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Neuro II Final > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

List the component changes in behavior that is targeted in general anesthesia.

A
  1. Unconsciousness
  2. Amnesia
  3. analgesia
  4. attenuation of autonomic reflexes
  5. Immobility in response to stimulation
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2
Q

During general anesthesia, sedation and monitored anesthesia care starts off with giving_1_ as premedication which provides anxiolysis, amnesia, and mild sedation. It is followed by giving 2 which is usually titrated and provides moderate to deep level of sedation

A
  1. Midazolam

2. propofol

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3
Q

1 and 2 are typically used for conscious sedation and they both can be reversed by specific receptor antagonist, such as flumazenil for 1, and nalxone for 2.

A
  1. Benzodiazepines

2. opioids

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4
Q

_ is associated with loss of protective reflexes, an inability to maintain a patent airway, and lack of verbal responsiveness to surgical stimuli.

A

Deep sedation

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5
Q

IV agents that are typically used in deep sedation protocols mainly include _ and _ and sometimes with potent opioid or ketamine depending on the level of pain associated with the surgical procedure.

A

Propofol and midazolam.

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6
Q

In general anesthesia, what channels are the primary inhibitory ion channels considered for anesthetic actions

A

Chloride and potassium

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7
Q

what are the volatile anesthetics that which are administered by inhalation?

A
  1. halothane
  2. enflurane
  3. isoflurane
  4. desflurane
  5. sevoflurane
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8
Q

The driving force for uptake of an inhaled anesthetic is _

A

alveolar concentration

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9
Q

what two factors determine how quickly the alveolar concentration changes?

A
  1. inspired concentration or partial pressure

2. alveolar ventilation

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10
Q

Partial pressure anesthetics in the alveoli is expressed as a ratio. what two elements make up that ratio?

A

Alveolar concentration over inspired concentration (Fa/Fi)

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11
Q

how is induction of anesthesia related to the Fa/Fi ratio?

A

The faster Fa/Fi approaches 1, the faster anesthesia will occur during an inhaled induction

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12
Q

Define blood:gas partition coefficient.

A

The relative affinity of an anesthetic for the blood compared with that of inspired gas (e.g. blood solubility)

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13
Q

what kind of relationship (direct or inverse) is there between blood:gas partition coefficient values and the rate of anesthesia onset? Explain

A

It’s an inverse relationship.

Agents with low blood solubility reach high arterial pressure rapidly, which in turn results in rapid equilibration with the brain and fast onset of action

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14
Q

Which of these have a lower blood solubility?
A. Halothane
B. Desflurane

A

Desflurane has a lower blood solubility and thus has a faster onset of action

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15
Q

In general, inhaled anesthetics have more or less soluble in the brain than in the blood?

A

more soluble in the brain than in the brain. that is why it is able to cross the Blood brain barrier to produce anesthesia

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16
Q 
Rank the following anesthetics based on it's increasing speed of onset given it's blood:gas partition coefficient). 
A. NO (0.47) 
B. Desflurane (.42) 
C. Sevoflurane (0.69)
D. Isoflurane (1.4)
E. Halothane (2.3)
A

B > A > C > D > E

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17
Q 
Which of the following anesthetics, the alveolar anesthetic concentration (FA) will approach the inspired anesthetic concentration the fastest? 
A. Halothane
B. Isoflurane
C. Sevoflurane
D. Desflurane
E. NO
A

In general, the alveolar anesthetic concentration (FA) approaches the inspired anesthetic concentration (Fi) feast for the least soluble agents. Oh the ones listed, NO has the lowest solubility and thus the Fa/Fi will approach 1 the quickest.

In increasing speed order:
E > D > C > B > A

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18
Q

How is cardiac output (CO) related to induction of anesthesia?
Explain

A

Increased CO decreases the rate of induction of anesthesia. With increased CO, the pulmonary blood flow increase and uptake of anesthetics into the blood increase, but the anesthetic taken up will be distributed and diluted into all tissues not just the CNS.

