Anesthetic Part 2 Flashcards
prototype of inhalational anesthetics
HALOTHANE
can be used in obstetrics when uterine relaxation is
indicated
HALOTHANE
HALOTHANE A/E
Cardiac
Malignant hyperthermia
blocks release of Ca2+ from the sarcoplasmic reticulum of muscle cells, reducing heat production and relaxing muscle tone
Dantrolene
drastic and uncontrolled increase in skeletal muscle oxidative metabolism
Malignanthyperthermia
overwhelming capacity to supply oxygen, remove CO2, regulate temp
Malignant hyperthermia
not toxic to the liver or kidney becuase of its little metabolism
ISOFLURANE
Has an A/E of pungent odor stimulates respiratory reflexes
ISOFLURANE
Rarely use for maintenance anesthesia cos its very expensive
DESFLURANE
popular for outpatient procedures
DESFLURANE
rapid induction, rapid onset and recovery, ↓blood solubility. Ideal to pediatric patients
SEVOFLURANE
low pungency = low irritation of airways
SEVOFLURANE
least hepatotoxic of all inhalational agents
NITROUS OXIDE
It can cause Diffusion hypoxia
NITROUS OXIDE
non-irritating potent analgesic, weak general anesthetic
NITROUS OXIDE
N2O replaces nitrogen in air spaces faster than the nitrogen leaves → N2O retards oxygen uptake during recovery
Diffusion hypoxia
↓blood supply, ↓effect to redistribution
adipose tissue
facilitate amnesia while causing sedation
Midazolam
Alternative to midazolam
diazepam and lorazepam
induces anesthesia, no analgesic activity
ETOMIDATE
replaced in most countries because of the availability of
other anesthetics with fewer complications
HALOTHANE
Most fatal toxicity by halothane
Hepatic necrosis
T/F. If halothane will undergoe oxidative metabolism, it will yield hydrocarbons and some type of halogen which can lead to toxicity.
True
What are the toxicities that lead by halogen and hydrocarbons in halogen if undergoe oxidative metabolism?
fever,anorexia,nausea,vomiting,hepatitis
Halothane interval
NLT2-3weeks
concentration-dependent hypotension
phenylephrine
vagomimetic and may cause atropine-sensitive bradycardia
Cardiac, adverse effect of halothane
Not use for anesthetic induction but can be use as anesthetic maintenance
Isoflurane and desflurane
low fresh gas flow = nephrotoxicity
SEVOFLURANE
usually maintained with inhalational anesthetics
IV anesthetic
one “arm-brain circulation time”
IV anesthetics
high proportion of initial drug bolus goes to cerebral
circulation → blood to brain conc gradient → exerts effects
INDUCTION
redistribution from the CNS
RECOVERY
brain → other tissues with less blood supply (skeletal muscle)
→ plasma conc falls
RECOVERY
Remedy to the reduced CO which leads to compensation
slow titration of the reduced dose for safe
induction
replaced thiopental (1st choice for induction of general
anesthesia)
PROPOFOL
IV sedative-hypnotic use for induction and maintenance
PROPOFOL
Milky appearance
PROPOFOL
ONSET redistribution of propofol
↓plasma levels (2-4 minutes)
T/F. In propofol, pharmacokinetics not affected by hepatic or renal failure
True
does not provide analgesia thats why its usually administered with narcotics
PROPOFOL
No post anesthetic, no post surgery vomiting because of it antiemetic propero
PROPOFOL
Its A/E may contribute to severe hypotension in px with hypovolemia or shock
Thiopental
Its has an A/E of apnea, coughing, chest wall spasm, laryngospasm, bronchospasm
Thiopental
onset<1minute,diffusionrapid
thiopental & methohexital
⚬ 15%ismetabolizedintheliver/hour
thiopental & methohexital
ultra short-acting with high lipid solubility
> potent anesthetic, weak analgesic
Thiopental
minimal CV depression but all are respiratory depressants
BZD
erythromycin prolongs effects
BENZODIAZEPINES
for sedation, induce anterograde amnesia
BENZODIAZEPINES
diazepam brand name
Valium
Lorazepam brand name
Antivan
administered IV, epidurally, intrathecally (CSF)
Opioids
Sufentanil and remifentanil derivative
Fentanyl
Has an Adverse effects of hypotension, respiratory depression, musclerigidity
OPIOIDS
poor water solubility of etomidate
propyleneglycol
for px with Coronary Heart Disease
ETOMIDATE
Called as dissociative anesthetic
KETAMINE
short-acting, nonbarbiturate anesthetic
Ketamine
used mainly in children and elder px for short procedures
KETAMINE
• causes a dream-like state like PCP
Ketamine
sedative used in intensive care settings and surgery
DEXMEDETOMIDINE
reduces volatile anesthetic, sedative, and analgesic
requirements
DEXMEDETOMIDINE
blocksnicotinicAChreceptorsintheNMJ
MOA of neuromuscular blockers
abolish reflexes for tracheal intubation and muscle relaxation for surgery
Neuromuscular blocker
Lidocaine brand name
Xylocaine
blocks nerve conduction of sensory impulses • higher conc, blocks motor impulses
Local anesthetics
topical, infiltration, peripheral nerve blocks, neuraxial
Local anesthetics
cardiotoxic if administered Iv
Bupivacaine
liposome injectable suspension that can give patients post surgical analgesia for 24hrs
Bupivacaine
not for OB use becase it increases neonates toxicity
Mepivacaine
Metabolism site of amides
Liver
Metabolism site of ester
plasma cholinesterase (pseudo cholinesterase)
T/F. Alterations of pH is important
True
Remedy of too much vasodilation = rapid diffusion away from the site = shorter DOA
epinephrine = minimize toxicity, ↑DOA
reported”allergies”effectofepinephrine
Some are psychogenic reactions,
■ urticaria, edema, bronchospasm
Treatment to Systemic local anesthetic toxicity which consider altered mental status or Cardiovascular disease
airway mgt, support breathing and circulation, seizure suppression, CPR ( cardiopulmonary resuscitation)
Amides drugs
Lidocaine , Bupivacaine, Ropivacaine, Mepivacaine, Prilocaine
Esters Drugs
Procaine, tetracaine, cocaine, chloroprocaine
short-acting, causes a dream-like state like PCP
KETAMINE
