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pharm 2 final > general anesthesia overview > Flashcards

general anesthesia overview Flashcards

1
Q

what are the “4 A’s” of general anesthesia?

A 
A controlled reversible state of:
– Amnesia (with loss of consciousness) 
– Analgesia
– Akinesia (skeletal muscle relaxation) 
– Autonomic and sensory areflexia
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2
Q 
define:
A) Balanced anesthesia
B) Regional anesthesia
C) combined technique
D) conscious sedation
A

A) Balanced Anesthesia- GA with several Agents

B) Regional Anesthesia- using LA’s to anesthetize a
body region

C) Combined Technique- regional plus “light” GA

D) Conscious Sedation- IV agents for analgesia/anxiolysis maintaining consciousness

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3
Q

what is the definition of Minimum Alveolar Concentration (MAC)?

A

The steady state minimum alveolar concentration (percent) of an inhalational agent that is required for immobility of 50% of the subjects exposed to a noxious stimulus (e.g., surgical incision)

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4
Q

what are the stages of surgical anesthesia?

A
  • Recurrence of regular respiration –> cessation
  • Loss of corneal, swallowing, eyelid reflexes
  • Skeletal muscle relaxation
  • Decreased blood pressure
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5
Q

T/F: intravenous and inhaled anesthetics are often used alone

A

FALSE- often used combined

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6
Q

T/F: Anesthetics are MORE hazardous than analgesia

A

true

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7
Q

what are the most common inhaled anesthetics?

A

halothane, isoflurane, desflurane and sevoflurane

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8
Q

The rate of partial pressure of inhaled anesthetics increase in the brain depending on:

A
  • Solubility
  • Inspired anesthetic concentration
  • Pulmonary ventilation
  • Arteriovenous concentration gradients
  • Pulmonary and cerebral blood flow
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9
Q

what does the blood-gas partition coefficient describe?

A

describes an anesthetic’s relative affinity for the blood compared to air

– # molecules in blood / # molecules in gas at SS

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10
Q

T/F: Agents with high solubility require relatively

few molecules to dissolve into the blood to raise partial pressure to equilibrium

A

FALSE

its LOW solubility

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11
Q

The rate of induction of anesthesia by an inhalational agent can be increased by increasing what?

A

the inspired concentration of the agent

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12
Q

Increasing ____________ generally increases the speed of induction

A

ventilation

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13
Q

Increased __________________ decreases the rate of rise of the arterial anesthetic gas tension

A

pulmonary blood flow (increased cardiac output)

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14
Q

T/F: Patients with low cardiac output would have a relatively quick induction

A

true

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15
Q

what anesthetic will sensitize the myocardium to catechol- amines, predisposing to ventricular arrhythmias

A

Halothane

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16
Q

what are the respiratory effects of inhaled agents?

A

A) Decreased tidal volume with an increased respiratory rate (drop in minute ventilation)

B) All inhalational agents decrease the ventilatory response to increases in PaCO2

C) Decreased ventilatory response to hypoxia

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17
Q

what are the risks associated with Halothane?

A

A) Malignant hyperthermia

B) 20% metabolism “toxic” products causing hepatic damage with repeated exposure

C) spontaneous abortion in pregnant Operating Room staff

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18
Q

what is malignant hyperthermia?

A

1) Rare, inherited, potentially lethal syndrome
2) hypermetabolic activity, marked CO2 production, altered skeletal muscle tone and metabolic acidosis
3) probably due to altered calcium metabolism?

19
Q

how is malignant hyperthermia treated?

A

Treatment = Dantrolene (CA++ blocker)

20
Q

how does Enflurane compare to halothane?

list pros/cons of the drug

A

A) Less soluble than halothane (Faster induction)

B) Less chance of dysrhythmia

C) more hypotension and respiratory depression

D) More neuromuscular depression

E) Less liver damage

21
Q

__________ is the most commonly used inhaled agent in the United States

A

Isoflurane

22
Q

how does Isoflurane compare to the other inhaled agents?

