General Anesthetics Flashcards
NMDA receptor antagonist used for mask induction in children, is an adjuvant to volatile anesthetics and opioids
Nitrous oxide
What are the major side effects of nitrous oxide
Post-op N/V
Inactivates Vit B–abnormal embryonic development, abortion
Does NOT produce muscle relaxation
Most potent volatile anesthetic that is the gold standard for maintenance of anesthesia
Isoflurane
Least soluble and least potent volatile anesthetic used for maintenance of anesthesia and allows for rapid emergence from anesthesia
Desflurane
What side effects are seen with desflurane
Airway irritation symptoms–due to pungency
Then all the other typical of volatile gases
Less soluble and less potent volatile anesthetic used for mask induction in children and adults and for maintenance of anesthesia
Sevoflurane
What is the major side effect of sevoflurane
Can form CO if not combine with CO2 correctly
Then typical
Barbiturate used to induce general anesthesia
Methohexital
What is the mechanism of action of methohexital
GABAa receptor agonist
Antagonist of NMDA-glutamate receptor
Produce hypnosis and sedation, but is anti-analgesic
Is an anti-emetic at low doses, is used for induction and maintenance of general anesthesia, used for sedation in ICU, and for procedural sedation
Propofol
What is the mechanism of action of propofol
GABAa receptor agonist
Antagonist of NMDA-glutamate receptor
a2 receptor activity
Rapid onset and offset
What are the side effects of propofol
Propofol infusion syndrome—given for several days leads to:
- metabolic acidosis
- rhabdomyolysis
- heart and renal failure
- Lowering of BP
- Bradycardia
- Death
Due to fatty acid oxidation
GABAa receptor agonist used for hypnosis and has no analgesic activity and is a good agent in patients with minimal cardiac reserve
Etomidate
What are the side effects of etomidate
Pain on adm
Myoclonic movements–subcortical disinhibition
Post-op N/V
What is the mechanism of action of ketamine
NMDA receptor antagonist
Kappa opiate agonist
Leads - Dose-dependent unconsciousness, amnesia, and analgesia
What are the uses of ketamine
Sedative/anesthetic for pediatric/developmentally delayed patients
Induction in pts with reactive airway disease, hypovolemia (trauma pts), cardiac dz,
Used with propofol for IV procedural sedation
Depression treatment
Ketamine is a great bronchodilator and is contraindicated in
CAD pts and those with intracranial lesions
a2 adrenergic agonist that binds a2a and a2b in locus coeruleus and spinal cord causing sedation, sympatholysis, and analgesia.
Dexmedetomidine
What are the uses of dexmedetomidine
Awake intubations
Awake craniotomies
Adjunct to general anesthesia in pts susceptible to narcotic-induced post-op respiratory depression
What is the advantage to using dexmedetomidine
GABA is not involved therefore waking up is much easier–mimics non-REM sleep for the pt
Used as a skeletal muscle relaxant for intubation through binding all ACh receptors and overstimulating them causing paralysis after fasiculations occur
Succinylcholine
What are the side effects of succinylcholine
Malignant hyperthermia Cardiac dysrhythmias Hyperkalemia Increased intraocular pressure Increased intracranial pressure
Competitive blockers of ACh used as skeletal muscle relaxants
Pancuronium Vecuronium Rocuronium Atracurium Cis-atracurium
What is sugammadex used for
Complexes with rocuronium causing it to become inactive and is used for immediate reversal of rocuronium
