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Brain and behavior > General Anesthetics > Flashcards

General Anesthetics Flashcards

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1
Q

Anesthesia

A

Amnesia, analgesia, muscle relaxation, loss of autonomic responses to noxious stimuli, loss of consciousness

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2
Q

EEG Levels 1 and 2

A

Stupor

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3
Q

EEG level 3

A

Surgical plane

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4
Q

EEG level 4

A

Medullary depression

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5
Q

Do benzos cause anesthesia?

A

No – stupor

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6
Q

Induction vs maintenance anesthesia

A

One drug is used to induce anesthesia, and another is used to maintain a patient in the surgical plane

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7
Q

Balanced anesthesia

A

The use of a combination of drugs to produce the effects of an ideal anesthetic. This allows for lower doses of the anesthetics, which avoids complications. Use of adjuncts

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8
Q

Popular adjuncts

A

Sedative-hypnotics, opioids, NMJ blockers

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9
Q

Inhalation anesthetics

A

High potency agents that are halogenated derivatives of ether. Sevoflurane, isoflurane, desflurane. All are volatile liquids at room temperature.

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10
Q

Nitrous oxide

A

Low potency inhalation anesthetic.

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11
Q

How do inhalation anesthetics work?

A

Current thinking is that they interact with membrane proteins to affect synaptic transmission. Increasing inhibition, decreasing excitiation

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12
Q

How is amount of inhaled anesthetic described?

A

By its partial pressure in a mixture, can be expressed as a percentage of atmospheric pressure (=760mmHg). So 15.5mmHg is 2%.

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13
Q

What is the maximum partial pressure that is available for a volatile agent?

A

Its vapor pressure.

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14
Q

MAC

A

Minimal Alveolar Concentration

The minimum steady state concentration required to suppress movement in response to an incision.

Given as a % of total pressure. 3% in 760mmHG = 3.0 MAC = 22.8mmHg

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15
Q

Is there variation in a dose response relationship for inhalation anesthetics?

A

No, 99% of individuals are suppressed at 1.2 MAC.

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16
Q

What happens to total mac when multiple agents are administered

A

They are additive. Agent 1 at 1 MAC, agent 2 at 2 MAC, total effect is 3 MAC of either.

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17
Q

How much inhalation anesthetics needed to suppress autonomics?

A

More than that to cause analgesia.

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18
Q

What is predictive of anesthetic potency?

A

Lipid solubility. Greater oil solubility, lower the MAC.

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19
Q

What is predictive of the number of molecules needed to attain therapeutic dose?

A

Solubility in blood. More soluble, more molecules needed to increase partial pressure in alveoli, induce more slowly.

20
Q

Another term for partial pressure?

A

Tension

21
Q

How to speed up induction?

A

Increased ventilation rate, decreased blood solubility.

22
Q

At what MAC is anesthesia usually maintained?

A

1.3-1.4 MAC, but higher mac multiple is used if inhalation anesthetic used alone

23
Q

What quality if inhalation anesthetics predict recovery time?

A

Low blood solubility -> faster recovery time.

24
Q

What happens to trapped air spaces when nitrous is administered? Why?

A

Usually administered at a high concentration (70%), nitrous replaces nitrogen, but nitrogen doesn’t move out as fast as nitrous moves in, because N2O has 35X greater blood solubility. Increases pressure in trapped air spaces.

25
Q

Diffusion hypoxia

A

When nitrous is turned off, it floods the alveoli as it moves out of the body. So need to terminate with 100% oxygen

26
Q

Second gas effect

A

As nitrous leaves the alveoli it creates a vacuum that increases ventilation rate for any other inhalation anesthetic.

27
Q

Concentration effect

A

Rate of equilibration for nitrous increases as the concentration increases due to the second gas effect.

28
Q

For which drugs is the second gas effect greatest?

A

For drugs with great blood solubilities.

29
Q

Cardiovascular effects of inhalation anesthetics

A

Decrease blood pressure.

30
Q

Which inhalation anesthetics have minimal effects on cardiac output?

A

Desflurane and isoflurane

31
Q

Does nitrous have effects on the heart?

A

No.

32
Q

Effect of high potency inhalation anesthetics on renal system?

A

Decrease renal blood flow and GFR.

33
Q

Effects of inhalation anesthetics on respiration

A

All except nitrous oxide cause a dose-dependent depression of spontaneous respiration.

All including nitrous oxide decrease ventilatory response to CO2.

34
Q

Why must arterial CO2 be measured when spontaneously breathing patients?

A

Because all inhalation anesthetics decrease respiratory drive to CO2.

35
Q

Effect of inhalation anesthetics on muscle?

A

Some muscle relaxing activity, lower doses of neuromuscular blockers are required in the presence of these anesthetics.

36
Q

Elimination of inhalation anesthetics?

A

The lung. Metabolism in minimal.

37
Q

What happens when inhalation anesthetics given with succinylcholine?

A

Can trigger malignant hyperthermia. Muscle rigidity, tachycardia, high fever, rhabdomyolysis, acidosis. Nitrous is safe

38
Q

How to treat malignant hyperthermia?

A

Give Dantrolene (interferes with the release of calcium at the ryanodine receptor)

39
Q

Propofol

A

Intravenous anesthetic that is a GABAa potentiator. Most widely used induction agent. Not analgesic.

40
Q

Negative effects of propofol

A

Decreases BP more than any other induction agent due to vasodilation, respiratory depression, pain on injection.

41
Q

How is propofol administered, and how is it metabolized?

A

Administered as fospropofol, metabolized using phase II reactions. After a bolus, recovery is mainly due to redistribution.

42
Q

Decline in plasma concentration of propofol?

A

Two-compartment pharmacokinetics. Rapid phase: distribution to poorly perfused tissues including fat. Slow phase: elimination by hepatic metabolism.

43
Q

Context sensitive half-life

A

Additional time required for plasma concentration to drop by 50% after an infusion. So when propofol is given via infusion, its half-life is greater than when given as a bolus.

44
Q

Etomidate

A

Like propofol, enhances Gaba A signaling, not analgesic. Reduces myocardial O2 consumption. Minimal decreases in BP, HR, CO. Better for cardiac patients, but causes nausea and vomiting.

45
Q

Ketamine

A

NMDA receptor antagonist. Produces a dissociative anesthesia. Analgesic even at sub-anesthetic concentrations.

Brain and behavior (55 decks)

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