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Junior Anaesthesia > GENERAL ANAESTHETIC AGENTS > Flashcards

GENERAL ANAESTHETIC AGENTS Flashcards

1
Q

Anaesthesia :

an – _______ ; esthesia - _______ = (reversible or irreversible?) loss of _______ to _______ stimuli

A

without ; sensation

reversible;response

noxious

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2
Q

General Anaesthesia: when anaesthesia is associated with _________________

General anaesthetic – a drug that brings about (reversible or irreversible ?) _________________ .

Administered by an _________________
Used to induce or maintain general anesthesia to facilitate surgery

A

loss of consciousness

reversible ; loss of consciousness.

anaesthesiologist

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3
Q

Stages of Anaesthesia
— —
—
Stage I : __________
Stage II : __________, __________ behaviour – __________ state
Stage III : __________ anesthesia

A

Analgesia

Excitement ; combative ;dangerous

Surgical ; Medullary paralysis

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4
Q

Stages of Anaesthesia
— —
—

Stage III : Surgical anesthesia

A

eyeballs

corneal reflex

pupils ; dilating ; muscle relaxation

abdominal ; dilated pupils
—

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5
Q

Anaesthesia is divided into 2

A and B

A is further divided into C and D

A

A- inhalational
B-Intravenous
C-halogenated
D-Non-halogenated

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6
Q

Balanced Anaesthesia= anaesthesia + _________ + _________ + _________ + _________

A

Muscle relaxation
Analgesia
Reflex abolition
Unconsciousness

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7
Q

Inhalational (General) Anaesthetic
—

Non halogenated
_____________

Halogenated hydrocarbons
_____________ _____________ _____________ _____________ _____________

A

Nitrous oxide

Halothane Isoflurane Desflurane Enflurane Sevoflurane

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8
Q

Background (History)
—
—
General anaesthesia was introduced into clinical practice in the ______ century
Started with the use of volatile liquids such as __________ and __________

A

19th

diethyl ether and chloroform.

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9
Q

_______________ limited the usefulness of chloroform (out of date!).
—

A

Cardiac and hepatic toxicity

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10
Q

Regimen for balanced anaesthesia

Pre-medication

________ for autonomic stabilization

________ for anxiolysis

________ for analgesia

A

Atropine
Diazepam
Pentazocine

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11
Q

Regimen for balanced anaesthesia

Induction

________ for unconsciousness

________ for muscle relaxation

________ for unconsciousness
______ for analgesia
————- for muscle relaxation

A

Midazolam
Succinylcholine
Halothane, NO2, Pancuronium

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12
Q

Regimen for balanced anaesthesia

Reversal

________ for reversal of neuromuscular block

________ for analgesia

A

Neostigmine

Pentazocine

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13
Q

The MAC is the _______________ of anaesthetic agent that produces ________ in ____% of patients exposed to a standard noxious stimulus.

A

minimum alveolar concentration

immobility

50

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14
Q

The ________ the MAC, the more potent the agent

A

LOWER

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15
Q

Arrange the Agents in order or increasing potency

A

Nitrous oxide
Desflurane
Sevoflurane
Enflurane
Isoflurane
Halothane
Methoxy-flurane

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16
Q

Factors that decrease MAC
_______thermia
_______ natremia
_______
_______ age
______ depressants (sedatives, analgesics, IV anaesthetics)
Severe _______
Severe _______

A

Hypothermia
Hyponatremia
Pregnancy
Old age
CNS depressants (sedatives, analgesics, IV anaesthetics)
Severe anaemia
Severe hypotension

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17
Q

Factors that increase MAC

_______thermia
_______natremia
CNS ___________ (e.g. amphetamine, caffeine)

A

Hyperthermia
Hypernatremia
CNS stimulants (e.g. amphetamine, caffeine)

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18
Q

Mechanism of action
— —
— —Partial Pressure in _______ <= = => partial pressure in _______ <= = = > partial pressure in _______.

A

Brain; arterial blood

alveoli.

