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OMS - 2 Neuro Final > General Anesthesia > Flashcards

General Anesthesia Flashcards

1
Q

Main difference between local and general anesthesia

A

Loss of consciousness with general anesthesia

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2
Q

Balanced anesthesia?

A

In addition to general anesthesia you also need to use opioids or NSAIDs

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3
Q

Balanced anesthesia provides (6)

A
  1. Amnesia
  2. Analgesia
  3. Reduce anxiety
  4. Sedation
  5. Sk. msk relaxation
  6. Suppress reflexes

(You must use multiple different drugs to obtain all of these effects)

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4
Q

Why are neuromuscular blockers used in general anesthesia?

A
  1. Tracheal intubation
  2. Muscle relaxation for surgery
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5
Q

2 routes of administration of general anesthetics

A
  1. Inhalation
  2. IV
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6
Q

Inhaled anesthetics are typically _______ (3)

A

Volatile, halogenated hydrocarbons

(except for nitrous oxide)

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7
Q

IV anesthetics usually consist of ______.

A

chemically unrelated drugs used to rapidly induce anesthesia

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8
Q

Adjunct agents used as pre-anesthetic medications (7)

A
  1. Anticholinergics
  2. Antiemetic
  3. Antihistamine
  4. BZD
  5. H2 blockers
  6. Non-opioid (tylenol)
  7. Opioids (fentanyl)
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9
Q

Why are anticholinergics used in anesthesia?

A

prevent bradycardia & secretion of fluids into the respiratory tract

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10
Q

What is the ideal stage of anesthesia for surgery?

A

Stage 3

(stage four risks death)

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11
Q

Three phases of anesthesia required for surgery

A
  1. Induction: admin (usually IV)→effect
  2. Maintenance (volatile anesthetics)
  3. Recovery: discontinuation → re-gaining consciousness
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12
Q

What does recovery from general anesthesia depend on?

A
  1. How fast the anesthetic diffuses from the brain
  2. Redistribution rather than metabolism

(recovery from inhalation drugs depends on respiration)

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13
Q

3 general mechanisms of action for general anesthetic

A
  1. Modulation of ion channels → increasesGABAA sensitivity→ increases Cl influx → depolarization
  2. NO & ketamine are mediated via inhibition of NMDA receptors (excititory))
  3. Inhalation anesthetics block excititory postsymnaptic currents of nicotinic receptors
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14
Q

Advantages of inhalation and anesthetics (3)

A
  1. Controlling depth of anesthesia
  2. Minimal metabolism (goes straight to brain)
  3. Excretion by exhalation
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15
Q

Factors influencing rate of induction of gen. anesthesia (6)

A
  1. Blood solubility
  2. Blood flow
  3. Concentration
  4. Second gas effect (effects are additive)
  5. Tissue solubility
  6. Ventilation rate and depth

(high blood gas solubility = slower rate of induction/recovery)

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16
Q

Rate of equilibrium of inhalation and anesthetics depends on ____

A

Blood/gas partition coefficient: ratio of anesthetic concentration in blood/alveolar space when partial pressures are equal

(Low blood/gas partition coefficient = higher rate of induction)

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17
Q

Low blood solubility = ______ rate of induction

A

fast

(high blood solubility = slow rate of induction)

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18
Q

Molecules with a higher λ (oil/gas) are _____ (more/less) potent.

A

more

(lipid-solubility increases potency)

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19
Q

High minimum alveolar concentration (MAC) = _____ (high/low) potency.

A

low

(High MAC = low potency)

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20
Q

The more lipid soluble the _____ (lower/higher) concentration needed and the ______ (lower/higher) the potency.

A
  • lower
  • higher
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21
Q

Factors that increase MAC (patient less sensitive) (3)

A
  1. Hyperthermia
  2. Drugs that increase CNS catecholamines
  3. Alcohol abuse
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22
Q

Factors that decrease MAC (6)

A
  1. Age
  2. α2-adrenergic receptor agonists
  3. Hypothermia
  4. Intoxication/other IV anesthetics
  5. Pregnancy
  6. Sepsis
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23
Q

Higher cardiac output removes anesthetic from the alveoli faster and slows the rate _____.

