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Pharmacology & Anesthesiology > General Anesthesia > Flashcards

General Anesthesia Flashcards

1
Q

what is the ultimate goal of anesthetic drugs

A

effect on brain: sedation and anesthesia

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2
Q

what is FA and what is FI

A

FA: alveolar fraction
FI: inspiratory fraction

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3
Q

why does FA differ from FI

A

because anesthetic is constantly being absorbed from the alveoli into the blood

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4
Q

if the anesthetic vaporizer is set to 2%, what is FI

A

2%

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5
Q

elimination involves both _________ and _________

A

biotransformation (metabolism) and clearance

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6
Q

what reflects the amount of anesthetic in the brain

A

alveolar concentration

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7
Q

how do we measure alveolar concentration (and therefore amt of anesthetic in the brain)

A

end-tidal concentration

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8
Q

what is the concept of dead space

A

the idea that not all anesthetic molecules are delivered to the alveoli (they can get caught up in the respiratory system)

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9
Q

alveolar concentration depends on what 5 things

A

1) inspired concentration (FI)
2) alveolar ventilation
3) solubility of inhalational anesthetic
4) cardiac output
5) tissue capacity and blood flow

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10
Q

what causes wasted ventilation

A

shallow breathing (dead space rebreathing)

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11
Q

what is the order of inhalational anesthetics from lowest to highest BGPC (and therefore fastest to slowest induction/recovery)

A
  • desflurane
  • H2O
  • sevoflurane
  • isoflurane
  • halothane
  • methoxyflurane
  • ether
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12
Q

are inhaled anesthetics soluble in the lipid or aqueous component of blood

A

lipid

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13
Q

high solubility =

A

prolonged recovery and induction

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14
Q

solubility can be expressed as ___/____

A

FA/FI

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15
Q

describe how alveolar-venous tension difference influences amount of anesthetic in the brain

A

higher blood flow = faster uptake = decreased Fa = decreased amount in brain

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16
Q

lower CO = (higher/lower) solubility

higher CO = (higher/lower) solubility

A

lower = higher solubility

higher = lower solubility

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17
Q

normally, what percentage of CO goes to the brain in healthy animals

A

8%

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18
Q

what happens to the percentage of CO in the brain in animals in shock

A

it goes up to a very high percentage

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19
Q

when there is low CO, (higher/lower) percentage of the CO goes to the brain

A

higher

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20
Q

why do sick animals induce faster than healthy animals

A

they have less CO, so a higher fraction of the CO goes to the brain and the animal is induced faster

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21
Q

brain concentration will not rise significantly until

A

alveolar concentration starts to rise

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22
Q

anesthetic quantity in the blood is dependent on both

A

solubility and alveolar concentration

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23
Q

once you turn off iso, what happens to inspiratory concentration and what happens to end-tidal concentration

A

inspiratory will drop to 0 and end-tidal will slowly decline as the animal eliminates the anesthetic through breathing

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24
Q

do more or less soluble anesthetics have a higher degree of metabolism by the liver

A

more soluble

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25
Q

recovery depends on (3)

A
  • movement from brain back to blood
  • movement from blood back to alveoli
  • removal from alveoli back to anesthetic circuit and eventually scavenging system
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26
Q

what are 4 properties of general anesthesia (what are 4 things we produce through inducing general anesthesia)

A
  • muscle relaxation
  • hypnosis
  • amnesia
  • analgesia
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27
Q

what is analgesia

A

reduced or absent perception of pain, in a conscious state

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28
Q

T/F all analgesics are general anesthetics

A

F

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29
Q

You need to do a procedure on an animal and you think it might be painful… based on the procedure, what 3 options do you have to control the animal/the animals pain

A

1) physical restraint
2) sedation and local anesthesia
3) general anesthesia

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30
Q

what are the 3 ways to perform general anesthesia and what is most commonly done

A
  • inhalational
  • total intravenous anesthesia (TIVA)
  • partial intravenous anesthesia (PIVA)

PIVA most common

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31
Q

what are the 3 PHASES of anesthesia

A

1) pre-anesthetic
2) anesthetic
3) post-anesthetic

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32
Q

which of the following drugs are analgesics: (there are 3)
- opioids
- acepromazine
- alpha-2 agonists
- benzodiazepines
- ketamine
- alfaxalone

