Anaesthesia Flashcards
1
Q
MAC
- anesthesia
- amnesia
- induction
- maintanence
A
1 MAC = 50% immobile
- anesthesia = 0.3 MAC
- amnesia = 0.5 MAC
- induction = 2 MAC (also lethal limit)
- maintenance = 1.3 MAC
2
Q
MOA
- fluranes, benzos, barbs
- Nitric Oxide, Ketamine
A
- Fluranes = potentiate GABA (GABAa, Glycine)
* NO, K = Inhibit Glutamate (AMPA, Kainate, NMDA)
3
Q
Solubility
*Speed
- N.O.
- Methoxyflurane
A
*Low solubitiliy = reach arterial PP/equilibrium fast, faster induction/onset - LOW BLOOD:GAS PARTITION COEFFICIENT
- N.O = low solubility
- methyflurane = high solubility
4
Q
Time course
A
Solubility in fat increases = lengthens time for equilibrium
HIGH FAT:BLOOD COEFFICIENT = longer time
5
Q
Most/least
- Potent
- Fastest onset
- difference b/w fat/lean
A
- Methoxyflurane/NO
- Desflurane/Methoxyflurane
- Halothane/N.O.
6
Q
Halothane
A
- Blood:gas 2.3 = high, slow induction/onset
- fat soluble
- Halothane hepatitis = immune response (hepatic necrosi, fever, N/V, rash)
7
Q
Enflurane
A
*Blood:gas high, slow induction/onset
- Cardio depression (less contractility)
- Seizures (no permanent damage)
- Uterine muscle relax
8
Q
Isoflurane
A
- MC inhalation anesthetic
- 1 MAC = 1.4%
- Blood:Gas low, Fast onset/induction
- CO maintained
- Systemic vessels dilate, small BP decrease
- less arryythmias
- Coronary dilation
- more pungent than Halothane
- respiratory depression
9
Q
Sevoflurane
A
- Low Blood:Gas= Fast induction/onset
- outpatient anesthesia
- possible toxicity
10
Q
Desflurane
A
- Blood:Gas low = fast induction, fast emergence (lasts 5-10 mins)
- Useful OUTPATIENT surgery - quick on/off
- not fat soluble - no obesity difference
- airway irritation
- Low volatility (need vaporizer)
- tach
11
Q
Methoxyflurane
A
- HIGH Blood:Gas = slow onset
- specialty rubber equipment
- Very potent
- Extensive metab
- Nephrotoxic
12
Q
Nitric Oxide
A
- 1 MAC = 105% (can’t anesthetize)
- Blood:Gas VERY low, very Fast induction/onset/recovery
- powerful ANALGESIC
- 70-80% in O2
- ANALGESIA b/f ANESTHESIA
- Weak
- hypoxia (100% O2 if d/c)
- pressure = closed spaces expand
- NO W/ pneumothorax, obstructed middle ear, air embolus, obstructed bowel loop, intraocular air bubble, intracranial air
13
Q
Malignant Hyperthermia
A
- Muscle contraction, high temp, lactate production
- SR can’t sequester Ca2+
TX: DANTROLENE
14
Q
IV agents
Rx
A
- Barbituates
- Propofol
- Etomidate
- Ketamine
15
Q
Inhalation Anesthetics
rx
A
- NO
- Desflurane
- Sevoflurane
- Isoflurane
- Enflurane
- Halothane
- Methoxyflurane
16
Q
Flow + capacity
- Vessel rich
- Muscle (skin/muscle)
- Fat
- Vessel Poor
A
- VRG = CNS, visceral organs, HIGH FLOW + LOW CAPACITY
- M = MED FLOW, HIGH CAPACITY
- FAT = LOW FLOW + HIGH CAPACITY
- VPG = LOW FLOW + LOW CAPACITY
17
Q
Barbituates
A
- little post excitement/ vomiting
- water soluble
- respiratory/cardio depression
- No antag
- Slow recovery
- No Analgesia
18
Q
Propofol
A
- rapid metab + recovery
- low accumulation
- milk of amnesia
- no water soluble
- no antag
- no analgesia
- Cardio/resp depression
- painful inj site
19
Q
Ketamine
A
- Analgesia
- No respiratory depression - UP BP
- dissociative
- UP muscle tone + movements
- hallucinations
- S.E. Less in kids
20
Q
Etomidate
A
- ANTAG available
- anterograde amnesia
- cardio stability (hypoTN patients)
- Accumulates - slow recovery
- no analgesia
- Painful inj site
21
Q
Preanesthetic meds
A
- benzo (midazolam, diazepam) = amnesia
- Anti-histamines = allergic rxn prevent + sedate
- Anti-emetic = aspiration, N/V = zofran
- Opioids (fentanyl, morphine)= analgesia
- Anti-muscarinics (scopolamine, atropine) = amnesia, stop brady, fluid secretion
- Muscle relaxant (pancuronium) = intubation
22
Q
Trauma Pt w/ volume depletion?
A
Careful hypoTN Rx!
