Chapter 8: Anesthesia Flashcards
Type of Agents that:
- Blunt hypoxic drive
- Caused unconsciousness, amnesia, some analgesia
- Most have myocardial depression, increase CBF, decrease RBF
Inhalational agent
Smallest concentration of inhalation agent at which 50% of patients will not move with incision
MAC (minimum alveolar concentration)
Inhalational agent that is Fast, minimal myocardial depression; tremors at induction
Nitrous oxide (NO2)
Inhalational agent that is-
Slow onset / offset, highest degree of cardiac depression and arrhythmias
- Least pungent, which is good for children for induction
Halothane
Manifestations of halothane hepatitis
Fever, eosinophilia, jaundice, increased LFTs
Inhalational Agent that is -
Fast, less laryngospasm and less pungent; good for mask induction
Sevoflurane
Inhalational agent
-Good for neurosurgery (lowers brain oxygen consumption; no increase in ICP) (recent studies show no clear difference between all these agents regarding ICP)
Isoflurane
Inhalational agent thatCan cause seizures
Enflurane
IV anesthetic that is:
- (Barbiturate) fast acting
- Side effects: decrease CBF and metabolic rate, decrease blood pressure
Sodium thiopental
IV anesthetic
- Very rapid distribution and on/off; amnesia; sedative
- Not an analgesic
- Metabolized in liver and by plasma cholinesterase’s
- Side effects: hypotension, cardiac and respiratory depression
Propofol
IV anesthetic
Dissociation of thalamic / limbic systems; places patient in a cataleptic state (amnesia, analgesia).
- No respiratory depression
- Contraindicated in patients with head injury
-known for causing hypersecretions
- Good for children
Ketamine
IV anesthetic
Side effects: hallucinations, cathetcholamine release (increase CO2, tachycardia), increased airway secretions and increased cerebral blood flow
Ketamine
IV anesthetic
- Fewer hemodynamic changes; fast acting
- Continuous infusions can lead to adrenocortical suppression (this is why its no longer used as a drip in ICU)
Etomidate
When is RSI (rapid sequence intubation) indicated?
- Recent oral intake
- GERD
- Delayed gastric emptying
- Pregnancy
- Bowel obstruction
Last muscle to go down and first muscle to recover from paralytics
Diaphragm
First to go down and last to recover from paralytics
Neck muscles and face
Only one is succinylcholine; depolarizes neuromuscular junction
Depolarizing agents
- Caused by a defect in calcium metabolism
- Calcium released from sarcoplasmic reticulum causes muscle excitation: contraction syndrome
Malignant hyperthermia
First sign of malignant hyperthermia
Increased end-tidal CO2
Side effects: first sign is increased end-tidal CO2, then fever, tachycardia, rigidity, acidosis, hyperkalemia
Malignant hyperthermia
Malignant hyperthermia; tx dosing
Tx: dantrolene (10mg/kg) inhibits calcium release and decouples excitation; cooling blankets, HCO3, glucose, supportive care
give 2.5mg/kg repeatedly until symptoms go away for maximum of 10-20mg; if does not resolve by then then diagnosis is unlikely
When do you NOT use succinylcholine?
Severe burns. Neurologic injury. Neuromuscular disorders. Spinal cord injury. Massive trauma. Acute renal failure.
Complications of succinylcholine
- Malignant hyperthermia
- Hyperkalemia
- Open-angle glaucoma
- Atypical pseudocholinesterases
Type of agents that
- Inhibits neuromuscular junction by competing with acetylcholine
- Can get prolongation of these agents with myasthenia gravis
Nondepolarizing agents