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Neuro IV > General anesthetics > Flashcards

General anesthetics Flashcards

1
Q

clinically effective concentration range

A

1-100mM. no single “receptor”

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2
Q

property determining general anesthetic potency

A

high lipid solubility

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3
Q

Lipid theory of general anesthesia

A

volatile general anesthetics exert their effects by partitioning into the lipid component of the nerve cell membrane

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4
Q

Protein theory of general anesthesia

A

volatile anesthetics act via interactions with hydrophobic pockets in membrane proteins

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5
Q

General anesthetic action in nervous system

A

potentiation of GABAa receptor activity, inhibition of excitatory synapses –> increased duration of inhibitory postsynaptic potentials –> greater inhibition in CNS, depression of neuronal excitability

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6
Q

Describe action potential conduction in the peripheral nervous system of anesthetized patients

A

Normal conduction. conduction block only appears at doses well above the clinical range

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7
Q

Sequence of general anesthesia progression

A

loss of fine motor function and coordination –> altered consciousness and analgesia –> loss of temp regulation –> unconsciousness –> effects on eye motion, pupil size, and light reflex –> loss of muscle tone –> respiratory failure –> cardiovascular failure –> coma and death

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8
Q

Stage I anesthesia

A

analgesia

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9
Q

Stage II anesthesia

A

excitement, delirium

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10
Q

Stage III anesthesia

A

surgical anesthesia

plane 1: regular metronomic respirations
plane 2: onset of muscle relaxation, fixed pupils
plane 3: good muscular relaxation, depressed excursion of intercostal muscles during respiration
plane 4: diaphragmatic breathing only, dilated pupils

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11
Q

Stage IV anesthesia

A

medullary paralysis

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12
Q

Stage able to be reached by N2O gas

A

Stage II

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13
Q

Time course of surgical anesthesia

A

Induction (time until stage III is reached)
Maintenance (surgery)
Recovery (termination to complete recovery from anesthesia)

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14
Q

steady state anesthesia

A

anesthetic gas partial pressure in lung = anesthetic gas partial pressure in blood = anesthetic gas partial pressure in body tissues

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15
Q

Four phases of uptake of volatile anesthetic

A

lung factors, uptake from alveoli to blood, uptake from blood to tissues, tissue distribution

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16
Q

lung factors for uptake

A

rate of partial pressure increase in proportional to rate of ventilation

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17
Q

Determinants of uptake rate from alveoli to blood

A

solubility of gas in blood, pulmonary blood flow

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18
Q

effect of higher gas solubility in blood

A

need more gas dissolved in blood to produce anesthesia. less solubility –> more rapid anesthesia

19
Q

Higher lung blood flow

A

slower achievement of anesthesia

20
Q

higher tissue blood flow

A

faster anesthetic delivery

21
Q

Estimation of anesthetic potency

A

1/MAC

MAC = minimum alveolar anesthetic concentration = alveolar concentration that prevents gross skeletal muscle response to painful stimulus

22
Q

Major elimination route for general anesthetics

A

lungs

23
Q

determinants of lung excretion

A

cardiac output and respiratory rate

24
Q

distribution to vessel-rich group

A

brain, heart, kidney, liver, endocrine glands. anesthetic effects in minutes

25
Q

distribution to muscle group

A

muscle and skin. uptake in 2-4h due to lower perfusion than vessel-rich group

26
Q

distribution to fat group

A

very slow uptake due to low perfusion and high lipid solubility. Eventually dominates rate of uptake into total body tissue

27
Q

fat group effects on recovery

A

longer duration of anesthesia –> higher fat load of anesthetic –> long recovery from anesthesia

28
Q

volatile anesthetics

A

xenon, nitrous oxide, diethyl ether, cyclopropane, chloroform, halothane, enflurane, isoflurane, desflurane, sevoflurane

29
Q

IV anesthetics

A

thiopental, propofol, etomidate

30
Q

IV adjuncts

A

ketamine, d-tubocurarine, morphine, fentanyl, diazepam, ondansetron, glycopyrrolate

31
Q

treatment of malignant hyperthermia

A

dantrolene

32
Q

nitrous oxide

A

advantages: excellent analgesia, rapid on/off, less increased cerebral blood flow (head injuries)
disadvantages: low potency –> not general anesthetic
contraindications: respiratory obstruction, pregnancy

33
Q

Diethyl ether

A

advantages: complete anesthetic
disadvantages: flammable and explosive, slow induction/recovery

34
Q

Chloroform

A

no longer used due to hepatoxocity and arrhymogenicity

35
Q

Halothane

A

Advantages: mid-high potency, fast on/off, non-explosive, non-irritant

Disadvantages: not good analgesic, can produce respiratory and cardiac failure, can cause liver damage, can trigger malignant hyperthermia (excessive Ca release from ryanodine receptors)

36
Q

Enflurane

A

Advantages: excellent analgesic, moderately fast on/off, good muscle relaxant

Disadvantages: can trigger seizures during induction/recovery

37
Q

Isoflurane

A

Advantages: more potent than enflurane, little hepato/renal toxicity, does not trigger seizures, fast on/off, minimal direct cardiac depression, good muscle relaxant. Most widely use inhalational anesthetic

Disadvantages: can trigger coughing (use IV to overcome)

38
Q

Desflurane

A

Advantages: fast recovery from extended anesthesia, similar pharmacokinetics to N2O with higher potency

Disadvantages: pungent odor –> airway irritation and cough. Requires special vaporizer

Contraindications: patients with predisposition to malignant hyperthermia

39
Q

Sevoflurane

A

Advantages: high potency, fast on/off, rapid adjustment of anesthetic depth, no coughing or airway irritation (can be used for induction of anesthesia)

Disadvantages: chemically unstable. releases F ions –> renal toxicity

40
Q

Thiopental

A

Advantages: Very short-acting barbiturate (potentiates GABAa), very rapid onset (15-20s) and offset (reawaken in 3-5 min)

41
Q

Propofol

A

Potentiates GABAa

Advantages: loss of consciousness in seconds, recovery faster than thiopental, less nausea post-op, no involuntary movements seen with etomidate

42
Q

Etomidate

A

Nonbarbiturate hyponotic. Potentiates GABAa

Advantages: minimal depression of CV and respiratory function, larger safety margin than thiopental, fast on/off

Disadvantages: involuntary movements during induction, high incidence of nausea, vomiting, pain on injection

43
Q

Ketamine

A

PCP derivative
glu-NMDA antagonist

Advantages: potent bronchodilator –> indicated for asthmatics

Disadvantages: catatonia, amnesia, disorientation and hallucination (reduced with IV diazepam), slow effect IV

44
Q

Use of neuromuscular blocking adjuvants

A

vecuronium and D-tubocurarine –> competitive antagonism of Ach at NMJ –> relaxation of skeletal muscle

Common in abdominal surgeries. relaxed abdominal wall –> lower dose of volatile anesthetic required –> reduced danger of anesthetic overdose

Neuro IV (21 decks)

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