A: 23, 24 Flashcards

Question

general anesthesia definition

Answer 1

* state of * unconciousness * analgesia * amnesia * skeletal muscle relaxation * loss of reflexes

Answer 2

PEKMully? TFuu.פחמימות לוריד ישר Propofol- GABA-A inhibition Etomidate- GABA-A inhibition Ketamine- NMDA inhib. (central glu R) Midazolam(benzo)- GABA-A inhibition Thiopental (barbiturate)- GABA-A Fentanyl- opioid u-r agonist Dexmedetomidine - ( centrally-acting alpha-2 agonist)

Answer 3

* Antagonist of action of excitatory glutamic acid on the NMDA-r

Answer 4

* **Cardiovascular stimulant** * Intracranial hypertension * disorientation, excitation, hallucination, delerium, vivid nightmare

Answer 5

**Metoclopramide - antiemetic ( perioperative)** מתוק לו כשאין דופמין כי דופמין מוריד פרולקטין וחלב זה מתוק אז כשאין דופמין יש חלב מתוק

Answer 6

* anxiolytics: benzo (**midazolam**, lorazepam) * **Analgesics :** * ****opioid ( fentanyl, morphine, hydromorphone) * NSAIDS (ketorolac, diclofenac, meloxicam) * Anti-emetic * **Metoclopramide (D2-r blocker)** oral, parenteral * droperidol * GI protective agents * **H2 blockers :** Cimetidine, famotidine, ranitidine, nizatidine * PPI * sucralfate * Anti-muscurinics * **Atropine: (non-selective) -oral, parenteral :** anti spasmodic , anti diarrhea, reversal of AV block, managing bradyarrythmias (IV) * Antibiotic prophylaxis * Ampicillin * cefazolin * cefuroxime * Acid-supressing agents (ANTACID) - weak bases neutralise stomach acid * NaHCO3 * Mg(OH)2 * AL(OH)3

Answer 7

* Intravenous anesthetic * Facilitates GABA-mediated **inhibition at GABA-A receptor** * **Thiopental** * thiamylal * methohexital

Answer 8

* pharma effects: * Circulatory and respiratory depression * decrease intracranial pressure (ICP) - depress cerecral blood flow * **High lipid solubility** - which promotes rapid entry into the brain and results in surgical anesthesia in one circulation time (\<1 min) * **fast onset** * **short duration** due to distribution * The anesthetic effects of thiopental are **terminated** by **redistribution** from the brain to other highly perfused tissues * but **hepatic metabolism** is required for **elimination** from the body

Answer 9

* Extensions of CNS depressant actions * Additive CNS depression with many drugs

Answer 10

Thiopental Metho-hexital * induction of anesthesia * for short surgical procedures.

Answer 11

* GABA-A inhibition * I.V anesthetic * Fast onset , Fast recovery due to inactivation * propofol produces anesthesia as rapidly as I.V barbiturate but **recovery is more rapid**! * Hepatic metabolism

Answer 12

* Vasodialation and hypotension * negative inotropy : decreased contractility force * Anti-emetic effect * Hypotension (during induction) * CV depression

Answer 13

* General anesthesia * Outpatient anesthesia * Prolonged sedation in patients in Intensive care setting * Anti-emetic activity I.V

Answer 14

* Imidazole derivative * GABA-mediated inhibition at GABA-A receptors * I.V * Rapid onset and short duration of action due to distribution

Answer 15

* This drug is **not analgesic**, its primary advantage is in **anesthesia for patients with limited cardiac or respiratory reserve.** * because it has Minimal effects on cardio-vascular and respiratory function * Pain on injection (may need opioid) * myoclonus * nausea and vomiting * Prolonged administration may cause adrenal suppression.

Answer 16

* Blocks excitation by glutamate at NMDA receptors * IV * Hepatic metanolism * moderate duration of action

Answer 17

* produces a state of **“dissociative anesthesia**” in which the patient * _remains conscious_ but has marked * catatonia * analgesia * and amnesia * * toxities: * Increased intracranial P ( due to Cardio-vascular stimulanting effect!) * emergence reactions (disorientation, excitation, and hallucinations) which occur _during recovery from ketamine anesthesia_, can be _reduced by the preoperative use of benzodiazepines_.

Answer 18

* centrally acting α2-adrenergic agonist * when used **intravenously** has: **analgesic** and **hypnotic actions** * **rapid clearance ; short elimination T1/2**

Answer 19

* mainly used for **short-term sedation in an ICU** setting. * When used in **adjunct to general anesthesia**, the drug _decreases dosage requirements_ for both _inhaled_ and _intravenous anesthetics_ * achieves sedation with no respiratory depression centrally acting alpha2 agonist has analgesic and hypnotic actions when used intravenously

Answer 20

* Benzodiazepine * Facilitates GABA-mediated inhibition at GABA-A receptors * I.V * Hepatic metabolism * post-operative respiratory depression reveresd by flumazenil

Answer 21

effect terminated by **flumazenil (**accelerates recovery)

Answer 22

* Flumazenil (anatginost at benzo site on GABA-A r) can be used to r**everse the CNS depressant effects** of **benzodiazepines**,(midazolam) * but there is **NO antidote for barbiturates or ethanol.**

Answer 23

* Preoperative sedation * Induction anesthesia * outpatient anesthesia ( eg colonoscopy) * SE: * CV and respiratory depression

Answer 24

Benzos are * **less depressants** than barbiturates * **slower onset** * **longer duration** than barbiturates

Answer 25

* Opoid receptors (u) agonist * I.V * Hepatic metabolism

Answer 26

* used with other CNS depressants (NO2, BENZO) in anasthesia resgimens * esp valuable in high-risk patients who might not survive ful general anesthesia * SE: * respiratory depression ( can be revesed postoperatively by naloxone)