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Drugs in General Anesthesia Flashcards

(51 cards)

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1
Q

Drugs used in GA

A

IV induction agents
Inhalational induction agents
Muscle relaxants and reversals
Analgesics

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2
Q

All the induction agents are _____ and act on _____ receptors which causes ______ and subsequently _______

A
  1. Depressants
  2. GABA receptors
  3. Increased chloride conductance
  4. membrane hyperpolarization
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3
Q

Examples of barbiturate induction agents

A

Thiopentone sodium
Methohexital

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4
Q

What is arm brain circulation time?

A

Time taken for onset of induction agents

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5
Q

Onset of Thiopentone sodium

A

15 secs

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6
Q

ph of Thiopentone sodium

A

10.5 (most alkaline)

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7
Q

Thiopentone sodium:
1. Smell
2. Termination of action is by ____ because the drug is highly ______
3. Dose
4. AOC in ________
5. Other use
6. Accidental intraarterial injection causes
7. Mx in case of intraarterial injection

A
  1. Garlic/ onion
  2. Redistribution, lipophillic
  3. 3-5mg/kg
  4. NeuroSx, Hyperthyroidism
  5. Truth serum
  6. pain, pallor, gangrene, edema
  7. Retain cannula (to prevent vasospasm), saline/ heparin flush, stellate ganglion block (lower cervical sympathetic ganglion)
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8
Q

Why is Methohexital avoided in neuroSx?

A

Proconvulsant

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9
Q

Indication of Methohexital
Dose

A

ECT
1-1.5 mg/kg

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10
Q

Examples of non barbiturate induction agents

A

Propofol
Etomidate
Ketamine

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11
Q

Propofol
1. Form? This leads to? What is done to prevent this?
2. Made of?
3. Should be used within?
4. Properties
5. Dose:
6. Duration

A
  1. Oily–> painful–> add lignocaine
  2. Egg lecithin, soya bean oil
  3. 6 hrs
  4. Antipruritic, antiemetic
  5. 1-2.5 mg/kg
  6. 8-10 mins (w/o hangover)
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12
Q

Propofol
1. AOC in?
2. Side effects?

A
  1. Day care Sx and MAC Ophthalmic Sx bc dec IOP
    LMA insertion and in laryngospasm bc dec reflexes
    TIVA
    Endoscopy and colonoscopy
  2. Propofol infusion syndrome– on prolonged–
    green urine, severe metaolic Acidosis, asystole
    addictive d/t pleasant hallucinations
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13
Q

Etomidate
1. Form:
2. Properties
3. Dose
4. AOC in
5. Side effects

A
  1. oily– propylene glycol
  2. Most cardiostable
  3. 0.2-0.3 mg/kg
  4. DC cardioversion, cardiac aneurysm Sx
  5. myoclonus, emetic and epileptogenic, inhibits adrenocortical synthesis
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14
Q

Ketamine
1. Form
2. Properties
3. ___ receptor antagonist
4. DOse:
5. How to increase duration

A
  1. Phencyclidine derivative
  2. Dissociative anesthesia, depressant (in vivo)
  3. NMDA; increases catecholamine
  4. 1-2 mg/kg IV; 4-6 mg/kg IM
  5. intrathecal admin; used with LA
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15
Q

Ketamine
1. AOC in
2. Side effects
3. C/I

A
  1. Shock ( to incr HR and BP)
    Asthma/ COPD (bronchodilator)
    TOF
    In low resource settings (burns, i and D)
    Pediatric Sx
  2. inc oral secretions (Tx: atropine/ glycopyrrolate), unpleasant hallucinations/ emergence (reduces with midazolam)
  3. HTN, cardiac conditions, ocular sx (inc IOP)
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16
Q

Inhalational agents enter and exit circulation via?

A

lungs

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17
Q

Inhalational induction agents are used to _____

A

maintain depth of anesthesia

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18
Q

Newer inhalational agents

A

Halothane, Isoflurane, Desflurane, Sevoflurane
They are non flammable

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19
Q

Older inhalational agents

A

Ether, chloroform, trilene, cyclopropane

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20
Q

Meyer overton rule

A

Potency proportional to lipid solubility

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21
Q

MAC

Study These Flashcards
A

min drug required to produce immobility to painful stimulus
potency inverse proportional to MAC values

22
Q

Arrange inhalational agents in order of least MAC to most MAC

Study These Flashcards
A

Methoxyflurane
Halothane
Isoflurane
Sevoflurane
Desflurane
N2O

23
Q

MAC of N20

24
Q

MAC of Desflurane

25
MAC of methoxyflurane
0.2
26
Concentration effect
increased conc--> quicker induction
27
Second gas effect
in presence of N2O, conc of other gas increases. d/t rapid movement of N2O into pulmonary circulation
28
What effects are seen at start of surgery?
Conc effect and second gas effect seen simultaneously
29
What effect is seen at the end of sx?
Diffusion hypoxia/ fink effect
30
Diffusion hypoxia?
AKA Fink effect Rapid diffusion of N2o from pulm circulation dilutes the o2 present-- hypoxia Mx: O2 supplementation
31
Blood gas partition coefficient
Conc of agent in blood/ conc of agent in alveoli
32
increased B/G ratio means?
delayed induction as it has more solubility in blood
33
Order drugs on least to highest B/G
Xenon Desflurane N2O Sevoflurane Isoflurane Halothane Methoxyflurane
34
Which new inhalational agents are avoided in asthmatics?
Isoflurane (pungent) desflurane (irritant)
35
AOC for asthmatics
Sevoflurane-- sweet smell Also used in Day care surgery and lung injury
36
Effect of new inhalational agents on resp system
dec RR dec pulm vascular resistance mild hypoxic pulm vasoconstriction
37
Effect of inhalational agents on CVS
Dec HR and BP
38
AOC for cardiac patients
Sevoflurane > Isoflurane
39
Which agent causes Coronary steal syndrome?
Isoflurane (only theoretically)
40
Maximum HR dec is seen with
Halothane
41
Which agent is avoided in cardiac patients?
Desflurane-- increases HR temporarily and irritant
42
Which agent sensitizes myocardium to adrenaline?
Halothane
43
Effect of inhalational agents on CNS
Incr cerebral blood flow and ICP
44
Which agent is c/i in neurosurgery?
Halothane (max increase in ICP)
45
Enflurane causes ____
Seizures
46
How is rise of ICP countered in inhalational agents?
by hyperventilation (dec EtCO2--> dec ICP)
47
AOC in CNS surgery
Iso = Des = Sev
48
Electrical silence
higher conc of inhalational agents causes flat lines on EEG
49
At what level is electrical silence produced for isoflurane
1.5 MAC
50
Main controller of ICP is ____ level
PaCO2
51

Anesthesia (1 decks)

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