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ANESTHESIA Flashcards

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1
Q

why are general anesthetics typically given via inhalational & intravenous route?

A

offer more immediate control over dose & hence duration of action

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2
Q

term for the concentration in the inspired gas required to render half of a group of pts unconscious, that is unresponsive to painful stimulus

A

minimum alveolar concentration (MAC)

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3
Q

what is the oil gas partition coefficient?

A

describes relationship b/w lipid solubility & potency of the drug in producing unconsciousness (the larger the number the more lipid soluble the drug)

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4
Q

what is the meyer-overton hypothesis?

A

states that anesthetic activity is directly linked to lipid solubility

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5
Q

which inhaled anesthetic has the highest min. alveolar concentration?

A

N2O

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6
Q

what is the general mechanism of action for the inhaled anesthetics?

A

reinforce of GABA & glycine inhibitor signaling, reinforcement of two more potassium channel activity & inhibition of glutamatergic signaling

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7
Q

Remember that loss of memory and perceptive awareness can precede the production of what?

A

analgesia (customary in anesthesia to rely upon analgesics to make sure the pt is pain free)

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8
Q

why do you add a fluorine molecule to the inhaled anesthetics?

A

removes the explosive nature of the drug product

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9
Q

the volatile anesthetics are most commonly administered in conjunction w/ what and oxygen?

A

nitrous oxide

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10
Q

which inhaled anesthetic has the highest blood:gas partition coefficient?

A

isoflurane

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11
Q

which inhaled anesthetic has the lowest blood gas partition coefficient?

A

nitrous oxide

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12
Q

which inhaled anesthetic drug has has very low hepatic metabolism?

A

nitrous oxide

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13
Q

the newer agents like (name the two) equilibrate more rapidly into the brain and produce a faster onset of unconsciousness than does halothane.

A

desflurane & sevoflurane (also when turned off these re-equilibrate from the brain to blood and then to alveoli flooding back into lungs and permitting a more rapid recovery of consciousness)

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14
Q

equilibration occurs most rapidly with high flow organs like the ___________ and less rapidly into skeletal muscle and adipose tissue

A

brain

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15
Q

once the anesthetic is turned off, elimination of drug is most rapid again in high flow organs, but overall duration of elimination is governed by the rate of release from __________tissue

A

adipose

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16
Q

what are the two factors that the anesthesiologist can control to adjust the speed of onset of unconsciousness?

A

can increase the percentage of anesthetic delivered with each breath

can adjust RR (more profound effect on N2O, which doesn’t block the reflex response to PaCO2)

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17
Q

with increasing delivery of anesthetic and thus depth of unconsciousness, there is both a loss of _______________ & reduction in tidal volume

A

loss of responsiveness to rising carbon dioxide levels

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18
Q

what are the two main respiratory effects of inhaled agents?

A

increased RR

decreased tidal volume

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19
Q

reflex response to PaCO2 is blocked by all inhaled agents except what?

A

N2O

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20
Q

when used alone which inhaled agent has no effects on the CV system?

A

N2O

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21
Q

what are some of the effects of CV depression by inhaled agents?

A 
direct depression
-decreased symp. outflow
Peripheral ganglion blockade
-decreased adrenal catecholamine release
Baroreceptor attenuation
-decreased Ca2+ flux
Vagal stimualation
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22
Q

name two inhaled agents that have irritating odor?

A

desflurane

isoflurane

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23
Q

none of the inhaled agents except for which drug produce analgesia?

A

N2O

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24
Q

none of the inhaled agents have effects on muscle relaxation except?

