Clinical Anesthesia Flashcards
1. Describe the rationale for the use of combinations of anesthetic agents to achieve safe and effective surgical anesthesia. 2. Provide examples of different combinations of anesthetic agents that could be used to achieve safe and effective anesthesia 3. Describe the mechanisms of common drug interactions and list the resulting effects in the use of combinations of anesthetic agents.
General goals of anesthesia
analgesia
amnesia
unconciousness
supression of responses to surgery
responses to surgery needed to be supressed
motor, CV, pain, hormonal
midazolam given for
preop sedation
fentanyl given for
preop sedation, anesthetic maintainance
propofol given for
anesthetic induction
cis-atracurium given for
muscle relaxant
isoflurane given for
anesthetic maintenance
furosemide and dexamethasone given for
reduction of ICP
phenytoin given for
prevention of postop seizures
neostigine and glycopyrrolate given for
reversal of NMB
ondansetron given for
post op nausea
rationale for using multiple drugs
max benefit, minimize problems
advantages for use of multiple drugs
allows selection of best drug for desired targeted effect, smaller doses
possible number of interactions with 7 drugs
21
define pharmacokinetic interaction
when precense of one drug alters the serum concentration of the 2nd drug
define pharmacodynamic interaction
precense of one drug alters concentration vs effect relationships for a 2nd drug
dehine pharmaceutcal drug
when precense of one drug causes another or both to precipitate or become less soluble
benzo/opoid combo used for
preop sedation (beneficial at low doses)
type of benzo/opioid interaction
dynamic and kinetic interaction
preop sedation/induction agent interaction type
dynamic and synergistic as well as mutual interaction
define 2nd gas effect
uptake of 2nd gas reduces lung volume and increases concentration and uptake of 2nd gas
combo of inhaled agent and muscle relaxant NOT TO BE USED
N2O and NDBD
type of interaction in inhaled agent and NDBD
dynamic synergistic (increases effect of NDBD)
labeltol/hydralazine combo good fir
decreases BP without increasding HR (good for coronary disease)
type of reaction of labeltol/hydralazine
dynamic
most common drugs causing n/v
N2O and opioids
risk factors for post op N/V
nonsmoker, female, previous history, long general anesthetic
drugs to treat post op n/v
ondansetroon and droperidol
MOST effective combo for post op n/v
5HT3 blockers and steroids
result of etomindate/Sch interactin
pHdifferences can lead to precipitate
result of phenytoin/cis-atracurium interaction
pharmadynamic antagonism of NdBd
type of case when phenytoin/cis-atracurium interaction can be particularly bad
neurosurgical case
way to monitor phenytoin/cis-atracurium interaction
tittration with nerve stimulator
drugs that can negatively interact with ephedrine
non selective MAO inhibitors, meth, cocaine,