A

opioids, alpha-2 agonists, ketamine

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33
Q

which of the following drugs are NOT analgesics: (there are 3)
- opioids
- acepromazine
- alpha-2 agonists
- benzodiazepines
- ketamine
- alfaxalone

A
  • acepromazine
  • benzodiazepines
  • alfaxalone
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34
Q

which of the following drugs are +/- at MAC reduction:
- opioids
- acepromazine
- alpha-2 agonists
- benzodiazepines
- ketamine
- alfaxalone

A

opioids and benzodiazepines

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35
Q

what are some benefits of pre-medicating your patients

A
  • facilitates patient handling
  • lowers dose of induction anesthetic needed
  • lowers dose of inhalational anesthetic (MAC reduction)
  • smoother induction
  • smoother recovery (if still present in bloodstream during recovery)
  • +/- analgesia
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36
Q

what is the best route to premedicate

A

IM

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37
Q

which of the induction drugs is the only analgesic

A

ketamine

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38
Q

which of the induction drugs is not a muscle relaxant

A

ketamine

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39
Q

which of the induction drugs always reduces MAC

A

ketamine and pentobarbital

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40
Q

what is neuroleptanesthesia

A

giving an opioid and a benzodiazepine to induce (only works for sick patients)

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41
Q

what induction anesthetic is good to induce on its own

A

propofol

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42
Q

what are examples of drug combinations that we can use to INDUCE a HEALTHY patient

A
  • ketamine + diazepam/midazolam
  • propofol/alfaxalone + diazepam/midazolam
  • propofol alone
  • inhalational anesthetic
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43
Q

what are advantages of using IV drugs to induce

A

1) rapid control of airways
2) rapid induction
3) smooth recovery
4) rapid adjustment in depth of anesthesia

44
Q

what are 4 disadvantages of injectable induction

A

1) have to restrain patient
2) depends on patients hepatic and renal function
3) cardiopulmonary depression if you inject into artery
4) prolonged recovery if used for maintenance of anesthesia

45
Q

what are advantages of inhalant anesthetic

A

1) does not require IV access
2) rapid recovery with newer agents

46
Q

what are disadvantages of inhalant

A

1) requires fancy equipment
2) dose-dependent cardiopulmonary depression
3) excitement
4) pollution
5) cancer

47
Q

what are 5 intubation routes

A

1) orotracheal
2) nasotracheal
3) pharyngostomy
4) tracheostomy
5) laryngeal mask

48
Q

what are 5 things we can use to monitor the depth of anesthesia

A

1) ocular signs (palpebral, eye position)
2) muscle relaxation, muscle reflexes
3) RR depth and pattern
4) HR and BP
5) pharyngeal and upper airway reflexes

49
Q

reflexes differ based on

A

species and drugs used

50
Q

rules for monitoring are (strict/not strict)

A

not strict

51
Q

what animals need a longer time before extubating

A

brachycephalics

52
Q

where is the highest rate of death in horses (what phase)

A

post-anesthetic (recovery) phase

53
Q

what do we monitor in recovery

A

cardiorespiratory and temperature (TPR)

54
Q

what types of things do we give in recovery

A

fluids, analgesia, sedation

55
Q

a lower MAC means (more/less) response to pain

A

less

56
Q

inhalant/injectable anesthetics stimulate what 2 receptors

A

GABA and glycine

57
Q

what triggers the respiratory center and where is this center located

A

chemoreceptors (peripheral and central) detect O2 and CO2 in the blood; located in the medulla and pons

58
Q

what triggers the cardiovascular center and where is this center located

A

triggered by signals from baroreceptors in the carotid sinus and aortic arch; located in the medulla

59
Q

what is respiration

A

the total process of delivering O2 and removing CO2

60
Q

what are the 3 processes involved in respiration

A

1) gas exchange in the lungs
2) movement of gas in the bloodstream
3) transfer of gases at the cellular level

61
Q

what is ventilation

A

the process of moving gases through the respiratory tract

62
Q

does respiration or ventilation control O2 and CO2

A

ventilation

63
Q

in an environment with no O2, what happens to ventilation and respiration

A

still ventilating because still moving air but not respirating because no O2

64
Q

T/F ventilation is a part of respiration

A

T

65
Q

what determines CO2 levels

A

minute ventilation (VE): RR x Vt

66
Q

fill in the following:
low VE = ______ventilation = ____ CO2
high VE = ______ventilation = _____ CO2

