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sx and anes test 2 > General anesthesia-injectable anesthetic agents > Flashcards

General anesthesia-injectable anesthetic agents Flashcards

1
Q

ideal anesthetic

A

does not depend on metabolism for termination

enables rapid induction, quick alteration in depth, rapid recovery

no cardiopulmonary changes

no tissue irritation

no special equipment

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2
Q

selection of anesthesia depends on

A

signalment

patient personality

physical status (ASA)

time required for surgical procedure

familiarity with technique

equipment and personnel available

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3
Q

why injectable?

A

simplicity

availability

cost-drugs and equipment

rapid, controllable onset

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4
Q

examples of when to use injectable anesthetics

A

short general anesthesia-dx, minor procedures

induction-intubation, follow with inhalant

longer periods of anesthesia-MRI, bronchoscopy, where inhalants are unavailable/CI

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5
Q

why not just injectables?

A

most procedures take > 20 minutes

difficult to achieve triad for long periods

recovery based on redistribution and metabolism

recovery may be unpredictable, prolonged, rough

depth is difficult to control

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6
Q

general pharmacology

A

blood is the delivary medium

drugs are bound to proteins

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7
Q

what affects a drug ability to cross the blood brain barrier?

A

lipid solubility

low MW

non-ionized

non-protein bound

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8
Q

thiopental

A

barbiturates

reconstitute with sterile water/saline (2.5, 5%)

alkaline must get intravascular

precipitates with most other drugs-flush catheter between drugs

onset: 20 to 30 s

short duration, cumulative

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9
Q

thiopental MOA

A

GABA-mimetic effect decreasing the rate of dissociation

can also directly activate Cl channels–>hyperpolarization (inactive neurons for short period of time)

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10
Q

thiopental metabolism

A

hepatic

sight hounds prolonged duration

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11
Q

thiopental cardiovascular effects

A

increased HR and SVR

ventricular bigeminy common plus other arrhythmias

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12
Q

thiopental respiratory effects

A

marked depression of both rates and tidal volume

apnea

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13
Q

thiopental other effects

A

decrease cerebral metabolic rate of oxygen consumption–>cerebroprotective

anticonvulsant

no analgesia

hyperglycemia, leukopenia, anemia-transient

splenomegaly

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14
Q

Ketamine characteristics

A

dissociatve anesthetic-depression of corticothalamic axis, thalamus, stimulation of limbic, hippocampus

NMDA antagonist-blocks action of glutamate in CNS

soluble in water

10% solution (100 mg/ml)

IV, IM

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15
Q

ketamine pharmacology

A

typically given with benzo (diazepam, midazolam)

onset :60 to 90 seconds (IV)

duration (5 to 20 minutes)

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16
Q

metabolism of ketamine

A

hepatic most species

cats-prolonged effect

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17
Q

ketamine cardiovascular effects

A

indirect CV stimulation-increased HR, MAP, CO

directly negative inotrope

sympathomimetic effects

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18
Q

ketamine respiratory effects

A

decreases rate and minute ventilation

bronchodilation

apneustic pattern seen in high doses, CRI

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19
Q

Ketamine CNS effects

A

increase CBF, ICP

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20
Q

ketamine other effects

A

increased IOP

muscle rigidity

laryngeal reflexes intact

somatic analgesia

+/- salivation

somatic analgesia at subanesthetic doses

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21
Q

telazol

A

Tiletamine & Zolazepam

dissociatve + Benzo

lyophilized power

reconstituted with sterile water (50 mg/ml of each drug)

potency higher and longer duration than ketammine

absoprtion with IM administration

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22
Q

propofol

A

phenol

prepared in lipid emulsion-soybean oil, glycerol, egg lecithin

supports bacterial growth-handle aseptically

no preservative-short shelf life-24 hours

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23
Q

propofol onset and duration

A

onset 30-60 sec

duration: 5 to 10 minutes

24
Q

propofol metabolism

A

hepatic and extrahepatic

significant pulmonary uptake

25
Q

propofol MOA

A

GABA receptor

decreased dissociation–>increased Cl–>hyperpolarization

26
Q

propofol CV effects

A

decreased HR, systemic vascular resistance–>decrease MAP

increase HR

negative inotrope

27
Q

propofol respiratory effects

A

dose dependent depression

apnea enhanced with opioids

decreases RR, and tidal volume

28
Q

propofol other effects

A

decrease CMRO2

decreases IOP

painful injections in small vessels

proconvulsant

propofol infusion syndrome (lactic acidosis)

