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Pharmacology Test #6 > General Anesthesia and Adjuncts > Flashcards

General Anesthesia and Adjuncts Flashcards

1
Q

Triad of Anesthesia

A
  1. Analgesia
  2. Amnesia
  3. Skeletal muscle relaxation
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2
Q

Triad plus of anesthesia includes

A

loss of consciousness, loss of sensory function, autonomic inhibition

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3
Q

Types of Anesthesia

A
  1. General
  2. Spinal (subarachnoid in CSF)
  3. Epidural
  4. Regional (Nerve trunk block)
  5. Local
  6. Monitored anesthesia care/sedation
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4
Q

General anesthesia modes of deliver

A
  1. Inhalational
  2. Intravenous
  3. Lipid soluble or able to cross BBB
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5
Q

Properties of inhalational anesthetics

A

rapid access to vascular system (brain); allows direct effects on pulmonary system

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6
Q

Properties of IV anesthetics

A

immediate access to vascular system; less than a minute (in the brain in 26 sec); advent of computer controlled pumps

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7
Q

Balanced anesthesia

A

combination of inhaled intravenous medications

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8
Q

Major anesthesia

A

IV induction, inhalational maintenance, muscle relaxant

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9
Q

Characteristics of anesthetic

A
  1. reduces excitability of the membranes
  2. no anesthetic specific receptors known
  3. no anesthesia specific antagonists
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10
Q

Stage 1 of anesthesia

A

analgesia - initially without amnesia

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11
Q

Stage 2 of anesthesia

A

disinhibition - delirium and excitement; amnesia, irregular respiration, retching, incontinence

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12
Q

Stage 3 of anesthesia

A

surgical anesthesia: unconscious, no pain perception, respiration regular again to apneic, BP maintained, 3 planes with eye changes

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13
Q

Stage 4 of anesthesia

A

Medullary depression: spontaneous respiration ceases, severe respiratory cardiovascular depression, death ensues without support

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14
Q

Characteristics of the ideal anesthetic

A
  1. quick in - rapid induction of anesthesia
  2. quick out - rapid recovery
  3. non-irritating to airway
  4. minimal physiologic trespass - nondisruptive and nontoxic
  5. lack of interactions with other drugs
  6. nonflammable, muscle relaxant properties
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15
Q

Dalton’s law

A

anesthetic exerts partial pressure proportional to % anesthetic in mixture

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16
Q

Fick’s law

A

anesthetic diffused down its concentration gradient

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17
Q

Henry’s law

A

amount of anesthetic dissolved in a liquid is proportional to partial pressure of the anesthetic in the mixture

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18
Q

Minimum alveolar concentration (M.A.C.)

A

minimum alveolar concentration at 1 atm that prevents movement in 50% of patients in response to a painful stimulus such as a surgical incision or clamping of the tail with a hemostat/clamp

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19
Q

Defines potency of inhalational anesthetics and serves as a means to compare anesthetics

A

Minimum alveolar concentration (M.A.C.)

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20
Q

The lower the MAC,

A

the more potent the agent

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21
Q

Factors decreasing MAC (less anesthetic agent is required)

A

increasing age, hypothermia, CNS depressants/drugs, acute EtOH intoxication, pregnancy, alpha adrenergic drugs (clonidine)

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22
Q

Factors that increase the MAC requirements (more anesthetic agent is required)

A

hyperthermia, chronic ethanol abuse, increase CNS neurotransmitters (MAO inhibitors)

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23
Q

Factors that have no change in MAC

A

duration of anesthetic, gender

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24
Q

Blood-gas partition coefficient

A

relative solubility in blood vs air; determines uptake alveoli to blood, thus determines rate of induction

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25
Q

Solubility is approximately

A

blood-gas coefficient

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26
Q

High blood solubility

A

slow induction

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27
Q

Low blood solubility

A

rapid induction

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28
Q

Induction of high solubility anesthetic hastened by

A

hyperventilation

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29
Q

“Laughing gas”

A

nitrous oxide

30
Q

Properties of nitrous oxide

A

insoluble, nonflammable, rapid onset, excellent analgesia and sedation, no skeletal muscle relaxation

31
Q

Disadvantages of nitrous oxide

A

not an anesthetic unless >100%, nausea, oxidizes cobalt in B12, expansion in closed spaces, diffusion hypoxia on emergence

32
Q

Properties of diethyl ether

A

liquid at room temp, easy to administer, explosively flammable, very slow induction, respirator irritant, complete anesthetic (muscle relaxant, unconsciousness, analgesia)

33
Q

Advantages of halothane

A

sweet nonpungent odor, smooth, rapid inhalation induction, fair analgesia, muscle relaxation, excellent hypnosis, fruity smelling

34
Q

Disadvantages of halothane

A

CV depression, catecholamine sensitization, hepatotoxicity, poor skeletal muscle relaxant, poor analgesic, strong respiratory depressant, direct CV depressant, sensitizes myocardium to catecholamines

35
Q

Why is halothane no longer used in the US?