A

hypo; high
hyper; low

67
Q

why is it highly recommended to have a horse on a ventilator

A

depending on positioning, their organs can put pressure on the lungs and impact gas exchange

68
Q

what is an issue with inhalant anesthetics and VE (think of Tainors graph)

A

when on inhalant anesthetic, the patient has a decreased ability to increase VE to compensate for higher CO2 (we may have to give breaths to counteract this)

69
Q

physiologic dead space consists of:

A

anatomical and alveolar dead space

70
Q

what does anatomical dead space consist of

A

air in the mouth, pharynx, larynx, trachea, bronchi and terminal bronchioles

71
Q

what is alveolar dead space

A

air in the alveoli not participating in gas exchange (ex. due to atelectasis)

72
Q

T/F PaCO2 = ETCO2

A

F

73
Q

an animal that is panting/shallow breathing is ___________ but is not _______________-

A

ventilating; respirating

74
Q

what is the consequence of panting/shallow breathing

A

less removal of CO2 from the lungs (may or may not impact O2 depending on FiO2)

75
Q

what is the normal V/Q

A

0.8

76
Q

V:
Q:

A

V: Ventilation
Q: CO or blood flow

77
Q

what happens to V/Q when there is dead space

A

ventilating but not perfusing therefore V/Q = > 1

78
Q

what happens to V/Q when there is a shunt

A

perfused but not ventilated therefore V/Q < 1

79
Q

what are examples of a shunt

A

atelectasis, bronchoconstriction, complete small airway closure, vascular shunt

80
Q

what pressure signifies relative hypoxemia and what pressure signifies absolute hypoxemia

A

relative: 80 mmHg
absolute: 60 mmHg

81
Q

what is hypoxemia

A

low FaO2

82
Q

what are 5 causes of hypoxemia

A
  • low PiO2
  • V/Q mismatch
  • cardiac shunt
  • hypoventilation
  • diffusion barrier
83
Q

what is PaO2 normally and under anesthesia

A

Normally: 93 mmHg
Under anesthesia: 663 mmHg

84
Q

what determines the amount of O2 available to tissues

A

Hg content and saturation

85
Q

you never want to see under what number on a pulse oximeter why

A

95; corresponds with PaO2 of 80 (patient is starting to get hypoxemic)

86
Q

one molecule of Hg can carry how many molecules of O2

A

4

87
Q

how easily does each of the 4 oxygen molecules bind

A

first one hardest, gets easier for each subsequent molecule

88
Q

hypoventilation is _____ dependent whereas hypoxemia is ____ dependent

A

CO2; O2

89
Q

at rest, how what % of delivered oxygen is being used by cells

A

25%

90
Q

T/F if you have an anemic patient you can prevent hypoxemia by delivering 100% oxygen

A

F; only a small portion of oxygen is dissolved in blood so without adequate Hb the patient will still be hypoxemic

91
Q

most oxygen is removed from Hb on the arterial or venous side

A

venous

92
Q

________ effect occurs in the lungs and ________ effect occurs in the tissues

A

Haldane; Bohr

93
Q

oxygen delivery to tissues is highly dependent on

A

Cardiac Output (CO)

94
Q

stroke volume is dependent on (3)

A

preload, afterload, contractility

95
Q

what is preload

A

amount of blood present in the ventricles at the end of diastole

96
Q

what is the effect of preload on cardiac output

A

increases CO to a certain point (volume), at which point the cardiac mm can no longer recoil effectively and the CO will decrease

97
Q

what is contractility

A

ability of the heart to contract in the absence of any changes in preload or afterload

98
Q

how can we “cheat” increasing contractility of the heart

A

by giving ionotropic drugs that act as B1 agonists: dopamine, epinephrine, dobutamine

99
Q

what is afterload and what is the effect on CO

A

resistance to ventricular ejection; decreases CO

100
Q

what is the effect of vasoconstriction on afterload and what drugs will do this

A

increases: a agonists

101
Q

what is the effect of vasodilation on afterload and what drugs will do this

A

decreases; a antagonists and B2 agonists

102
Q

BP depends on

A

CO and SVR (systemic vascular resistance)

103
Q

CO depends on

A

HR and SV

104
Q

oxygen delivery (DO2) depends on

A

cardiac output and CaO2

105
Q

T/F if you see a good BP while monitoring anesthesia you can conclude that CO is also good as there is a correlation between CO and BP

A

F; not necessarily

Pharmacology & Anesthesiology (22 decks)

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