Anesthetics

Question 1

Triad of anesthesia

Answer 1

Asleep, pain-free, still

Question 2

Things to consider before anesthesia

Answer 2

FMH of malignant hyperthermia, cardiovascular problems, respiratory disease, allergies.

Question 3

4 Phases of General Anesthesia

Answer 3

Induction, Maintenance, Emergence, Recovery

Question 4

4 Stages of General Anesthesia

Answer 4

Analgesia, Excitement, Surgical Anesthesia, Medullary Depression.

Question 5

Mechanisms of Action

Answer 5

Increase GABA-A activity, Activate Voltage Gated K+ channels, Inhibit glutamate NMDA receptors.

Question 6

Inhalable Anesthetic Agents

Answer 6

Halothane, Fluranes, N2O. Easy to control, easily reversed. Not very smooth or quick.

Question 7

Pulmonary Ventilation Rate

Answer 7

Drugs with higher solubility are more affected by the ventilation rate.

Question 8

Solubility

Answer 8

N2O is sand, Halothane is sugar. High lipid solubility = Lower MAC

Question 9

Pulmonary Blood Flow

Answer 9

Low blood flow = faster onset to the brain

Question 10

Elimination

Answer 10

Less soluble = faster elimination

Question 11

Minimum alveolar concentration (MAC)

Answer 11

Concentration % in the inspired air at equilibrium when there is no response to noxious stimulants in 50% of patients.

Question 12

Nitrous Oxide

Answer 12

Good analgesia, Nontoxic, MAC = 110% insufficient potency. Can be used as a carrier gas which reduces induction time, required concentration, and toxicity. Diffusion Hypoxia risk. Bone marrow suppression.

Question 13

Halothane

Answer 13

Complete anesthetic, poor analgesic and muscle relaxant. Decreases Cardiac output and causes hypotension. Can cause post op hepatitis.

Question 14

Enflurane

Answer 14

Smelly, similar to halothane but less heptotoxicity. Can have CNS stimulation effects, dont use in patients with seizures.

Question 15

Isoflurane

Answer 15

Current maintenance agent, pungency limits mask use, long duration, Low toxicity.

Question 16

Desflurane

Answer 16

Fastest onset and recovery, excellent minute to minute control. Can be a respiratory irritant.

Question 17

Sevoflurane

Answer 17

Rapid onset and recovery, very potent, excellent control. Low air way irritation, used for mask induction.

Question 18

General Adverse effects of inhalable anesthetics

Answer 18

Depression of CV function, depression of respiration and response to CO2, decreased blood flow to liver and kidneys.

Question 19

IV Anesthetics

Answer 19

Quick, easy, smooth induction, rapid and complete recovery. Harder to reverse.

Question 20

Thiopental

Answer 20

One of the most common induction agents. Hyperalgesia, Repeated doses can accumulate in adipose tissue.

Question 21

Propofol

Answer 21

Newer drug and one of the most frequent IV, continuous drip. 99.9% of all inductions. Excellent quality of recovery. Venous irritant(combo with lidocaine)

Question 22

Ketamine

Answer 22

Dissociative Anesthesia. Intense analgesia, catalepsy, and amnesia. NC glutamate NMDA receptor antagonist. Emergency phenomenon. Good for cardiac problems. Ketamine can be given IM. contraindication: psychiatric history.

Question 23

Midazolam

Answer 23

Adjuvant Benzo. Good for sedation, amnesia, and anxiolytic. Provides cardiovascular stability.