General Anesthetic

Question 1

What leads to higher potency in inhalatioal aneshtetics?

Answer 1

Lipid solublity determines potency

Question 2

What do inhalational anesthetics work on for its effects?

Answer 2

GABAa receptors which are Cl- channesl to produce an IPSP

Question 3

Is there an antidote for inhaled anesthetics?

Answer 3

No

Question 4

What influences potency and the MAC level for inhaled anesthetic?

Answer 4

Age, Temperature, Medicine

Question 5

What happens with increased cardiac output with inhaled anesthetics?

Answer 5

Slower induction of effects

Question 6

What is Fa/Fi?

Answer 6

End Tidal Partial Pressure (aka brain partial pressure)/Inspired concentration

Question 7

What do we measure to get the measurement of the inhaled drug in the pt?

Answer 7

Measure hte expiratory concentration of anesthetic

Question 8

What determines the anestheic uptake into blood after delivery to alveoli?

Answer 8

Solubility
Partial Pressure Difference
Cardiac Output

Question 9

Whichis imore soluble in blood halothane or NO?

Answer 9

Halothane is very soluble in blood

NO is not soluble

Question 10

Why does halothane take a long time to reach equilibrium?

Answer 10

Halothane likes to be in blood- > blood can thus hold halothane as it diffuses throuhg -> longer time to reach eqiulibrium

Thus it takes longer to spill over into brain as well than NO

Question 11

What a does a lamda value indicate?

Answer 11

Blood/Gas Partition coefficient

Question 12

What is solubility?

Answer 12

How much a gas diffuses from alveoli into arterial blood

More soluble gas will take longer to equlibriate due to rapid solubilization into blood

Question 13

Which organs do the inhaled anesthetics reach first?

Answer 13

BHLK: Brain Heart Lung Kidneys which are vessel rich organs

Then skin and muscle

Last: Fat

Question 14

How does increased C.O decrease induction?

Answer 14

Increased blood flow near alveolus slows equilibrium due to increased uptake of anesthetics -> brain concentration takes longer time to reach equilibrium now if heart rate is higher

Question 15

How do pts emerge from the anesthetics?

Answer 15

Turn off gas and give 100% oxygen or extubate to protect airway

Question 16

What are hte side effects of general anesthetics?

Answer 16

Decreases Cardiact output and O2 consumption
Decreased vascular resistance (vasodilations)
Increased blood flow to brain but decreased CMRO2 (cerebral metabolic rate of O2 ) => uncoupling

Question 17

Which anesthetic has hte most rapid onset and recovery?

Answer 17

Sevoflurane

Question 18

Which anesthetics have a medium rate of onset and recovery?

Answer 18

Isoflurane
Enflurane
Halothane

Question 19

Which anestheic is an incomplete anesthetic?

Answer 19

NO

Question 20

What is propofol?

Answer 20

IV anesthetic agent

Can be used to maintain anesthetic to keep pts asleep

Question 21

How does propofol work?

Answer 21

IPSP via gaba receptor

Question 22

What are the effects of propofol?

Answer 22

Decreased CMRO2 and ICP in brain
Veno/Vasodilation
Respiratory Depression

Question 23

What is thiopental?

Answer 23

Barbiturate using GABA

Not avilable in US

Question 24

What are the effects of thiopental?

Answer 24

Decreased CMRO2 and Vasoconstriction

Question 25

What is ketamine?

Answer 25

NMDA receptor antagonist for dissociative anesthesia (Pt looks awake despite being asleep)

Question 26

What is ketamine used for?

Answer 26

Induction and short procedures
Pain Control
Keep breathing (Bronchodilator) and does not decrease respiratory drive

Question 27

What are the effects of ketamine?

Answer 27

Increased CMRO2, Cerebral blood flow and ICP

Inc BP and HR

Question 28

What are hte indications for ketamine?

Answer 28

Trauma

Asthma

Question 29

What is Etomidate?

Answer 29

GABA receptor agonist anesthetic with the least CV side effects

Question 30

What are the effects of Etomidate?

Answer 30

Vasoconstrictor and dec CMRO2

Decreased adrenal -> dec NE -> body response to stress ddecreased