)

Pharm II (16 decks)

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