General anesthetics Flashcards by Lauren Akahoshi

Stages of anesthesia

Induction
Maintenance
Emergence

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Current theory of anesthetics

Anesthetics reversibly interact with hydrophobic sites of specific membrane proteins altering signal transduction

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Faster induction determined by

Low blood solubility faster induction

Low partition

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Partition coefficient

blood conc/gas conc

If you decrease blood concentration (smaller partition coefficient = less time needed

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Potency defined as

Minimum alveolar concentration

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1 MAC

alveolar partial pressure that prevent movement of 50% of adult patient in response to pain

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Ideal MAC for surgery

1.3 MAC

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Low Mac

High potency

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Why do you give a patient O2 when they are emerging from anesthesia?

Diffusion hypoxia

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True or false MAC is age and condition dependent?

True

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Increased MAC

Infancy

Chronic alcohol

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Decreased MAC

Elderly

Acute alcohol

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What is the second gas effect?

Bulk agent can pull more agent into the lung with a combination with another gas
= More gas, faster

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Tx outpatient dental

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Can cause pneumothorax

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Inhibits B12

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Still commonly used for children because it is not pungent

Halothane

Significant cardiac depression that decreases MAP

Halothane

Sensitizes the heart to EPI causing tachycardia

Halothane

Increases ICP

Halothane

Immune response to hepatic proteins

Halothane hepatitis

Four agents that cause malignant hyperthermia

Halogenated inhalation "-anes"
Halothane
Isoflurane
Desflurane 
Sevoflurane

General anesthetic that causes bronchial irritation

Desflurane

Malignant hyperthermia caused by

Halogenated inhalation anesthetics
Genetic mutation in dihydropyridine ryanodine RYR1 receptor (SR Ca2+) causing excessive accumulation of Ca2+ = continued contraction

Malignant hyperthermia symptoms

hypercapnia muscle rigidity tachycardia hyperthermia muscle breakdown hyperkalemia FATALITY

Antidote to malignant hyperthermia

Dantrolene sodium

IV anesthetics are used for what phase?

Induction

Duration of action is determined by

Distribution out of CNS

Which three IV agents activate GABAa

Methohexital Propofol Etomidate

Which is the ideal anesthetic for induction because of its duration?

Propofol | Onset 40sec, Duration 6min

Which anesthetic can cause hypotension, pain at injection, and hypertriglyceridemia?

Propofol

Which anesthetic cannot be used in patients with cardiac problems/Hypotension?

Propofol

Which IV anesthetic is good for cardiac patients or hypotensive patients?

Etomidate

Which causes myoclonic movements, N/V, adrenal insufficiency with continuous infusion?

Etomidate

Which IV anesthetic is a PCP derivative?

Ketamine

Which IV anesthetic acts on NMDA receptor as an antagonist?

Ketamine

Which causes dissociative sedation and hallucinations?

Ketamine

Which IV anesthetic is used for induction and maintenance of pediatric anesthesia?

Ketamine (trance state) does not cause hallucinations in children

Off label use procedural sedation/analgesia

Ketamine

Use for patients with airway disease

Ketamine

Which IV anesthetic does not have post-op emesis and can be used as an anti-emetic?

Propofol

Which inhaled anesthetic has minimal cardiac effects?

NO Isoflurane Desflurane Sevolfurane