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P3 - ANAESTHESIA > Anaesthetic Agents > Flashcards

Anaesthetic Agents Flashcards

1
Q

What are the main uses of intravenous anaesthetic agents?

A
  • Induction of GA
  • Maintenance of GA
  • Procedural sedation
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2
Q

What is the ideal intravenous anaesthetic agent characterized by?

A

Physical : soluble, stable in solution,air, when diluted, in lights and at room temperature inexpensive

Pharmacological: potent, rapid induction , analgesia, no pain on injection, no epilepsy, no cardiac irritability ,no cardiovascular and respiratory depression , muscle relaxation , no increasing ICP , non-teratogenic, inactive and nontoxic metabolites , Rapid onset and relatively short duration of action.

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3
Q

Name three common intravenous anaesthetic agents.

A

Thiopental (barbiturate)
Propofol
Ketamine
Etomidate

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4
Q

What is Thiopental?

A

A sulphur analogue of the oxybarbiturate pentobarbital.

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5
Q

What is the presentation of Thiopental?

A

Pale yellow powder with a faint garlic smell, formulated as sodium salt. Contains sodium carbonate and nitrogen in place of air

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6
Q

What is the pKa of Thiopental?

A

7.6

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7
Q

Thiopental uses

A

Induction of anesthesia
status epilepticus
traumatic brain injury by reducing cerebral oxygen requirements

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8
Q

What is the induction dose range for Thiopental and duration of action

A

3 – 7 mg/kg.

5-10mins

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9
Q

List effects of Thiopental on the systems

A

CVD - dose dependent decrease in cardiac output, stroke volume and systemic, vascular resistance, compensatory tachycardia

Respi - dose dependent respiratory depression, laryngospasms predisposition

CNS- decrease cerebral oxygen consumption, cerebral blood flow, cerebral blood volume , CSF pressure, no analgesia

Renal - decreased urine output

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10
Q

What type of metabolism does Thiopental undergo?

A

Hepatic oxidation.

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11
Q

What are the complications associated with Thiopental?

A
  • Extravasation causing local damage
  • Intra-arterial injection complications ( risk of amputation)
  • Avoid in porphyria
  • Severe anaphylactic reactions
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12
Q

What is Propofol?

A

An alkyl phenol used as an intravenous anaesthetic.

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13
Q

What is the formulation of Propofol?

A

1% or 2% emulsion in a mixture of soya bean oil, purified egg phosphatide, glycerol
White milky emulsion

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14
Q

What is the induction dose for Propofol?

A

2-2.5 mg/kg.

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15
Q

Describe the mechanism of action of Propofol.

A

It potentiates GABA activity at the GABAA receptor and blocks voltage-operated sodium channels.

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16
Q

What are the effects of Propofol?

A

CVS - decreased cardiac output, hypertension
Respi - respiratory depression with apnea ( better than thiopental)
CNS - expectation dystonia
GIT - anti-emetic
Miscellaneous- green urine and hair

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17
Q

What is Ketamine?

A

A phencyclidine derivative used for anaesthesia and analgesia.

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18
Q

What is the mechanism of action of Ketamine?

A

Noncompetitive antagonism of NMDA receptors.

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19
Q

What are the effects of Ketamine?

A

CVS - sympathetic stimulation, increased heart rate, cardiac output, blood pressure

Respi - spontaneous, ventilation, preserved, increased salvation, bronchodilator

CNS- sleep, analgesia, dissociation, increase intracranial pressure , lateral gaze nystagmus

increased uterine tone

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20
Q

What is the main adverse effect of Ketamine?

A

Emergence delirium up to 24h

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21
Q

What is Etomidate?

A

An imidazole derivative used for rapid induction of anaesthesia.

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22
Q

Administration of Etomidate?

A

IV Bolus 0.15- 0.30 mg /kg

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23
Q

What are the effects of etomidate

A

CVS- less depression so good for hemodynamically unstable patient

Respi - does dependent depression with cough and hiccup

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24
Q

What is Minimum Alveolar Concentration (MAC)?

