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.
1) Etomidate, propofol, barbiturates
2) volatile (uçucu) anesthetics
3) N2O, Xenon
4) Ketamine
Bu gruplardaki anesteziklerin nasıl bilinç ve hareketi inhibe ettiğini anlat. (conscioussness and movement is inhibited.)
1) Etomidate, propofol, barbiturates: GABAa receptor activation–> neuronal excitability is inhibited.
2) volatile anesthetics: GABAa receptor act + K channel act + na channel inh –> Neural excitability + excitatory neurotransmission are inhibited.
3) N2O, Xenon: K channel act, NMDA receptor inh –> Neural excitability + excitatory neurotransmission are inhibited.
4) Ketamine: NMDA inh–> excitatory neurotransmission is inhibited.
Info abt inhalation anesthetic agents?
Gas + vapor.
Gases: N2O, Cyclopropane, Xenon
Vapors: Dietil Eter, Trilene, Methoxyflurane, Chloroform
Modern Inhalation Agents: Halothane, Enflurane, Isoflurane, Desflurane, Sevoflurane –> Usually Halogenated
Bunları bilmek önemli!
Methoxyflurane en güçlü inhaler anestezik. Ondan halotan ve o şekil güçsüzleşerek sıraladık.
Lokal, regional ve general anestezi ajanlarının sınıflandırılması nasıldır?
Local–> Topical, infiltration
Regional–> Peripheral nerve block, epidural, spinal, RIVA
General–> Total inhalation anesthesia, total intravenous anesthesia (TIVA), Balanced anesthesia
Methoxyflurane yan etkisi nedir?
Böbrek yetmezliği
Enflurane yan etkisi nedir?
Seizure
Modern inhaler ajanlar arasında en çok hangilerini kullanıyoruz?
Desflurane ve Sevoflurane
Desflurane–> obez hasta
Sevoflurane–> Çocuk hasta
Info abt intravenous anesthetic agents
Barbiturates: ++N-methylbarbiturates: -Metohenxital Hexobarbital- ++Thiobarbiturates: -THIOPENTAL -Thiamilal
Opioids: MORPHINE, FENTANYL, meperidine, alfentanyl, sufentanyl, REMIFENTANYL, (antidote is naloxan),
Non-Opioids: Ketamine, etomidate
Diprivan (AKA propofol)
Benzodiazepins: DIAZEPAM, lorazepam, MIDAZOLAM (antidote is flumazenil)
Droperidol (antiemetik, antipsychotic)
Naloxan is an antidote for which group of anesthetic agents?
Opioids
Flumazenil is an antidote for which group of anesthetic agents?
benzodiazepins
Barbiturate grubunun en ayırt edici özelliği nedir?
Çok alkali olması: ph 10. IV dışına çıksa deriyi yakabilir. Depresses reticular activating system, onset time of action is 30 seconds, very fast!
Fentanyl ve Morfin arasındaki güç kıyaslaması nasıldır?
Fentanyl morfinden 100 kat daha güçlüdür ve fentanyl yağda birikirken morfin böbrekte birikir. (Böbrekte birikir? Bundan emin değilim.)
Info abt muscle relaxant agents?
Suxamethonium (Succinylcholine)
Decametonium
Pancuronium
Pipecuronium
Vecuronium
Rocuronium
Atracurium
Cis-atracurium
Mivacurium
Doxacurium
Info abt Decametonium?
Depolizer neuromuscular blocker. Succinylcholine kardeşidir.
What is the antidote for muscle relaxant anesthetic agents?
Physostagmine
What is the antidote for Vecuronium and Rocuronium ?
Suggamadeks (selective relaxant binding agent)
What are some anesthetic agents’ like many inhalation agents, barbiturates, benzodiazepines and propofol etc. relation with Cl channel complex linked to the GABA-A receptors?
They potentiate GABA’s opening of the Cl channel
Some barbiturate and inhalation agents themselves activate the Cl channel.
Info abt GABAa receptor complex?
*The GABAA receptor is on the neuron membrane in the synaptic cleft.
*GABA allows the receptor to turn on its endogenous component
*GA drugs do not bind to the same place where GABA binds…
*GABA binding receptors are located between the alpha and beta subunits
*Positive modulators increase GABA effect: benzodiazepines, barbiturates, alcohol, propofol
Cl, K ve Na kanallarına anestezik ajanların etkileri nasıldır?
Cl ve K aktive edilir
Na inhibe edilir. Na inhibisyonu lokal anesteziklerde olur.
Effect of opioids other than anesthetic affect?
Analgesic effect
Effect of propofol and etomidate other than anesthetic affect?
Hypnotic effect
Effects of intravenous anesthesia?
*Sedation
*Anesthesia induction
*Anesthesia maintenance
*Brain protection
*Anticonvulsant (sedasyon için, anti seizure)
Remifentanyl info
IV agent, Infusion, 5dk etkisi var, çok güçlü bir ilaç. Etkisi geçtikten sonra hiperaljezi yapar, o yüzden başka opioid ile kullanmak lazım.
Etomidate info
İnfüzyon yok. Kalp damar hastalarında ve yaşlı hastalarda kullanılır çünkü daha az hemodinamik yan etkisi vardır.
Ketamine info
Phencyclidine Analogue,NMDA, Excellent analgesia, hallucinogen, no decrease eff. BP, hipovolemic patients
Travma veya kanama hastalarında kullanılabilir.
Dissociation yapar. Tansiyonu yükseltir ve nabzı yükseltir diğer ajanlarda tam tersi olur. Salya akmasını sağlar, bronkodilatördür. Talamus ve limbic system dissociation yapar. Limbik hayaller kurdurur.
Midazolam info
benzodiazepine ilacıdır. Her yerdenbu ilacı verebiliriz ama burundan vermemek iyidir zira anozmi yapabilir.
Fast onset, short-acting (Renal failure prolongs sedation) Amnestic, premedicinal
Sedative – hypnotic
Anesthesia induction and maintenance
Controls grand mal seizures
Respiratory depression
It’s effect can be antagonized with «Flumazenil»
