general anesthetics Flashcards
3 volatile anesthetic: from most potent to least potent
- isoflurane (most potent; gold std for maintenance of anesthesia)
- sevoflurane (not irritating)
- desflurane (least soluble and potent; most pungent)
NMDA receptor antagonist that is used for mask induction in children
nitrous oxide
which anesthetic induces PONV; inactivates vitB (abn baby development –> abortion); and bc it is INSOLUBLE in blood–>it accumulates in closed, air containing spaces (bowel, middle ear, pneumothoraces, air emboli),
nitrous oxide
-dose dependent decreases: CNS, BP, respiratory fnc,
-increases: cerebral blood flow, ICP, HR (reflex), body temp (malignant hyperthermia)
-relaxes sk mm
(3)
isoflurane, desflurane, sevoflurane
which anesthetic boils at RT, and thus is a dual gas blender?
desflurane
which anesthetic can for CO (canister fires!) if not combined with CO2 correctly; can also cause all the other volatile anesthetics SEs.
-used for mask induction in children and adults (sweet smelling)
sevoflurane
which anesthetic does not give you muscle relaxation at all?
nitrous oxide
volatile anesthetics (2) for induction of anesthesia? for maintenance?
- nitrous oxide and sevoflurane
- isoflurane
barbiturate that is used to induce general anesthesia?
methohexital and thiopental
GABAa agonist
NMDA antagonist
produces hypnosis and sedation but are anti-analgesics
methohexital
alkylphenol (fatty acid) that is a: GABAa receptor agonist NMDA-glutamate antagonist some a2 receptor activity (sedation) rapid onset, offset
propofol
only D-dimer is GABAa agonist
etomidate
a phencyclidine that is:
potent NMDA receptor antagonist
kappa opiate agonist
dose dependent unconsciousness, amnesia, analgesia
ketamine
a2 adrenergic agonist (binds a2a and a2b in locus coeruleus and spinal cord (sedation, sympatholysis, analgesia)
dexmedetomidine
this anesthetic is redistributed from brain to mm and fat;
-metabolized by liver
and u dose based on lean body mass
methohexital (barb)
at low dose, its an anti-emetic
-induction and maintenance of general anesthesia
used for sedation in ICU, and procedural sedation
SE: worry about ___sd: (days on this –> MAcid, rhabdo, renal failure, dec BP, brady, death (likely due to FA oxidation)
propofol
painful injection site (2)
propofol and etomidate
induction agent that produces hypnosis and no analgesic activity
-GOOD to use in pts w. min cardiac reserve bc this drug has min cardiorespiratory depression
SE: involuntary myoclonic movmt (subcortical disinhibited), PONV, single dose inhibits cortisol synthesis.
etomidate
used for sedation in the ICU and for procedural sedation that does not induce malignant hyperthermia
propofol
- for sedating/anesthetizing kids/developmentally delayed pts,
- reactive aw dz
- hypovol (trauma pts)
- cardiac dz
- with propofol for sedation
- during and after surgery to reduce opioid use, MULTIMODAL pain therapy regiment; depression tx
ketamine
for awake intubations and awake craniotomies
- adjunct ot general anesthesia in pts susceptible to narcotic-induced post-op resp depression
- for w/d and detox
dexxmedetomidine
stimulates SNS outflow (inc pul BP, sysBP, inc cerebral bf, inc ICP
-delerium, nystagmus, lacrimation, salivation, dissociative anesthesia (cataleptic state)
ketamine
when is ketamine CI?
what does it also produce that’s great?
pts with CAD and intracranial lesions
-bronchodilation
how is ketamine metabolized?
p450
