General Anesthetics

Question 1

• 5 Stages?
• Potency =? (2)
• Balanced: Sedative? Analgesics? Anti musc?
• 2 factors that influence onset? High B:G? (2) Low?
• Depth =? Order of filling? (3)
• IV adjucvtvants: Etomidate (GA)? Ketamine (Dissoc.)? Midazolam (BDZ)? Propofol (GA)? Fentanyl (opoid)? Thiopental (GA)?

Answer 1

• analgesia, delerium, surgical, no surgery, medullary paralysis
• Lipid sol., 1/ MAC
• BDZ; opioid/ LA; glycopyrolate
• Conc., and Low B:G; Halothane/methoxyflurane; N2O
• Conc. of anesthetic in brain; Brain, Muscle, Fat
• Rapid onset; CV stim for increased CBF; Amnesia; Induction/ anti emetic; analgesia; fast onset

Question 2

• GA’s act on? (3)
• 2 first GA? Next flammable? Then?
• 3 potent GA’s?
• MOA: 2 hypotheses?
• Ideal characteristics? (3)
• Progression of anesthetic? Order? (8)
• What is often used for fast onset stage 1 to 3?

Answer 2

• GABA/ Ca and K at higher concentrations
• NO, diethyl ether; cyclopropane; Halothane
• Methoxyflurane/Halothane/Chloroform
• Lipid due to potency being related to oil:gas; protein act via hydrophobic pockets in membrane proteins
• Rapid/smooth onset; rapid recovery; wide safety margin
• Descending depression: Fine motor, altered consc/analges, loss of temp reg, uncosciuss., eye stuff, muscle tone, resp. failure, CVD, coma
• Thiopental

Question 3

• Uptake elimination icnrease with? (5)
• Volatile vs. IV GA?
• 3 rules of breathing in high volume gas?

Answer 3

• higher conc., Higher AVR, Less PBF, Lower Blood:Gas, High potency
• IV known MOA on NT release
  1. ) Conc. effect: Lose O2 out of lungs with gas in
  2. ) 2nd gas: When breathing 2 gas; increase intake of second drug higher than normal
  3. ) Diffusion hypoxia: When stop intake, alveoli fill with gas and O2 dillutes out