A

of rise in alveolar concentration of gas (takes longer for the gas to reach eq. between the alveoli & brain)

(higher cardiac output slows the rate of induction)

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24
Q

Why does nitrous oxide equilibriate rapidly

A

Insoluble in blood and other tissues

(this serves to concentrate co-administered halogenated anesthetics → second gas effect)

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25
Q

Primary use of inhalation of anesthetics

A
  1. Anaesthetic maintenance
  2. Depth altered by changing inhaled concentration
  3. Steep dose response curves
  4. Narrow therapeutic indices

(caution: no defined receptor for drugs)

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26
Q

Halogenated hydrocarbons are a potent anesthetic but a weak _____

A

analgesic

(same for propofol)

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27
Q

Why are halogenated hydrocarbons contraindicated in obstetrics?

A

Relaxes uterine muscles

(also causes bronchodilation, respiratory & cardiac depression)

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28
Q

Halogenated hydrocarbons are usually co-administered with ______ to achieve balanced anesthesia.

A

nitrous oxide, opioids, muscle relaxants and other adjuncts

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29
Q

Adverse effects of inhalation anesthetics

A

Malignant hyperthermia: mutation in RYR 1

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30
Q

Antidote to malignant hyperthermia

A

Dantrolene (blocks the release of calcium from the sarcoplasmic reticulum in muscle cells)

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31
Q

Isoflurane is less potent than ______ and is metabolized in the ____.

A
  • Halothane
  • Little metabolism (non-toxic to the liver or kidney)
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32
Q

Isoflurane uses

A

Muscle relaxation

(may cause hypotension)

33
Q

Why is Sevoflurane used frequently in pediatric patients?

A
  • Low pungency and respiratory irritation
  • Rapid onset and recovery due to low blood solubility
  • Low hepatotoxic potential
  • Nephrotoxic potential
34
Q

Sevoflurane uses

A

Induction (suitable for pediatric population)

(may be nephrotoxic)

35
Q

Desflurane decreases _____ and _____ all major tissues.

A
  • vascular resistance
  • perfuses
36
Q

Desflurane: onset, solubility, volatility

A
  • rapid onset
  • low blood solubility
  • low volatility (admin. via heat vapor)

(not for inhalation-causes respiratory tract irritation)

37
Q

Nitrous oxide non-halogenated (aka laughing gas) characteristics

A
  • Potent analgesic
  • Weak general anesthetic
  • Poorly soluble in blood and other tissues (moves rapidly in and out of the body)
38
Q

Uses of nitrous oxide non-halogenated laughing gas

A
  • Combined with other more potent agents for surgical anesthesia
  • Dentistry
39
Q

Side effects of nitrous oxide non-halogenated laughing gas

A
  1. Diffusion hypoxia
  2. Chronic exposure can cause megaloblastic anemia

(must give full O2 to bring them out)

40
Q

What sets sevoflurane apart from isoflurane and desflurane?

A

Decreased respiratory reflexes

(the other to cause an initial simulation)

41
Q

Tissue compartments (3)

A
  1. Vessel rich group vs. vessel poor group
  2. Skeletal muscle (moderate perfusion)
  3. Fat (poor profusion)

(highly perfused issues = rapid steady state; poor profusion = reservoir)

42
Q

Which tissue is our vessel-rich group (5)

A
  1. Brain
  2. Endocrine glands
  3. Heart
  4. Kidney
  5. Liver
43
Q

3 tissues that are vessel-poor groups?

A
  1. Bones
  2. Ligament
  3. Cartilage
44
Q

The rate of induction depends on which factors (2)?

A
  1. Lipid-solubility (higher is better)
  2. Arteriole concentration
45
Q

General anesthesia recovery depends on ______ (2)

A
  • Redistribution from CNS
  • Metabolism and plasma clearance with repeated doses
46
Q

The greater the cardiac output, the _____(more/less) anesthetic enters the cerebral circulation. Decreased CO will cause ______(rapid/prolonged) circulation time.

A
  1. more (dose must be reduced)
  2. prolong

(Cardiac output with the inhalation drug quickly transports blood to brain = slower induction time)

47
Q

Propofol uses

A
  1. Induction (fast - 30-40 sec)
  2. Maintenance (due to re-distribution)
48
Q

Propofol side effects (4)

A
  1. Muscle twitching, spontaneous movement, yawning & hiccups
  2. Decrease BP
  3. Reduce ICP
  4. Less depressant affect than volatile anesthetic

(No analgesic effect)

49
Q

Etomidate used for _______; good for patients who have ______.

