CCS 401 Anesteziyoloji Flashcards
What is the definition of anesthesia?
Greek: an- “without” & aisthesis- “sensation”
It is the occurrence of regional or total loss of sensation with or without loss of consciousness.
The loss of sensation occurs with a disease, trauma or anesthetic drugs given intravenously or by inhalation.
What are the types of anesthesia?
Local, regional and generalized.
Info abt local, regional and generalized anesthesia?
Local–> It is the reversible disappearance of sensation in a small area, without loss of consciousness.
Regional–> - It is the reversible disappearance of sensation in a part of the body, without loss of consciousness.
Generalized–> - It is characterized by a temporary loss of consciousness and a decrease in reflex activity without a change in vital functions.
What is the triad of anesthesia?
Hypnosis, analgesia and muscle relaxation.
Hypnosis: Amnesia & unconsciousness. When General Anesthesia is required.
Analgesia: Reducing motor response to surgical stimulus Reducing autonomic responses to surgical stimulus
Muscle relaxation: Attenuation of autonomic responses to noxious stimulation. Immobility (if needed)
Anestezi, korteks ve subkortekse etki eder. Peki, korteks ve subkortekse olan etkileri hangi sonuçlara sebep olur?
Korteks–> unconsciousness, amnesia
Subcortex–> Antinociception, immobility, autonomic stability
Types of sedation?
Mild, deep sedation, general anesthesia.
Mild s–> Awake & conscious. spontaneous breathing (+). Response to verbal stimuli (+)
Deep s–> Somnolence. spontaneous breathing (+) . Response to verbal stimuli (-)
General anesthesia–> Somnolence. spontaneous breathing (-) . Response to verbal stimuli (-)
Which patients need general anesthesia?
Infants and children
Long-term interventions
Patients with mental disorders
Patients/interventions in which regional intervention is not appropriate and sufficient
Anticoagulant therapy (hematom riski yüksek!)
Selection of the patient
Anestezi sırayla beynin hangi bölgelerine etki eder? (Burada şuraya takıldım, bu en çok etki eden yerler mi yoksa sıralama şeklinde mi?)
Cortical and psychic centers–> Subcortical centers –> Basal ganglia and cerebellum –> spinal cord –> medullary center.
How is the depression Sequence in Anesthesia & Anesthesia Levels?
It is divided to 4 stages.
1–> Stage of analgesia. Beginning of inhalation to loss of consciousness. Used in minor surgical procedures.
2–> Stage of excitement. Loss of consciousness to regular inhalation. Not suitable for surgical procedures.
3–> Stage of surgical anesthesia. Regular resp to cessation of breathing. Suitable for surgeries.
4–> Stage of respiratory paralysis. Cessation of breathing to failure of circulation and death. Medullada çok fazla anestezi birikirse ölüme götüren bir arrest yaşanır medullary depression ile. This stage should be avoided.
Bir anestezik ajanın yağda çözünürlüğü ile gücü arasında nasıl bir bağlantı vardır?
Doğru orantı. Ajan ne kadar güçlüyse yağda o kadar iyi çözünür. Tersi de doğru. (inhalation ajanlar için özellikle. Mayer Overton Rule)
What are the Theories of General Anesthetic Action?
1–> Anestezik Ajan ne kadar güçlüyse yağda o kadar iyi çözünür. Mayer Overton Rule
2–> Bazı proteinler anesteziye çok duyarlı. GABA, Glycine, Glutamate (yani NMDA), NiACH receptors gibi ligand gated ion channellar mesela.
3–> Anestezik ajanlar sinapslara da etki edebiliyorlar: Presynaptic inhibition of neurotransmitter release. Inhibition of excitatory neurotransmitter effect. Enhancement of inhibitory neurotransmitter effect
Anestezik ajanlar beynin her kısmına etki edebilir. En çok etkiledikleri anatomik beyin bölgeleri nelerdir?
TALAMUS (Inhibition of Ni Ach receptors)
HYPOTHALAMUS
BRAIN STEM
LIMBIC SYSTEM (Hippocampus and Amygdala; memory function and anesthetic mediated amnesia)
RAS
Hippocampus
Medulla spinalis
Inhalational anestezikler nasıl bilinç kaybının olmasına sebep olabiliyorlar?
Inhalational agents can depress the excitability of “thalamic neurons”, block “thalamo-cortical” and “fronto-parietal” communications –> the potential result is loss of consciousness.
What are the inhibitory and excitatory receptors of brain?
Inhibitory receptors: GABAA (g-aminobutyric acid), Glycine receptors, Potassium channels
(They are activated by anesthetics)
Excitatory receptors: Na channels (sadece local anesthesia!!!!!), Glutamate, Neuronal Nicotinic Receptors, NMDA (N-methyl-D-aspartate)
(They are inhibited by anesthetics)
Ketamine glisine mi yoksa NMDA blokörü müdür?
NMDA. + olarak, sadece ketamine’in analjezik görevi de vardır, diğer anestezik ajanlarda yoktur bu.
İnorganik gaz anestezi ajanları nelerdir?
+ malignant hyperthermia yapmayan gaz anestezi ajanı nedir?
- N2O ve Xenon
+ Xenon
Hiponatreminin beyne etkisi nedir ve hangi değerin altına düşerse hastaya anestezi yapılmamalıdır?
Hiponatremi beyin ödemine sebep olur. 130un altına indiği zaman anestezi verilmemelidir hastaya.