splenomegaly

no analgesia

29
Q

propofol shakes

A

proconvulsant activity

rare

not cortical epileptic activity

spontaneous excitatory movements of subcortical origin

no need to avoid in patients with seizure hx

30
Q

cats and propofol

A

slower recoveries

oxidative RBC damage

heinz body anemia

because it is a phenol

not symptomatic

31
Q

propofol 28

A

shelf life 28 days

labeled for dogs only

preservative-2% benzyl alcohol-toxic to cats in high doses

safe in cats at clinical doses

32
Q

Etomidate characteristics

A

imidazole derivative

35% propylene glycol

new lipid emulsion?

pH: 6.0

high osmolality–>hemolysis, pain

33
Q

etomidate onset and duration

A

30 to 60 seconds

duration: 3 to 10 minutes ,dose related

34
Q

etomidate metabolism

A

hydrolysis via hepatic enzymes and Plasma esterases

35
Q

etomidate MOA

A

GABA

decreased dissociation–>increaesd Cl–>hyperpolarizationE

36
Q

Etomidate CV effects

A

minimal changes in HR, SV, CO

+/- decrease in systemic vascular resistance

MAP may decrease up to 15%

37
Q

etomidate respiratory effects

A

depression caused by decreased in tidal volume

occasionally increase RR

38
Q

etomidate other effects

A

decrease CMRO2

may activate seizure foci (may have anticonvulsant properties)

depresses adrenocorticla function

myoclonus-usually give benzo

retching/vomiting

no analgesia

expensive

39
Q

alphaxalone

A

neurosteroid

clear, aqueous solution,

iso-osmolar

pH: 6.5 to 7.0

sturcture similar to progestterone

IM and IV

Schedule III

40
Q

alphaxalone onset and duration

A

onset: 30 to 60 seconds
duration: 3 to 8 minutes

41
Q

alphaxalone metabolism

A

hepatic

42
Q

alphaxalone MOA

A

GABA

decreased dissociation–>increased Cl–>hyperpolarization

involvement of centrally located glycine receptors

43
Q

alphaxalone CV effects

A

decreased HR, MAP

negative inotrope

increased HR with low MAP

44
Q

alphaxalone respiratory effects

A

dose dependent depression

hypoventilation and apnea-side effects

45
Q

alphaxalone other effects

A

similar to propofol

painful on IM injections

hyperaesthetic recoveries-reduced with sedatives

decreased CMRO2

no analgesia

46
Q

therapeutic index

A

LD50/ED50

Larger TI are safer drugs

47
Q

indution qualities of thiopental

A

alkaline must go IV

smooth reliable

not available currently

48
Q

etomidate induction qualities

A

hyperosmolar–>pain

myoclonus, retching

physiologically nice

expensive

49
Q

propofol induction qualities

A

lipid emulsion, must be aseptic

smooth, reliable

50
Q

alphaxalone induction qualities

A

IM, IV

smooth reliable

51
Q

ketamine/diazepam induction qualities

A

IM or IV

widest safety margin

52
Q

thiopental recovery qualities

A

smooth

prolonged in sight hounds

53
Q

etomidate recovery qualities

A

usually smooth but can be rough

premeds important

54
Q

propofol recovery qualities

A

smooth reliable

55
Q

ketamine/diazepam recovery qualities

A

acceptable

increased motor activity

Telazol have prolonged recovery

56
Q

alphaxalone

A

anedcotally can be rough

57
Q

titrate to effect

A

calculate expected dose-premeds, sedative effects

give a portion of expected dose

assess effect

repeat…

continue until desired effect reached

sx and anes test 2 (5 decks)

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