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Year 2 Pharmacology > General anesthesia > Flashcards

General anesthesia Flashcards

1
Q

what does general anesthesia do to respiration and BP?

A

lowers respiration and BP

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2
Q

what is the triad of anesthesia?

A

asleep, pain free, still

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3
Q

which anesthesia adjuvants relieve anxiety?

A

benzodiazepines (midolazam)

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4
Q

which anesthesia adjuvants prevent allergic reactions?

A

antihistamines (diphenhydramine, ranitidine)

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5
Q

which anesthesia adjuvants prevent nausea and vomiting?

A

antiemetics (dexamethasone, scopolamine)

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6
Q

which anesthesia adjuvants provide analgesia?

A

opiods (fentanyl, morphine, hydromorphone)

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7
Q

which anesthesia adjuvants prevent bradycardia and secretion?

A

atropine, glycopyrrolate

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8
Q

what kind of clinical conditions might be important to know about when a patient is to undergo anesthesia?

A

prior anesthetic history of patient and blood relatives:

malignant hyperthermia
CV problems
respiratory disease
allergies

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9
Q

what are the four phases of general anesthesia?

A
  1. induction
  2. maintenance
  3. emergence
  4. recovery
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10
Q

which route of anesthesia is usually used for maintenance?

A

inhalable

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11
Q

which route of anesthesia is usually used for induction in pediatric patients?

A

inhalable

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12
Q

which route of anesthesia is usually used for induction and short surgical procedures in adults?

A

IV

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13
Q

what are the general mechanisms of action for general anesthetics?

A
  1. depress spontaneous and evoked neuronal activity

2. alter ion channel function

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14
Q

how do general anesthetics depress spontaneous and evoked neuronal activity?

A
  1. induce neuronal hyperpolarization
  2. increase firing threshold (lessen activity)
  3. inhibit synaptic transmission and response to released NTs
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15
Q

which ion channels are altered under general anesthetics?

A
  1. increase GABAa receptor chloride activity
  2. activate voltage gated potassium channels
  3. inhibit glutamate NMDA receptors
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16
Q

what are the stages of general anesthesia with respect to effects on the brain?

A
  1. analgesia
  2. excitement
  3. surgical anesthesia
  4. medullary depression
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17
Q

which stage of general anesthesia do anesthesiologists want to avoid?

A

stage 2 (excitement)

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18
Q

what does ketamine do?

A

inhibits glutamate NMDA receptors - decreases excitatory neurotransmission

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19
Q

what are the advantages to inhalable anesthetic agents?

A
  1. easy to control depth of anesthesia
  2. readily reversible
  3. minute to minute control
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20
Q

what are the disadvantages to inhalable anesthetic agents?

A

induction not as fast or smooth as with fixed agents

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21
Q

which pharmacokinetic factors affect the rate of anesthetic onset and recovery?

A
  1. concentration in inspired air
  2. ventilation rate
  3. solubility in blood and lipid
  4. lung blood flow
  5. arteriovenous concentration gradient
  6. elimination
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22
Q

the partial pressure of anesthetic with higher solubility are affected by what physiological process?

A

ventilation rate

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23
Q

what is the ostwald coefficient?

A

blood - gas partition coefficient - solubility in blood

lower coefficient means lower solubility

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24
Q

how does low solubility in blood affect equilibration with brain and induction?

A

less solubility leads to a rapid rise in partial pressure in blood and a faster equilibration with brain and induction

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25
Q

what does the brain-blood partition coefficient describe? what is it related to?

A

solubility in lipid

related to anesthetic potency

26
Q

which solubility factor relates to anesthetic potency?

A

solubility in lipid

27
Q

how does high blood flow affect onset? low flow?

A

high flow - slow onset

low flow - fast onset

28
Q

how does alveolar and arterial concentration affect onset?

A

the greater the uptake of agent, the difference between inspired and alveolar concentrations - slower rate of induction

29
Q

elimination is dependent on what solubility coefficient? why?

A

blood - gas partition coefficient: ostwald

less soluble - faster elimination

30
Q

what is the minimum alveolar concentration? what does a low MAC value mean? high MAC value?

A

concentration of anesthetic (%) in inspired air at equilibrium when there is no response to noxious stimulus in 50% of patients

low MAC - more potent
high MAC - less potent

31
Q

how does lipid solubility related to minimum alveolar concentration (MAC)?

A

high lipid solubility - more potent (lower MAC)

32
Q

when is anesthesia produced, as related to partial pressure in brain and MAC?

A

when partial pressure of drug is equal to or exceeds the MAC

33
Q

is MAC affected by age, height, sex, or weight?

A

no

34
Q

MAC values for inhaled anesthetics have what property?

A

additive

35
Q

what is the gaseous inhalable anesthetic?

A

nitrous oxide

36
Q

what is the major limitation of nitrous oxide?

A

incomplete anesthetic

insufficient potency for surgical anesthesia due to low potency (110% MAC value)

37
Q

what is the second gas effect?

A

reduces induction time for primary agents - carrier agent

reduced induction time
reduced requirement concentration of primary agent
reduced toxicity of primary agent

38
Q

what are the advantages of nitrous oxide?

A
  1. 2nd gas effect
  2. minimal effects on CVS, respiratory, liver, kidney, GI
  3. minimal toxicity
39
Q

what are the disadvantages of nitrous oxide?

A
  1. lack of potency
  2. diffuse hypoxia
  3. increased risk of spontaneous abortion
40
Q

what are the uses for nitrous oxide?

A
  1. general anesthesia

2. analgesic for minor procedures

41
Q

can nitrous oxide be used as sole anesthetic agent?

A

no

42
Q

what is the general use for halogenated agents?

A

maintenance of anesthesia

43
Q

what are the properties of halothane?

A
  1. complete anesthetic
  2. poor analgesia
  3. muscle relaxant
44
Q

what is the toxicity of halothane?

A

post-op hepatitis

45
Q

what are the systemic effects of halothane?

A

decreased CO and hypotension

46
Q

why is enflurane not as popular?

A

CNS stimulation effects - EEG convulsion pattern, jerking, twitching

47
Q

isoflurane is used for what phase of anesthesia?

A

maintenance

48
Q

what are the primary advantages of desflurane?

A

fastest onset and recovery, excellent minute to minute control

49
Q

what are the advantages of sevoflurane?

A
  1. rapid onset and recovery
  2. very potent
  3. excellent controllability due to low solubility and high potency
  4. low airway irritation - USED FOR MASK INDUCTION AND THOSE WITH AIRWAY IRRITATION
50
Q

thiopental is used for what phase of anesthesia?

A

induction

51
Q

propofol is what class of anesthetic?

A

barbiturate

52
Q

what are the advantages of propofol?

A
  1. can be used as IV drip

2. excellent quality of recovery

53
Q

propofol is used for what phase of anesthesia?

A

induction

54
Q

ketamine produces what type of anesthesia?

A

dissociative anesthesia

55
Q

what is dissociative anesthesia?

A

intense analgesia, catalepsy, and amnesia

56
Q

what is the MOA of ketamine?

A

NMDA receptor antagonist

57
Q

what is an adverse effect of ketamine?

A

emergence phenomenon

58
Q

what is emergence phenomenon?

A

unpleasant dreams, hallucinations, disorientation

59
Q

ketamine is ideal for what situation?

A

compromised cardiac status - tamponade, bleeding GSW, GI bleed

60
Q

midazolam is used for what adjunctive purposes?

A

sedation for painful procedures, induction

Year 2 Pharmacology (70 decks)

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