8 - Anesthesia Flashcards
Smallest concentration of inhalation agent at which 50% of pts will not move with incision
MAC (minimum alveolar concentration)
MAC is inversely related to
potency (small MAC = more lipid soluble = more potent)
Anesthetic agent - Fast, minimal myocardial depression, tremors at induction
Nitrous Oxide (NO2)
Anesthetic agent - Least pungent, slow onset/offset; MOST cardiac depression and arrhythmias; good for CHILDREN
Halothane
Anesthetic agent - Fast onset/offset, less laryngospasms, GOOD for MASK induction
sevoflurane
Anesthetic agent - Lowers brain O2 consumption, no ICP increase; Good for NEUROSURGERY
Isoflurane
Anesthetic agent - Can cause seizures
Enflurane
Anesthetic agent - very rapid onset/offset; sedative; anesthesia and amnesia, NO anagelsia; SEs: HoTN, Metabolic Acidosis
Propofol
Anesthetic agent - dissociation of thalamic/limbic system; no resp depression; SEs: hallucinations, tachycardia, increase airway secretions
Ketamine
Anesthetic agent - Contraindicated in pt with head injury b/c increase cerebral blood flow, increase ICP
Ketamine
Anesthetic agent - fast acting, fewest cardiac effects; good for CHF or angina pts; can leads to adrenocortical suppression
Etomidate
Last muscle to go down and 1st to recover from paralytics
Diaphragm
1st muscle to go down and last to recover from paralytics
Neck and face muscles
Anesthetic agent - fast acting, depolarizing agent; causes fasciculations; can NOT be reversed; causes hyperkalemia from depolarization release of K
Succinylcholine
1st signs of malignant hyperthermia
Increase end-tidal CO2
Side effect of succinylcholine caused from calcium release from sarcoplasmic reticulum; Ca metabolism defect
Malignant hyperthermia
What does Dantrolene treat and how
Malignant hyperthermia - inhibits Ca release and decouples excitation complex
MOA of non-depolarizing agents
Inhibits neuromuscular junction by competing with acetylcholine
Non-depolarizing agent - that can be used in liver and renal failure; causes Histamine release (HoTN)
Atracurium
Non-depolarizing agent - fast, intermediate duration, HEPATIC metabolism
Rocuronium
Non-depolarizing agent - slow acting, long duration; RENAL metabolism
Pancuronium
Non-depolarizing reversal agent (2) - blocks acetylcholinesterase (increase ACh)
Neostigmine
Edrophonium
Works by increasing action potential threshold (prevents Na influx)
Local anesthetics
Max lidocaine dosing single and w/epi
4mg/kg; 7mg/kg w/epi
Max bupivacaine dosing single and w/ epi
2mg/kg; 3mg/kg w/epi
Opioids are metabolized by
Liver, excreted via kidneys
Narcotic that can cause seizures, tremors, fasciculations; can NOT be given in pts on MAOIs (serotonin release syndrome); avoid in renal failure pts
Demerol (normeperidine analogue)
Most potent narcotic
Sufentanil
Agonist to GABA receptors in CNS; anticonvulsant; resp depression
Benzodiazepine
Short acting benzo, crosses placenta, contraindicated in PREGNANCY
Midazolam (versed)
Tx for benzo overdose; may cause seizures and arrhythmias
Flumazenil
Epidural anesthesia allows anesthesia by
Sympathetic dennervation
Drug given in epidural causes respiratory depression
Morphine
Drug given in epidural causes decreased heart rate and blood pressure
Lidocaine
Epidural insertion level for thoracotomy
T6-9
Epidural insertion for laparotomy
T8-10
Spinal anesthesia is injection into subarachnoid space below what spinal level to avoid spinal cord
L2
Perioperative conditions associated with most postop hospital mortality (1st and 2nd)
1st - pre-op renal failure
2nd - CHF
Most effective agent to prevent intra-op and post-op CV events
Beta-blocker
How long to wait after MI before elective surgery
6-8 wks
Intra-op sudden transient rise in end-tidal CO2 followed by massive drop
CO2 embolus
Most common cause of post-op hypoxemia
Atelectasis (alveolar hypoventilation)
Most common cause of post-op hypercarbia`
Poor minute ventilation (need to increase TV, bigger breaths)