A
  1. Hypnotic agent used for induction
  2. coronary artery disease are cardiovascular dysfunction
50
Q

Etomidate characteristics (3)

A
  1. Rapid induction
  2. Short-acting
  3. Little to no effect on heart and circulation

(good for patients w/cardiac dysfunction)

51
Q

Etomidate adverse effects (2)

A
  1. Decrease plasma cortisol and aldosterone levels by inhibiting 11 beta-hydroxylase involved in steroidogenesis
  2. Seizure
52
Q

Ketamine MOA

A

NMDA receptor antagonist

(aka PCP- dissociates patients)

53
Q

Ketamine uses (3)

A
  1. Induction and maintenance
  2. Patients with hypovolemic or cardiogenic shock, asthmatics, pediatric patients (does not cause them to have dissoc. amnesia)
  3. Stimulate central sympathetic outflow
54
Q

Ketamine contraindications

A

Hypertensive or stroke patients due to the stimulation of the central sympathetic outflow

(side effect: hallucination, disorientation)

55
Q

_______ has a higher blood solubility than desflurane & sevoflurane.

A

Isoflurane

56
Q

Barbiturates activate the _____ receptors

A

GABA (inhibition)

(potent anesthetic but weak analgesic)

57
Q

Why do barbiturates remain in the body for a long time?

(ex: Methohexital)

A

Small percent is metabolized by the liver

(enters and exits the CNS rapidly)

58
Q

Barbiturate side effects (2)

(ex: Methohexital)

A

Respiratory and cardiovascular depression

59
Q

Benzodiazepines (ex: Midazolam) uses

A
  1. Sedation
  2. Amnesia

(they act on Gaba receptors, like barbiturates)

60
Q

All benzodiazepines have potential to depress the respiratory system & can induce temporary _____.

A

Anterograde amnesia

61
Q

______ may prolong the effects of midazolam (benzodiazepine).

A

Erythromycin

(reversed by flumazenil)

62
Q

Administration route of opioids

A
  1. IV
  2. Epidural
  3. Intrathecal
63
Q

Physiologically all opioids will cause _____ (3) side affects.

A
  1. Respiratory depression
  2. Muscle rigidity
  3. Post anesthesia N/V
64
Q

Neuroleptanalgesia (twilight sleep) is induced with _____ (2).

A

Fentanyl + droperidol (antipsychotic)

(side effect: chest wall rigidity)

65
Q

What determines the speed of recovery from intravenous and anesthetics used for induction?

A

Redistribution of the drug from sites in the CNS

66
Q

Which medication is a potent intravenous anesthetic but a weak analgesic?

A

propofol

(as well as halogenated hydrocarbons; must give with an analgesic)

67
Q

What would you expect to see in a patient with heart failure and significantly reduced cardiac output during surgical anesthesia?

A

Slower induction time with IV anesthetics

68
Q

General anesthesia can lead to hypertension which may result in _____

A

Reduced perfusion pressure and ischemic tissue injury

69
Q

What are two things to consider in regards to the respiratory system when choosing an anesthetics?

A
  • All supress respiration (inhaled, IV & opioid)
  • Inhaled agents may also bronchodilate
70
Q

What is the concern with repeated administration halogenated hydrocarbons?

A

Release of fluoride, bromide → damage to liver, kidney & CNS

(neurologic disorders)

71
Q

General anesthetics in early pregnancy may cause ______(2).

A
  1. Disrupt fetal organogenesis
  2. NO → plastic anemia in fetus
72
Q

Dexmedetomidine is a _______ & _______ used in ICU settings

A
  • analgesic
  • sedetive
73
Q

Dexmedetomidine decreases the release of ________ leading to hypotension & bradycardia.

A

catecolamine by stimulating a2 receptors in the brain

74
Q

What makes remifentanil unique

A

rapidly metabolized

75
Q

Remifentanil is an _____ at low doses and a _____ at higher doses.

A
  • anxiolytic
  • sedative
76
Q

Transient use of nitrous oxide in pregnant patients may cause _______ in the fetus

A

aplastic anemia

77
Q

Inhaled agents depress respiration but also act as _______.

A

bronchodilators

78
Q

Which 4 general anesthetics are used for induction?

A
  1. propofol
  2. ketamine
  3. sevoflurane
  4. etomidate

(propofol & ketamine are also used for maintenance)

79
Q

Which 2 general anesthetics are used for maintenance (as well as induction)?

A
  1. Propofol
  2. Ketamine

OMS - 2 Neuro Final (36 decks)

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