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19
Q

Mechanism of action

The DEPTH of anesthesia induced by an inhaled anesthetic depends primarily on the _____________ !!!

The ______________ determines the movement in and out of different compartments

The rate of induction and recovery from anesthesia of the anaesthetic in the brain is dependent on the rate of change of ________ in the ________.

A

PARTIAL PRESSURE

pressure gradient

partial pressure in the brain

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20
Q

LOW solubility in blood= ______ induction and recovery
HIGH solubility in blood= _______ induction and recovery

A

fast

slower

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21
Q

Factors that determine anaesthetic depth, (rapid induction and recovery) include

● _________ concentration
● alveolar _________
● _________ of anaesthetic in blood;
● _________ of anesthetic in tissues
● _________

A

● inspired concentration
● alveolar ventilation
● solubility of anaesthetic in blood;
● solubility of anesthetic in tissues
● cardiac output

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22
Q

The Ideal inhalational agent

________ odour
(Irritant or Non-irritant?) allowing pleasant and rapid induction

A

Pleasant ; Non-irritant

Low ; Chemically

anaesthesia circuit ; soda lime

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23
Q

Ideal inhalational agent

Capable of producing _________ , _________ and some _________

A

unconsciousness, analgesia and some muscle relaxation

high ; metabolised

-toxic ; allergic

depression ; CVS, RS.

other anaesthesia drugs ; inert.

24
Q

Nitrous oxide

It is ____________

______ color and _____ odor

 (Explosive or Non-Explosive?) and (Inflammable or Non-
Inflammable?)

 _______ at room temperature and can be kept as a _______ under pressure.
 Relatively (expensive or inexpensive?)

A

laughing gas

Colourless and odourless

Non-Explosive and Non-Inflammable

Gas ; liquid

inexpensive

25
Q

Only inorganic anaesthetic gas in clinical use is??

A

Nitrous oxide

26
Q

Nitrous oxide

CVS:
— (Stimulate or Depress?) sympathetic nervous system.

Directly depresses ________________ .
—
Arterial blood pressure ,heart rate and cardiac output are slightly _____eased.

RS:
— Increases _________ with decreases ___________
—
Minimal change in ________________

A

— Stimulate ; myocardial contractility.

increased.

respiratory rate ; tidal volume.
—
minute ventilation

27
Q

Nitrous oxide

CNS:
—
Increases ________ thus increasing ___________

Renal:
— It _____eases renal blood flow thus leads to _____ in glomerular filtration rate and urinary output.

A

CBF ; intracranial pressure

decreases ;drop

28
Q

Nitrous Oxide

Hepatic:
— ——-eases the Hepatic blood flow but to a (lesser or greater?) extent than other inhalation agents.

GIT:
— It causes ______________________

Analgesia
* ________ anaesthesia as Entonox 50:50 Oxygen & Nitrous oxide)

A

— Decreases ;lesser

Post operative Nausea and Vomiting (PONV)

Labour

29
Q

Nitrous oxide

Advantages

nonflammable & non explosive
non-irritant potent analgesic
_________ onset, changes in depth and recovery
little or no _______ during normal application

A

very rapid

toxicity

30
Q

Nitrous oxide

Disadvantages

______ anaesthetic agent
no augmentation of _________

____________ on recovery

Expansion of closed internal air-spaces

long term use in excessive quantity associated with ______________________ due to reduced haemopoiesis neuropathy , tinnitus , numbness

A

weak; muscle relaxation

diffusion hypoxia

Vit B12 deficiency anemia

31
Q

Nitrous oxide

Contraindication of N2O
— _________
— ____________
— Acute_______________
Tension _____________
____________________ grafting

A

Airembolism
— Pneumothorax
— AcuteIntestinalObstruction
Tension Pneumocephalus
Tympanic membrane grafting

32
Q

HALOTHANE
—
A halogenated hydrocarbon supplied as a ________ and is ________ for use as an inhalation anaesthetic

Used for __________ and __________ of anaesthesia

(Flammable or Nonflammable?) and (Explosive or Non explosive?).

