anesthesia Flashcards
which inhaled anesthetic produces analgesia? which maintains protective CO2 reflex?
nitrous oxide for both
which inhaled anesthetic is not as lipid soluble as the others? what is the result? how is that taken advantage of?
nitrous oxide
reaches saturation rapidly
mass effect: coformulated with other agents
which inhaled anesthetic has no effects on CV system? what is the exception to that?
nitrous oxide
opioids can block reflexive sympathetic effects and unmask depressive effects
which inhaled anesthetic is most responsible for diffusional hypoxia on termination?
nitrous oxide
what does the initial administration of anesthetics show?
period of delirium:
exaggerated mechanics of respiration, breath holding
increased muscle tone and BP, mydriasis
why would analgesics be routinely used in anesthesia?
loss of memory and perceptive awareness may precede analgesia
which inhaled anesthetic has greatest potency? why?
halothane: lowest MAC
why can’t nitrous oxide be used alone?
MAC = 105%
incomplete anesthetic: requires supra-atmospheric pressures to work on own
which inhaled drugs work fastest? why?
N2O>desflurane>sevoflurane
less lipid soluble->lower blood:gas partition coefficient
besides lower blood:gas partition coefficients, why else do the newer inhaled drugs work faster?
lower brain:blood partition coefficients
enter brain faster
irritating odor is adverse effect of which anesthetics?
enflurane, isoflurane, desflurane
which inhaled anesthetics produce muscle relaxation?
enflurane and isoflurane
which inhaled anesthetic is pro-arrhythmogenic? why?
halothane: sensitizes heart to catecholamines
what is a unique toxicity of halothane?
halothane hepatitis
which inhaled anesthetic is pro-epileptic in susceptible individuals?
enflurane
what are two unique adverse effects of N2O?
diffusional hypoxia
increased pressure in gas-containing areas of body
which drugs cause malignant hyperthermia? what is the antidote?
volatile anesthetics (not N2O) dantrolene
what is thiopental and what is it used for?
barbiturate
IV induction of anesthesia
what is propofol and what is it used for? what is worrying about its MOA?
IV induction of anesthesia
blocks NMDA glutamate receptors, GABA agonist
at high concentrations, acts in place of GABA
what is unique about ketamine? what is its mechanism of action?
dissociative anesthetic: dissociates cortex from external environment
NMDA glutamate antagonist
what are the longest and shortest acting benzodiazepines used in IV anesthesia?
longest: diazepam
shortest: midazolam
which opioid used in anesthesia produces ultra-short acting analgesia? long-acting? just short?
remifentanil
morphine
fentanyl
what is the risk with the formation of lipid-soluble IV anesthetics?
surfactants can cause thrombophlebitis
which IV anesthetics act on glutamate NMDA receptors?
propofol and ketamine
etomidate
GABA agonist
which IV anesthetic’s are most and least stored in fat?
most: diazepam, thiopental
least: etomidate
what are the effects of thiopental, etomidate, and propofol on CBF, oxygen requirements, and ICP? exception?
decrease them all
ketamine: increases CBF and ICP, no effects on O2 requirements
which IV anesthetics increase HR? what is their effect on CO and MAP?
propofol and thiopental
decrease CO and MAP
which IV anesthetic is good for cardiac patients? why?
etomidate
no effects on heart of vasculature
what drug causes a fatal CV and multi-organ failure of unknown etiology?
propofol infusion syndrome
what drug inhibits steroidogenesis, potentially fatally?
etomidate
what IV anesthetic preserves important protective reflexes and is an analgesic?
ketamine
what drug produces hallucinations when awakening?
ketamine
what local anesthetic is used in dental procedures with epi? why?
articaine
supposed better penetration of bone
what topical anesthetics can be applied to mucous membranes? which can’t?
benzocaine and dyclonine
dibucaine and pramoxine
what drugs might be administered with local anesthetics to increase efficacy?
epinephrine or levnordefrin
vasoconstrictors
what drug might be administered to speed recovery from local anesthesia? why?
phentolamine
alpha-blocker->dilate vasculature
methemoglobinemia is primarily seen with which anesthetic? what other drug? how can it be reversed?
prilocaine and benzocaine to lesser extent
methylene blue or ascorbic acid
what local anesthetics have greatest and least chance of cardiotoxicity and why?
greatest: bupivacaine, long-acting
least: ropivacaine, short-acting
