General Anastheasia Flashcards
What are the five clinically desirable effects of general anaesthetics? State which two effects are caused by ALL general anaesthetics.
Loss of consciousness (ALL) Suppression of reflex responses (ALL) Relief of pain Muscle relaxation Amnesia
Name 4 inhalational general anaesthetics.
Nitric oxide
Diethyl ether
Halothane
Enflurane
Name 2 IV general anaesthetics.
Propofol
Etomidate
What is the Meyer/Overton correlation?
For a long time it was believed that anaesthetic potency increases in direct proportion with the oil/gas partition coefficient
In other words: anaesthetic potency is directly correlated with lipid solubility
What were the proposed mechanisms of the meye/overton correlation? What problems with this are there?
The drugs disturbed the lipid bilayer
At therapeutic doses, the changes to the lipid bilayer were minute
How would the change in membrane impact on membrane proteins anyway?
What are the two real mechanisms of action of general anaesthetics?
Reduced neuronal excitability
Altered synaptic function
Describe the difference in the selectivity of IV and inhalational agents.
IV agents are more selective for GABA-A
Inhalational agents are far less selective - large antagonistic action on NMDA and Nicotinic Ach
Which specific subunits of the GABA-A receptor do IV agents that alter synaptic function target and what are their effects?
Beta 3 – important in suppression of reflex responses
Alpha 5 – important in amnesia
What are the two main targets of inhalational agents that alter synaptic function?
GABA-A receptors
Glycine receptors
Which subunit of the GABA-A receptor do inhalational agents seem to be more selective for?
Alpha 1 – important in suppression of reflex responses
Explain how nitrous oxide induces its anaesthetic effect.
Nitrous oxide competes for the glycine-binding site on NMDA receptors (glutamate receptors)
Glycine is an important co-agonist of NMDA receptors – it allows the full receptor response to be transduced
What is the effect of blocking neuronal nicotinic acetylcholinereceptors with regards to general anaesthesia?
Blocking nAChR leads to reduced nerve conduction
This is important for amnesia and relief of pain
Which channels are important in reducing neuronal excitability via the action of inhalational agents?
TREK – background leak K+ channels
These lead to hyperpolarisation of neurones and inhalational agents facilitate the opening of these channels
Inhalational agents are less selective than IV agents. What effect does this have on the dose needed to induce general anaesthesia?
Generally speaking, a higher dose of inhalational agents is required
Explain how general anaesthetics cause a loss of consciousness.
Loss of consciousness is caused by depressing the excitability of thalamocortical and reticular formation neurones
This is mediated by TREK channels and GABA-A