Does not decompose in contact with __________

A

—
liquid ;vaporized

induction ; maintenance

Nonflammable ; Non explosive.

warm soda lime

33
Q

Least expensive halogenated hydrocarbon agent is ??

A

Halothane

34
Q

HALOTHANE

CVS:
— Dose dependent reduction of arterial blood pressure by direct _____________ .

It is a coronary artery vaso_______

It causes __________ of SAN node conduction resulting in _______cardia

Sensitize heart to _____________ in presence of hypoxia & hypercapnoea

RS:
Causes ________,_______ breathing.

______ease in alveolar ventilation and Paco2 __________.
Potent broncho________.

CNS
It ______eases cerebral blood flow.

A

myocardial depression ; vasodilator

slowing ; bradycardia

catecholamines ; rapid ,shallow

Decrease ; elevated

bronchodilator.

CNS

It increases cerebral blood flow.

35
Q

Halothane

NEUROMUSCULAR:

__________ skeletal muscle and _________ Non-depolarizing neuro-muscular blocking agents.

Renal:
__________ renal blood flow, glomerular filtration rate and urinary output.

Hepatic:
______eases hepatic blood flow.

A

Relaxes

Reduces

Decreases

36
Q

Halothane

Contraindication:
— Unexplained ______ dysfunction.
_________ mass lesions.
__________ patient with severe _______ diseases.

A

liver

— Intra-cranial

— Hypo-volemic

cardiac

37
Q

Halothane Advantages

_________ potency, __________ blood:gas partition coefficient ®

induction and recovery not prolonged
______________ changes in depth of anaesthesia

relatively non-irritant & broncho______ ® laryngospasm & bronchospasm uncommon

____________ and ____________ in combination with O2

_____tensive effect sometimes desirable
uterine relaxation

A

moderately high; moderately low

moderately rapid; dilator

nonflammable & non explosive

hypo

38
Q

Halothane disadvantages

only _______ is completely obtained ® require additional analgesia, muscle relaxation, etc.

______/__________- respiratory depression
Hypotension

transient __________ - especially with __________

increases the ___________ of the myocardium, and when combined with adrenergic agonists ® ectopic pacemakers

Safe dose for infiltration =___:________ ® 60 ml/hr, or 1 ml/min

A

sleep; hypoxia/hypercapnia

arrhythmias; adrenaline

automaticity

1:200,000

39
Q

Isoflurane
—
maintenance.

Has a ________ smell hence usually not used for _________

(Flammable or Nonflammable?) & (explosive or non explosive?) in combination with O2

A

—
maintenance.

pungent ;induction

Nonflammable ; non explosive

40
Q

Isoflurane
CVS
Causes minimal _____________

________ increase in MAC lead to increase in ______ and ______ .( Coronary ____)

________ coronary arteries. —

RS
Respiratory depression
Acts as a good broncho_______.

CNS:
— If conc > ___MAC causes increase in __________

A

cardiac depression

Rapid; HR and BP; Steal

Dilates; dilator

1

CBF and Intracranial pressure.

41
Q

Isoflurane

N/MUSCULAR:
—_________ skeletal muscles.

Renal:
—_____eases renal blood flow, glomerular filtration rate and urinary output.

Hepatic

_________ hepatic blood flow

A

Relaxes

Decr

Reduces

42
Q

Isoflurane Advantages

___________ potency, ___________ blood:gas partition coefficient

_______ induction of and recovery from anaesthesia , _______ changes in depth of anaesthesia

enhancement of muscle relaxation
incidence of arrhythmias is less than ___________

maintenance of _______ and lack of myocardial __________

minimal ___________
_______ controllable via PaCO2

A

moderately high; low

rapid ;rapid

halothane; CO ; depression

biotransformation ; ICP

43
Q

Isoflurane

Disadvantages
a. _______ anaesthesia with
isoflurane ® respiratory & circulatory _________ . hypoxia /hypercapnia/hypotension
b. _________ odour and initial respiratory _________
c. possible _________ syndrome with _________ in IHD
d. uterine relaxation contraindicated at _________
e. more _________

A

deep ; depression

more pungent ; irritation

subendocardial steal ;hypotension

parturition; expensive

44
Q

Isoflurane

CONTRAINDICATION
— Patient with severe ________ may not tolerate its vasodilating effects.