A

1) Less CV or respiratory depression than enflurane but moreso than halothane
2) Cardiac output maintained through increase in HR.
3) Minimal liver toxicity

23
Q

what are the risks associated with Isoflurane?

A

A) Risk of malignant hyperpyrexia

B) No convulsant EEG pattern

C) Mildly pungent; bronchial irritation and
secretion.

24
Q

what inhaled agent has the fastest induction time?

A

Desflurane

Least blood soluble of all the anesthetics -
most rapid induction

25
Q

when would Desflurane be contraindicated as the sole anesthetic?

A

Contraindicated as sole anesthetic agent in

cases of coronary artery disease or where rise in heart rate or blood pressure is undesirable.

26
Q

what is the most common side effect of Desflurane?

A

Very pungent- causes severe laryngospasm, secretion, apnea.

27
Q

T/F: Sevoflurane is non-pungent, poorly soluble, and has few real problems associated with it

A

True

28
Q

how do intravenous anesthetics work?

A

– a) potentiating the action of an inhibitory
ionophore (the GABAA receptor).

– b) blocking the action of excitatory
ionophores (Nicotinic Ach & NMDA receptors).

29
Q

what are the advantages/disadvantages of intravenous anesthetics?

A

■ ADVANTAGES - Rapid onset, controlled dosage, ease of administration.

■ DISADVANTAGES - Overdose not readily corrected, no antagonists or antidotes, prolonged after effects (hangover).

30
Q

what are the classes of intravenous anesthetics?

A 
• Sedative-hypnotics
– Barbiturates
– Imidazoles (Etomidate)
– Alkylphenols (Propofol)
– Benzodiazepines
  • Opioids
  • Dissociative anesthetics – Ketamine
31
Q

T/F: Barbiturates have an ultra-short acting life, and are very lipid soluble

A

True

32
Q

what drugs are given to combat the initial side effects of Barbiturates?

what are these side effects?

A
  • give atropine or SCOPOLAMINE

- stops coughing/sneezing or laryngospasms

33
Q

what are the contraindications for Barbiturates?

A

Porphyria, status asthmaticus

34
Q

what are the risks of barbiturates?

A

■ Barbiturate solutions VERY ALKALINE → avoid extravasation

■ Thrombophlebitis a risk with i.v. injection

■ Respiratory depression marked →
mechanical ventilation should be available.

35
Q

give the characteristics of Thiopental:

A

Thiopental = barbiturate

– Crosses BBB rapidly

– Short effect due to redistribution (t1/2a)

– Dose dependent decreases in SV, MAP, CO

– Potent respiratory depressant

36
Q

T/F: Etomidate has minimal CV effects

A

true

37
Q

_____________ is a newer class of drugs that behaves similar to Thiopental, but gives less of a “hangover” after its effects wear off

A

Alkylphenols

38
Q

when would you NOT use Alkylphenols?

A

Contraindicated for sedation in children due to acidosis and possible neurological sequelae.

39
Q

List the characteristics of Propofol (an Alkylphenol)

A
  • Effects similar to barbiturates
  • Amnestic and anti-emetic effects
  • Useful as sedation agent
  • Most popular ambulatory surgery induction agent –> least residual sedation
40
Q

___________ have a rapid onset (seconds) BUT NO ANALGESIA or Areflexia.

A

Imidazoles

41
Q

what is the primary use of Benzodiazepines?

A

Primarily for anxiolytic/amnestic effects – Preop/intraop sedation

42
Q

Ketamine is in what class of drugs? how does it function?

A

Cyclohexylamines

  • Blocks both nicotinic ACh and NMDA (glutamic acid) receptor channels
43
Q

T/F: Ketamine gives dissociative anesthesia, but not true surgical anesthesia

A

true

44
Q

what class of drug is Etomidate in?

list its side-effects

A

Etomidate = Imidazole

S.E.’s:

1) nausea/vomiting or pain on injection
2) inhibits steroidogenesis- surpasses adrenocortical production

pharm 2 final (7 decks)

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