Anesthesia Flashcards
To minimize side effects and maximize efficacy, most anesthesiologists employ balanced anesthesia, meaning they utilize small doses of
Multiple agents
Minimal amounts of amnestied and opioid given and patient is still able to converse and respond to timelines and commands
-Able to protect airway and maintain ventilation
Conscious Sedation
Involves decreases in responsiveness to painful stimuli and commands and ability to protect airway and maintain normal ventilation
General Anesthesia
Once the patient has lost the ability to protect the airway, it is considered
General anesthesia
The only gaseous anesthetic is
Nitrous Oxide
Liquid at room temperature such as the halogenated ethers
Volatile anesthetic
Used primarily for maintenance except in pediatrics where it is used for induction
Volatile Anesthetic
The driving force for uptake of inhaled anesthetic to its target organ is
Alveolar Fraction (or Alveolar partial pressure) of anesthetic
Which two things lead to a high onset (FA)
Increased F1 and increased alveolar ventilation
The more insoluble the anesthetic is the
Faster the onset
What is the order of solubilities of the anesthetics?
ISO > SEVO > DES > N2O
Alveolar ventilation is the most important factor in
Emergence
A minor factor in emergence
Metabolism
What is the degree of metabolism for the inhaled anesthetics?
SEVO > ISO > DES > N2O
Measure of potency of anesthetic
Minimal Alveolar Concentration (MAC)
The partial pressure of inhalation anesthetic in the alveoli at which 50% of the population of non-relaxed patients remain immobile at skin incision
MAC
Increase respiratory rate and decrease Vt for an overall decrease in minute volume
Inhaled anesthetic affects on respiration
Inhaled anesthetics cause a decrease in
BP
Can potentially cause. Decrease in methionine synthase activity, causing megaloblastic anemia
Nitrous Oxide
Hypermetabolic syndrome in generally susceptible patients after exposure to triggering agents
Malignant Hyperthermia
Caused by a decrease in reuptake of Ca2+ from the sarcoplasmic reticulum
-Incidence is rare
Malignant Hyperthermia
Prolonged muscle contraction leading to hyperthermia, hypercapnia, hypoxia, and hyperkalemia
Malignant hyperthermia
Given as the antidote to malignant hyperthermia
-Inhibits release of Ca2+ from the sarcoplasmic reticulum
Dantrolene
What are the three IV anesthetics?
Propofol, Etomidate, and Ketamine
Are all lipophilic, so there is preferential partitioning into highly perfumed lipophilic tissues
Propolof, etomidate, and ketamine
Have rapid redistribution from highly perfumed tissues into lean tissues for quick offset of action
Propofol, etomidate, and ketamine
Used for induction and maintenance of general anesthetic as well as sedation
-Milk of amnesia
Propofol
A non-analgesic GABA agonist
- Vasodilatory and negatively inotropic
- Antiemetic
Propofol
Used for induction and short sedation
- Minimal hemodynamics effects
- GABA agonist
Etomidate
Respiratory depressant that burns on injection
Etomidate
Phencyclidine derivative that gives dissociative anesthesia w/ nystagmus (cataleptic state)
Ketamine
Airway reflexes are preserved in most situations with
Ketamine
Hallucinations and unpleasant emergence may occur with
-Co-administration of a benzodiazepine is recommended
Ketamine
Used for sedation or adjunct to general anesthesia
Dexmedetomidine
An alpha-2 agonist that acts as both a sedative and analgesic
Dexmedetomidine
The receptors for dexmedetomidine are in the
Locus Ceruleus and spinal cord