A

hypovolemia

45
Q

Desflurane

Highly __________ __________ _________
ether

Used for __________ of general anaesthesia

Like halothane, enflurane, and isoflurane, it is a racemic mixture of (R) and (S) optical isomers (enantiomers)
Recovery time are approximately ____ % less than those of Isoflurane
—

A

fluorinated methyl ethyl ether

maintenance

50 %

46
Q

Desflurane

CVS
Similar to _________ (____eases HR and BP when increased MAC rapidly)
— ________ coronary arteries.

RS
Causes decrease in __________ and increase in __________
Pungent and airway irritation so causes __________ and sometime __________

A

Isoflurane ; increases

— Dilates ; tidal volume

resp rate.

coughing ; bronchospasm

47
Q

Desflurane

NEUROMUSCULAR:

________ skeletal muscle.

Renal & Hepatic Sys:

_______________ has been documented.

A

Relaxes

No any evidence

48
Q

Desflurane

Contraindication
—
Severe ___________.

________ _____tension.

________ ________.

A

— Severe hypovolaemia.
Intracranial hypertension. Malignant hyperthermia.

49
Q

Sevoflurane

Sevoflurane is an ________ inhalation anaesthetic agent used for the ________ and ________ of general anesthesia.

A ________, (flammable or non-flammable?) , (irritant or non- irritant?), and _____-to-administer compound with a ______ solubility profile and blood-to-gas partition coefficient.
Induction and recovery is ______.
It is _______ smelling and pleasant.
It does not cause irritation of the airway

A

ether

induction and maintenance

A volatile, non-flammable, non- irritant

easy; low ; fast.

sweet

50
Q

Sevoflurane

CVS: (Mildly or Severely?) depresses myocardial contractility

RS: ________ respiratory rate. It ________ bronchospasm

Renal: _________ renal blood flow. Higher Conc Causes ___________

CNS: Increases ________ and _____________ pressures

A

Mildly; Depresses; reverses

Slightly decreases

Nephro-toxicity

CBF and intra-cranial

51
Q

Sevoflurane

Renal: Slightly ______eases renal blood flow. Higher Conc Causes __________

Hepatic: _______eases portal vein blood flow but _____eases hepatic artery blood flow thus maintaining total hepatic blood flow.

N/Mslar: _________ muscle relaxation.

A

decr; Nephrotoxicity

Decr; incr

Adequate

52
Q

Sevoflurane
 Advantages

it has a ________ odour
—
________ induction & emergence

highly suitable for ________ anaesthesia

A

pleasant

very rapid

paediatric

53
Q

Sevoflurane disAdvantages

(Cheap or Expensive?)
— unstable in _________, however, metabolites are apparently ________

A

Expensive

soda-lime; non-toxic

54
Q

Sevoflurane

Contraindication
— —
List 3

A

Severe hypovolaemia.
Intracranial hypertension.
Malignant hyperthermia.

55
Q

Ether
W.T.G Morton on 16th Oct 1846 used for removal of ________.
________ smelling ________, that ________ in presence of light, air, heat.

Highly _________ and ________
— Highly ________ vapour.
— Very (Cheap or Expensive?) .
— Also called as _________ Anaesthetic agents

A

jaw tumor; pungent

Liquid ; decomposed

inflammable and explosive.

Irritant ; cheap; Complete

56
Q

Ether

Induction very _______, ________ smells and may causes ___________
— Very good ____________
—
Very good ______________

A

slow; pungent

laryngeal spasm; analgesic.
—

muscle relaxants

Junior Anaesthesia (17 decks)

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