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PMCOL 343 > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

What is anesthesia?

A

drug-induced reversible depression of the CNS resulting in the loss of response to, and perception of, all external stimuli

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2
Q

which type of general anesthetic are usually administered to children? adults?

A
  • children = inhalant
  • adult = IV
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3
Q

what are the 3 stages of general anesthesia? Which is usually IV or inhalational?

A

1) induction (usually IV)
2) maintenance (usually inhalational)
3) emergence / reversal / recovery

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4
Q

During which level of sedation is a patient not rousable, airway reflexes not protected, and apnea?

A

general anesthesia

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5
Q

List the inhalation anesthetic agents.

A
  • sevoflurane
  • desflurane
  • isoflurane
  • N2O
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6
Q

List the IV aesthetic agents.

A
  • propofol
  • ketamine
  • etomidate
  • methohexital
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7
Q

List the adjuvant agents.

A
  • opioids
  • midazolam
  • lidocaine
  • dexmedetomidine
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8
Q

List the neuromuscular blockade drugs.

A
  • succinylcholine
  • rocuronium
  • atracurium
  • cisatracurium
  • NEOSTIGMINE
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9
Q

how is anesthesia measured?

A

minimum alveolar concentration (MAC)

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10
Q

What is minimum alveolar concentration (MAC)?

A

alveolar partial pressure of gas at which 50% of humans do not respond to a surgical incision

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11
Q

What are some factors that increase MAC?

A
  • chronic alcohol use
  • infancy (highest MAC at 6 months)
  • hypernatremia
  • hyperthermia
  • amphetamines
  • cocaine
  • ephedrine
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12
Q

What are some factors that decrease MAC?

A
  • acute alcohol use
  • older age
  • hyponatremia
  • hypothermia
  • anemia
  • pregnancy
  • NO
  • opioids
  • propofol
  • Alpha2 agonists
  • IV lidocaine
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13
Q

Why are more anesthetics required for younger patients?

A

MAC is very high in infancy

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14
Q

What are the protein receptor targets of general anesthetics?

A
  • GABA(A) receptor
  • voltage-gated ion channels (Na, K, Ca)
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15
Q

What is the mechanism of intravenous anesthetics?

A
  • 1) potentiate movement of Cl- ions through GABA(A) receptor
  • 2) GABA is inhibitory
  • 3) decreased neuronal activity
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16
Q

What is the mechanism of inhalational anesthetics?

A
  • 1) activate thalamic ‘extrasynaptic’ GABA(A) receptors
  • 2) hyperpolarization
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17
Q

What is the Meyer-Overton Rule?

A

greater oil/gas partition coefficient = more potent

18
Q

What does blood:gas partition coefficient determine about a drug? How does a high B:G relate to solubility and speed of onset?

A
  • determines speed of onset
  • high B:G = greater solubility, lower speed of onset
19
Q

What is the function (mechanistically) of anesthetic agents?

A
  • alter intrinsic firing rate of individual neurons
  • alter communication between neurons via synaptic transmission
20
Q

What are the effects of taking inhalational anesthetics on the CNS? What is the main effect to take note of?

A
  • decreased cerebral metabolic rate
  • increased cerebral blood flow
  • increase intracerebral pressure (ICP)
  • postoperative cognitive dysfunction

MAIN: flow-metabolism uncoupling (see first 2 points)

21
Q

What are the effects of taking inhalational anesthetics on the circulatory system?

A
  • decrease in SVR –> decreased BP and CO
  • dose-dependent reductions in myocardial contractility
  • coronary steal
  • decreased sympathetic output
22
Q

What are the effects of taking inhalational anesthetics on the pulmonary system? What is the main effect to take note of?

A
  • decrease in tidal volume, increase respiratory rate
  • dose-dependent decrease in ventilatory response to CO2
  • bronchodilation
  • attenuate hypoxic pulmonary vasoconstriction

MAIN: respiratory depression

23
Q

Why is it important to note that inhalational anesthetics may be beneficial for patients with COPD?

A

inhalational anesthetics cause respiratory depression but also BRONCHODILATION

24
Q

Which inhalational anesthetic is sweet smelling?

A

sevoflurane

25
Q

Which inhalational anesthetic is the most pungent?

A

desflurane

26
Q

which inhalational anesthetic is the most potent?

A

isoflurane

27
Q

which inhalational anesthetic has the lowest B:G?

A

desflurane

28
Q

Which inhalational anesthetic is environmentally unfriendly?

A

desflurane

29
Q

what is the most frequently used IV anesthetic?

A

propofol

30
Q

Why does propofol have a rapid onset?

A

high lipid solubility

31
Q

Which IV anesthetic is an NMDA receptor antagonist?

A

ketamine

32
Q

Which IV anesthetic is the most widely used benzodiazepine perioperatively? What is its mechanism?

A

midazolam; GABA-A receptor antagonist

33
Q

Which IV anesthetic is an alpha-2 adrenergic agonist?

A

dexmedetomidine

34
Q

What is unique about dexmedetomidine?

A

very limited respiratory depressant effects

35
Q

which 3 short-acting opioids are often used as adjuncts to anesthesia?

A

fentanyl, remifentanil, sufentanil

36
Q

Arrange the following opioids from least potent to most potent:

  • fentanyl
  • sufentanil
  • remifentanil
A

fentanyl < remifentanil < sufentanil

37
Q

Arrange the following opioids from least lipophilic to most lipophilic:

  • fentanyl
  • sufentanil
  • remifentanil
A

fentanyl < remifentanil < sufentanil

38
Q

Which short-acting opioid is often used to reduce CV response to noxious stimuli?

A

fentanyl

39
Q

Which short-acting opioid maintains stable hemodynamics and CO?

A

sufentanil

40
Q

TRUE or FALSE: MAC can never exceed 100%

A

FALSE

PMCOL 343 (27 decks)

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