Anesthetics

Question 1

Non inhalation anesthetics

Answer 1

PropofolAllosteric modulation of GABA receptors. Sedative, hypnotic effect

Maintenance of general anesthesia
Induction anesthesia
Sedation in case of diagnostic manipulations
Postoperative sedation

Ketamine
NMDA receptor channel blockerAnalgesia, * dissociative anesthesia

Maintenance of general anesthesia
Induction anesthesia
Postoperative sedation

Question 2

Inhalation, volatile

Answer 2

IsofluraneDesfluraneSevoflurane

GABA receptor modulatorsAnesthetic effects
Maintenance anesthesia

All flurans have arrhythmogenic effects

Malignant hyperthermia (genetic) -↑ T, tachycardia, respiratory failure, acidosis, rigidity, rhabdomyolysis

Question 3

Inhalation anesthetics

Gaseous substances

Answer 3

Nitric oxide (N2O)NMDA receptor antagonistSedative, analgesic effect,anesthetic effects without muscle relaxationN2O causes release of endogenous opioid peptides (endorphins) in brain stem
Maintenance anesthesia

Question 4

Premedication

Answer 4

Premedication may reduce the SE of anesthetic or surgical manipulationPremedication is given before general anesthesia, for example, the night before the scheduled manipulation or just a few minutes before.Premedication uses drugs from different pharmacological groups.For example, cholinolitics, anxiolytics, sedatives, BAB,hypotensive agents, antihistamines, hypoacids

DiazepamMidazolam

Question 5

Central action muscle relaxants

Peripheral action muscle relaxantsN cholinoreceptor agonistSuxamethoniumN cholinoreceptor antagonistsRocuronium

Answer 5

BZD

N cholinoreceptor agonistSuxamethoniumN cholinoreceptor antagonistsRocuronium
N cholinoreceptor antagonist Rocuronium intoxicationcan be prevented by antidoteSugammadex,

Question 6

Local anesthetics

Answer 6

Aminoamides or amides
Amides are metabolized by hepatic microsomal enzymes P450,therefore, their duration of action may be ~ 2 times longer than that of esters
* Lidocaine ** Bupivacaine

Na + channel blockade (membrane stabilization),inhibition of excitation pulse conduction in sensory fibers, anesthetic effectNB! Lidocainei / v - Class 1B antiarrhythmic

• All types of anesthesia
• • Infiltration, spinal, epidural and wire anesthesia(for example, obstetrics / nerve block in chronic back pain)

Amino esters or estersBenzocaineMain disadvantages of surface anesthetics - esters:1.Short-term action duration(rapid hydrolytic metabolism due to esterases in tissues and plasma)2.Allergic complications are more common (sensitization to ester hydrolysis metabolite -paraaminobenzoic acid or PABA)For local anesthetics-amides, these disadvantages are not typical
Surface anesthesia