A

isoflurane

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25
which inhaled agent is protective in that reflexes are maintained if this agent is used alone?
nitrous oxide
26
which inhaled agent is teratogenic?
N2O (spontaneous abortions)
27
N2O is an inhibitor of what vitamin?
vitamin B12
28
what is the second gas effect for N2O?
high volume of N2O + relative insolubility = rapid uptake of gas from alveoli including any accompanying anesthetic agent for O2
29
what is diffusional hypoxia with N2O?
that brief period of time when the anesthetic is turned off and large quantities of anesthetic gas exit the body by being exhaled (important that anesthesiologist applies oxygen by mask during this critical period)
30
increase pressure with N2O could give rise to what adverse outcome?
eardrum perf. (N2O has 34x solubility that of nitrogen)
31
why do we use N2O?
``` vapor sparing effect (reduced requirement for expensive volatile agent) reduced inspired volatile concentration -reduced resp. depression -reduced CV effects -smoothens the anesthetic procedure cheap ```
32
the need to accomodate such a high volume of nitrous oxide compromises the ability to provide high levels of what?
oxygen
33
which two drugs have actions on NMDA receptor system for glutamate?
propofol | ketamine
34
which IV anesthetic is unusual in that it can function like GABA itself?
propofol
35
propofol blocks the binding of glutamate to what receptor?
NMDA
36
which IV anesthetic works to physically occlude the NMDA channel?
ketamine
37
name the 4 induction agents?
thiopental propofol etomidate also Ketamine
38
it is very difficult for a patient to overdose on what class of drugs?
benzodiazepines
39
what is the rate limiting step in the final elimination of IV anesthetics following surgery?
ultimate release of drug from adipose tissue
40
awakening of the pt who has undergone IV anesthesia is due only to what?
drug-redistribution
41
after extended periods of administration the elimination half-lives of IV anesthetics become governed by what?
become governed by processes of accumulation & release from fat, metabolism and elimination
42
which IV anesthetic causes increased cerebral blood flow & intracranial pressure?
ketamine
43
which drug has no inhibitor effect upon cardiac output and MAP, which makes it useful for surgery with cardiac pts?
etomidate
44
most of the IV anesthetics have what effect on respiratory function?
depressive
45
which IV anesthetic does not have a negative effect on respiratory function?
ketamine
46
which drug can cause like porphyria?
thiopental
47
which IV anesthetic has analgesic action and can cause hallucinations (hint: structurally related to angel dust)?
ketamine
48
which IV anesthetic has inhibition of steroidogenesis?
etomidate
49
what are the adverse effects of propofol?
antiemetic | propofol infusion syndrome
50
which benzo- has the shortest duration of effect?
midazolam
51
which benzodiazpine has the longest duration of effect?
diazepam
52
name the class of drugs: anticonvulsant, amnesia, wide therapeutic safety margin, minimal CV & respiratory depression if used alone
benzodiazepines
53
anesthetics reduce the normal ventilation response to what?
PaCO2
54
name the 20 minute drug for a 20 minute procedure
fentanyl (N/V are rare in contrast to morphine)
55
which class of drugs can have malignant hyperthermia?
all volatile anesthetic agents (including desflurane, sevoflurane)
56
what are the amide type local anesthetics?
lidocaine prilocaine bupivacaine
57
what are the ester type local anesthetics?
procaine | tetracaine
58
which local anesthetic is used for topical use only?
benzocaine
59
what is the mechanism of action of the local anesthetics?
lipophilic drug that passes through neuronal membrane and binds inner surface of the sodium channel causing it to block the ability of an action potential to produce threshold depolarization
60
the local anesthetic produces a differential blockade, what is that?
larger diameter nerves require more local anesthetic, and the time it takes to impact fibers in the center of the bundle
61
the __ is longer for a myelinated nerve than for a non-myelinated nerve because in the former the action potential actually skips along the sufrace of the nerve
zone of anesethetic
62
the local anesthetic usually binds to receptor during which phase of sodium channel activation?
the majority of drug binding takes place with inactivated sodium channels
63
the component of overall local anesthetic drug in the neutral form is dependent on what?
local pH (the majority of local anesthetics are weak bases w/ pKa around 8)
64
application of local anesethetic is discouraged in what areas?
areas of inflammation (b/c very low proportion of drug can access teh nerve and won't cause blockade)
65
which part of the nerve fibers is the last part to experience blockade by a local anesthetic?
-nerve fibers in the center (which serve distant anatomic locations) are the last to be blocked
66
loss of sensation by local anesthetic begins from what to what?
proximal to distal | -note recovery happens from proximal to distal
67
caines are considered what local anesthetic structure?
amide "caine contains I" (lidocaine, prilocaine, bupivacaine) -note if local doesn't have an I then it's an ester
68
why do we use vasoconstrictors with local anesthetics?
removes gradient b/w drug and vasculature, permitting a larger portion of drug to pass down gradient into the adjacent nerve bundle
69
what is the longest acting local anesthetic?
bupivacaine
70
what is the shortest acting local anesthetic?
procaine
71
name the drug: anti-dopamine/cholinergic/histaminergic effects given IM, PO to lower threshold for seizures
promethazine
72
which 1st gen. antihistamine is used as a bronchodilator, sedative, anxiolytic and analgesic with preop ?
diphenhydramine
73
what is the purpose of using 1st. gen. antihistamines in the preoperative period?
have sedative effect and anticholinergic effect which dries secretions & provides prophylaxis of emesis
74
return of the function of what must return before the pt can be discharged following hopsitilization (following opiate therapy)?
gastrointestinal motility
75
why do we prophylactically treat all pts with neutralization of stomach acid before going into surgery?
reduces the risk of aspiration
76
name one of the H2 blockers used to reduce the incidence of aspiration pneumonitis, also works rapidly to reduce the rate of acid secretion?
ranitidine
77
what do bicitra & polycitra do?
neutralize stomach pH (sodium & potassium citrate + citric acid)
78
the effectiveness of agents like metoclopramide (in gastric emptying) is compromised by the pharmacologic antagonism by what two classes of drugs?
anticholinergics & narcotics
79
name inhaled anesthetic that is considered proemetic?
nitrous oxide
80
Which anticholinergic is most potent in reducing tracheobronchial secretions?
glycopyrrolate
81
what is the typical sequence of drug delivery for rapid sequence intubation?
IV push of sedative, then NMB, usually succinylcholine
82
what is the most common reason for delayed awakening?
residual anesthetics & ancillary drugs
83
what are some of the respiratory components to anaphylaxis in anesthesia?
cyanosis, wheezing, increased peak airway pressure, acute pulmonary edema, bronchospasm
84
what are some of the CV components to anaphylaxis in anesthesia?
tachycardia, dysrhythmias, pulmonary htn, CV collapse
85
what are two common aspects of anesthetic agents (ancillary) which can cause anaphylaxis?
bone cement | radio contrast dye
86
what is the MCC of compression of the optic chiasm?
pituitary adenoma

NEUROLOGY (9 decks)

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