A

hepatotoxicity: massive hepatic necrosis, death, probably immune related

36
Q

Advantages of Enflurane

A

rapid induction and recovery; good analgesia, muscle relaxant, hypnosis; no catecholamine sensitization

37
Q

Disadvantages of Enflurane

A

pungent (breath holding, coughing); CNS stimulation at high concentrations (may induce seizures); CV depression, decreased CO, renal >9.6 MAC hrs

38
Q

Advantages of isoflurane

A

rapid induction and emergence, good analgesia, sedation

39
Q

Disadvantages of isoflurane

A

more pungent/irritating than enflurane, decreases BP by decreasing SVR (used on HTN patients in surgery)

40
Q

Advantages of sevoflurane

A

rapid induction of anesthesia, non-irritating to airways (allows smooth inhalational induction); non flammable

41
Q

Disadvantages of sevoflurane

A

inability to use for low flow anesthesia

42
Q

Desflurane

A

rapid achievement of anesthesia; uterine relaxant; rapid recovery and awakening, decrease in CO, BP>forane; too quick?; used in balanced anesthetic

43
Q

Cardiovascular effects of anesthesia

A
  1. All halogenated agents decrease MAP
  2. All affect heart rate
  3. N2O stimulates sympathetics obscuring
44
Q

Halothane and Enflurane depress

A

CO

45
Q

Isoflurane, Desflurane and Sevoflurane decrease

A

SVR

46
Q

Respiratory effects of anesthetics

A
  1. All decrease tidal volume, increase rate
  2. Impair mucociliary apparatus (pooling of mucus, atelectasis, pneumonia)
  3. Bronchodilation (Halothane is best)
47
Q

CNS effects of anesthetics

A
  1. Decrease cerebral metabolic rate
  2. Most decrease CVR, thus in CBF
  3. May increase ICP
  4. Enflurane may induce seizures
  5. N2O is analgesic/amnestic even at low concentrations
48
Q

Renal effects of inhaled anesthetics

A
  1. All decrease GFR, RPF, increase fitration fraction
  2. Methoxyflurane high metabolized
  3. Enflurane, sevoflurane produce fluoride
49
Q

Malignant HTN

A

Potentially fatal result of anesthesia, autosomal dominant

50
Q

Triggers of malignant HTN

A
  1. Halogenated inhalational agent

2. Depolarizing muscle relaxant (Succinylcholine)

51
Q

What happens in malignant HTN?

A

Ca2+ in sarcoplasmic reticulum is unleased; hypertension, tachycardia, skeletal muscle rigidity, acidosis, hyperthermia, hyperkalemia, excess CO2

52
Q

Treatment of malignant HTN

A

IV Dantrolene Sodium

53
Q

Sedative hypnotics

A
  1. Barbiturates
  2. Ketamine
  3. Propofol
  4. Etomidate
  5. Benzodiazepines
54
Q

Barbiturates uniquely depress the

A

reticular activating system and CNS sympathetic outflow

55
Q

Clinical uses of Barbiturates

A
  1. Induction of anesthesia
  2. Treatment of ICP
  3. Decreases cerebral blood volume
  4. Decrease in cerebral metabolism
56
Q

Most common Barbiturates

A
  1. Sodium Pentothal (thiopental)
  2. Methohexital (Brevital)
  3. Thiamylal (Surital)
  4. Secobarbital (intermediate acting)
  5. Pentobarbital (intermediate acting)
57
Q

Barbiturates used for the induction of anesthesia

A

Thiopental (Pentothal) and Methohexital (Brevital)

58
Q

What does it mean to say that “barbiturates have antianalgesic properties”?

A

if undergoing a painful procedure, it may make it even more painful afterwards

59
Q

Sodium pentothal (Thiopental) can trigger

A

intermittant porphyria

60
Q

Properties of sodium pentothal (thiopental)

A

sedation; hypnosis; anesthesia; rapid onset; short duration; isoelectric EEG; no muscle relaxation/antianalgesic; profound respiratory depression; cough, bronchospasm, laryngospasm

61
Q

Ketamine (Ketalar)

A

glutamic acid antagonist at NMDA receptor; dissociative anesthetic; rapid onset, short duration of action, profound anterograde amnesia; profound analgesia; copious salvation

62
Q

Which patients do you not give ketamine to?

A

do not give in someone with a head injury - increases ICP

63
Q

MOA of ketamine

A

sympathomimetic; blocks reuptake of catecholamines, smooth muscle relaxant

64
Q

Emergence delirium is associated with?

A

ketamine

65
Q

What is emergence delirium?

A

auditory hallucinations, vivid dreams, reduced by benzodiazepines

66
Q

Propofol (Diprivan)

A

IV - rapid onset, short duration, hypnosis; sedation, hypnosis, anesthesia, no analgesia, but antiemetic

67
Q

Etomidate (Amidate)

A

Nonbarbiturate, more rapid awakening, non analgesic, minimal cardiac depression, pain on injection, myoclonus, adrenal supression

68
Q

MOA of benzodiazepines

A

receptors on alpha subunits GABA in CNS; enhance Cl- channel gating function (hyperpolarization); post-synaptic CNS

69
Q

Common benzodiazepines

A
  1. Dizepam (Valium)
  2. Lorazepam (Ativan)
  3. Midazolam (Versed)
70
Q

Clinical uses of Diazepam (Valium)

A
  1. Preoperative medication
  2. Induction of anesthesia
  3. IV sedation
  4. Anticonvulsant activity
  5. Treatment of delirum tremens
  6. Skeletal muscle relaxation
71
Q

Difference between Midazolam and Diazepam

A

Negative effects of diazepam (valium) are gone; more rapid onset of action; 2-3X as potent as valium

72
Q

Properties of Lorazepam (Ativan)

A

More potent amnestic than diazepam; slow onset, long duration, slow dissociation, confusion; minimal effects on skeletal muscle, CV/pulmonary systems

Pharmacology Test #6 (12 decks)

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