General Anesthesia 2

Question 1

During the premedication phase, what class of drug is usually employed as an anxiolytic (which one)? What class of drug may be used in combination (which one)?

Answer 1

Benzodiazapine (midazolam)

Opioid (Fentanyl)

Question 2

During induction, majority of induction agents first go to _ before redistributing to other parts of the body. In addition to an induction agent, what other drug may be administered at this time?

Answer 2

Brain

Muscle relaxant

Question 3

During the maintenance phase of anesthesia, _ and _ are used in addition to a volatile anesthetic because of their MAC sparing properties?

Answer 3

Muscle relaxant

Opioid

Question 4

What occurs to the anesthetics that allows for the emergence and recover phase? Why do patients emerge quickly from anesthesia?

Answer 4

Drug elimination and metabolism

The drugs quickly redistribute from the brain

Question 5

What property of volatile anesthetics allow them to quickly accumulate in the brain?

Answer 5

Lipid solubility

Question 6

The newest anesthetic induction agent, this agent is used for induction and sometimes for maintenance and sedation. It produces cardiovascular and respiratory depression and cannot be antagonized. What is this drug? What is it usually dissolved in? What makes it unique among anesthetic agent?

Answer 6

Propofol
Intralipid
No “hang over”

Question 7

This anesthetic is adminstered intravenously and used mainly for induction. It produces respiratory depression but not cardiovascular depression. It cannot be antagonized. This describes _. What should you NOT use this drug for?

Answer 7

Etomidate

Sedation

Question 8

This anesthetic is and NMDA receptor antagonist and is described as a dissociative anesthetic. Used for induction, and produces sedation, amnesia and analgesia. It doesn’t produce either respiratory or cardiovascular depression and it cannot be antagonized. It is associated with emergence delirium. This describes _

Answer 8

Ketamine

Question 9

What are the 2 examples of barbiturates provided? What are their subgroups?

Answer 9

Methohexital (Oxybarbiturate)

Thiopental (Thiobarbiturate)

Question 10

How are barbiturates administered? What part of the anesthesia protocol are they used for? What property allows them to produce rapid, profound unconsciousness due to rapid uptake into the brain? What is their effect on cardiovascular depression? Respiratory depression?

Answer 10

IV
Induction
Lipid soluble 
N/A
Profound respiratory depression

Question 11

Recovery from barbiturates is rapid (5-8 mins). What causes this? How are they antagonized? What is their effect on parasymp outflow from the brain? Symp outflow?

Answer 11

Redistribution from the brain
Cannot be antagonized
No mentioned effect on parasymp
Decrease sympathetic outflow

Question 12

Propofol, ketamine, etomidate, benzodiazapines and barbiturates. What receptors do these drugs work on?

Answer 12

All but Ketamine (NMDA) function at GABA receptor

Question 13

What part of the anesthesia protocol are benzodiazapines used for? Which do they produce (analgesia, sedation, amnesia)? What is their effect on cardiovascular depression? Respiratory depression? What is the drug that can antagonize their effect?

Answer 13

Premedication (anxiolytic)
Sedation and amnesia
No mentioned effect on cardiovascular
Depress repiration
Flumenazil

Question 14

How does Fentanyl compare to morphine with regards to:

• Lipid solubility
• Onset of action
• Potency
• Duration of action

Answer 14

• Higher lipid solubility
• Fast onset
• High potency
• Shorter duration of action

Question 15

Ordinarily, what causes the termination of fentanyl’s effects? What drug can be used to antagonize its actions?

Answer 15

Redistribution

Naloxone

Question 16

What part of the anesthesia protocol is fentanyl used for? How does it affect volatile anesthetics? What is their effect on cardiovascular depression? Respiratory depression?

Answer 16

Premedication
Reduces MAC requirements
No mentioned effect on cardiovascular
Marked respiratory depression

Question 17

What are 2 drugs comparable to fentanyl i.e. potent, fast

onset, short acting opioids?

Answer 17

Sufentanil

Alfentanil

Question 18

What is an opioid that can be used as an infusion? What enzyme metabolizes it?

Answer 18

Remifentanil

Plasma esterase

Question 19

What class of drug is usually used when placing a tube down throat with a laryngoscope? What reflex is blocked by this class of drugs?

Answer 19

Muscle relaxant

Blocks cough reflex

Question 20

What is the purpose of an opioid that is used during the maintenance phase of anesthesia?

Answer 20

Used for MAC sparing effects

Question 21

What is a major difference between the general anesthetics and the induction agents?

Answer 21

Induction agents are lipid soluble, anesthetics are not

Question 22

Despite lipid solubility, why won’t fat take up a lot of lipid soluble induction agents?

Answer 22

There isn’t a lot of blood flow to fat to deliver the drug in the first place

Question 23

Etomidate is an anesthetic that doesn’t produce cardiovascular depression. What group of patients may this drug be good for? What drug that doesn’t produce respiratory or cardiovascular depression may also be good for this group of patients?

Answer 23

Patients who are hemorrhaging, cardiogenic shock, sepsis or hypotension
- Ketamine

Question 24

Despite being an NMDA antagonist, why can’t ketamine be antagonized? What is the characteristic of the ketamine EEG?

Answer 24

It is a non-competitive antagonist

Described as unusual

Question 25

Beyond midazolam, what are 2 other benzodiazepines used in anesthesia?

Answer 25

Diazepam

Lorazepam

Question 26

It is generally hard to overdose on benzodiezapines. Under what conditions does this rule not apply (2)?

Answer 26

When they are combined with alcohol and or opioids

When they are administered IV

Question 27

Fentanyl is used in anesthesia. Why is it notconsidered an anesthetic?

Answer 27

It doesn’t produce amnesia