A

The concentration required to prevent reaction to a standard surgical stimulus in 50% of subjects at 1 atmosphere

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25
What is Halothane known for?
The first modern halogenated inhaled anaesthetic Most potent .
26
What are the adverse effects associated with Halothane?
* Cardiac dysrhythmias * Direct myocardial depression * Halothane hepatitis
27
What distinguishes Sevoflurane from other inhaled agents?
Intermediate solubility, faster induction and elimination. No smell
28
What is a notable property of Desflurane?
Lowest blood:gas solubility, resulting in rapid induction and elimination. Least potent. Highly pungent
29
True or False: Inhaled anaesthetics act solely by enhancing excitatory transmission.
False
30
What is the blood: gas solubility characteristic of Desflurane?
Lowest blood: gas solubility, resulting in rapid induction and elimination.
31
How does Desflurane compare in potency to other inhaled anesthetics?
Least potent, requiring higher concentrations for clinical effect.
32
What adverse effect is associated with Desflurane due to its highly pungent odor?
Airway irritation (laryngospasm, bronchospasm, breath-holding).
33
What can rapid increases in Desflurane concentration lead to?
Transient increases in heart rate.
34
What environmental concern is associated with Desflurane?
Significantly worse environmental impact.
35
Which enzyme metabolizes Desflurane and what does it release?
Hepatic cytochrome P450 (CYP2E1) metabolizes the C-(halogen) bond to release halogen ions (F−, Cl−, Br−).
36
What is the primary function of muscle relaxants during general anesthesia?
To achieve muscle paralysis to facilitate endotracheal intubation and surgical exposure.
37
How do muscle relaxants work at the neuromuscular junction?
By preventing acetylcholine from interacting with nicotinic receptors on the motor endplate of skeletal muscle.
38
What are the two groups of muscle relaxants?
* Depolarizing (e.g., Suxamethonium) * Non-depolarizing (e.g., Vecuronium, Rocuronium, Atracurium)
39
What is the mechanism of action for depolarizing neuromuscular blocking agents (NMBAs)?
Direct activation of ACh receptors.
40
What is the mechanism of action for non-depolarizing NMBAs?
Competitive antagonism of ACh receptors at the motor endplate.
41
Name two classifications of non-depolarizing NMBAs based on chemical structure.
* Aminosteroids * Benzylisoquinoliums
42
Give examples of aminosteroid non-depolarizing NMBAs.
* Pancuronium * Vecuronium * Rocuronium
43
Give examples of benzylisoquinolium non-depolarizing NMBAs.
* Atracurium * Cisatracurium * Mivacurium
44
What is the chemical structure of Suxamethonium?
Two Ach molecules linked by their acetyl groups.
45
What is the typical dose of Suxamethonium for IV administration?
1 - 1.5 mg/kg.
46
What occurs after the injection of Suxamethonium?
A short period of muscle fasciculation followed by muscular paralysis in 40–60 seconds.
47
What is the recovery time after Suxamethonium administration?
4–6 minutes.
48
What is a common cardiovascular effect of Suxamethonium after large doses?
Bradycardia secondary to vagal stimulation.
49
What is the dosing range for Vecuronium?
0.1-0.15 mg/kg.
50
What is the duration of action for Vecuronium?
30-40 minutes.
51
What is the primary pathway for Vecuronium metabolism?
Primarily hepatic, resulting in pharmacologically active metabolites.
52
What is the effect of liver failure on Vecuronium duration of action?
Prolonged duration of action.
53
What is the most commonly used anticholinesterase for NMBD reversal?
Neostigmine.
54
What is the fixed dose of Neostigmine for adults?
2.5 mg intravenously.
55
What should Neostigmine be given concurrently with to prevent muscarinic effects?
* Atropine 1mg * Glycopyrrolate 0.5 mg
56
What is the dose and route of administration for Ephedrine?
3-6mg bolus IV.
57
What is the mechanism of action for Ephedrine?
↑ NA release (indirect α1) and direct α and β agonism.
58
What is an IV anaesthetic agent
Agent that induce loss of consciousness in one arm brain circulation time
59
Complication of propofol and how to avoid
Pain on injection reduced by using large veins through administration, adding lidocaine Allergic rxn to soya or egg
60
Presentation of ketamine
racemic mixture with S+ in enantiomer more potent
61
Mode of administration of ketamine
1- 2 mg / kg IV or 5 -10 mg / kg IM
62
What is an inhalational anesthetic Agent?
Agents with low boiling points who enter circulation via the pulmonary alveolar capillaries and get into central neural tissue to achieve anesthesia
63
When are inhaled anesthetic Agent
Maintenance of general anesthesia induction of general anesthesia
64
The ideal inhalational volatile Agent
Physical - liquid at room temperature stable in lights at room temperature non-flammable inexpensive and environmentally safe Pharmaco- pleasant smell button analgesic no epilepsy no cardiac irritability no cardiovascular and respiratory depression non-irritant to airways muscle relaxation no increased ICP minimum metabolism no Reno or hepatic failure

P3 - ANAESTHESIA (3 decks)

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