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19
Q

How is alveolar and venous partial pressure related to elimination and time it takes for patient to awake?

A

since the anesthetic must be carried from the tissue to the lungs for primary elimination, larger A-V concentration differences means less drug are returning for elimination, which may increase the time for awakening. The slower the rate and extend of tissue uptake, the greater the difference in anesthetic gas tension between A-V.

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20
Q

What happens to induction of anesthesia when opioid analgesics are given?

A

Given that concentration of anesthetics in the blood will increase as the rate and depth of ventilation is increased, if ventilation is decreased which is achieved via opioid anesthetics, the onset of anesthesia of inhaled anesthetics ill decrease.

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21
Q

What is minimal alveolar concentration?

A

ED50. The concentration of inhalation anesthetics that prevents movement in response to surgical stimulation in 50% of subjects.

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22
Q

What does it mean when MAC is greater than 100%?

A

It indicates that even if 100% of the inspired air at the barometric pressure is the anesthetic, the MAC value would still be less than 1 and other agents must be supplemented to achieve full surgical anesthesia.

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23
Q

Give an example of an inhale anesthetic whose MAC is greater than 100%

A

NO

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24
Q

By which stage of anesthesia is both analgesia and amnesia accomplished?

A

By end of stage 1

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25
Q

In which stage of anesthesia does the patient appear deliruous and respiration is irregular, and retching and vomitting may occur?

A

Stage II

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26
Q

In which stage of anesthesia is surgery usually performed?

A

Stage III

27
Q

In which stage of anesthesia is death likely to occur without circulatory and respiratory support?

A

Stage IV

28
Q

Inhaled anesthetic are usually not beneficial in patients with increased intracranial pressure. why?

A

Inhaled anesthetics decrease metabolic rate of the brain and increase cerebral blood flow.

29
Q

What effect on heart rate is halothane known to have?

A

halothane causes bradycardia

30
Q

What effect on heart rate is isoflurane known to have?

A

Increase heart rate

31
Q

Inhaled volatile liquid anesthetics (decrease or increase) mean arterial pressure in direct proportion to their alveolar concentration

A

decrease

32
Q

Side effects that are common to all inhaled anesthetics is nausea and vomiting. However, in addition, halothane is known to cause 1 with or without previous exposure; and enflurane and sevoflurane are known to cause 2.

A
  1. hepatitis

2. renal toxicity

33
Q

In inhaled anesthetics are combined with succinylcholine, malignant hyperthermia can result. what can be given to reverse malignant hyperthermia?

A

Dantrolene

34
Q

Which IV anesthetic would you use that will provides CV stability, and has a rapid onset and moderately fast recovery; and is usually used for induction of anesthesia?

A

Etomidate. also known to cause decreased steroidogenesis and inventory muscle movement.

35
Q

which IV anesthetics is used for induction of anesthesia, has a moderately rapid onset and recovery, stimulates CV, increase cerebral blood flow, and has emergency reactions that impair recovery.

A

ketamine

36
Q

Which IV anesthetics is usually preferred for short ambulatory procedures?

A

methohexital. this one is preferred over thiopental.

37
Q

which IV anesthetic is used for balanced anesthetic and conscious sedation, provides CV stability and marked amnesia.

A

Midazolam. can be reversed by flumazenil.

38
Q

which IV anesthetic can be used for induction and for maintenance, is known to cause hypotension and is also useful as antiemetics

A

Propofol

39
Q

Which IV anesthetic is a standard induction agent which causes CV depression; and should be avoided in patients with porphyrias.

A

Thiopental

40
Q

What is the MOA for propofol?

A

Targets GABA-A receptors as an agonist and potentiates the chloride current

41
Q 
which of the following has the shortest context-sensitive half-life? 
A. Etomidate
B. Propofol
C. Ketamine
D. Midazolam
E. Thiopental
F. Diazepam
A

A. Etomidate.

Context-sensitive half life describes the half life after a continuous infusion as a function of the duration of infusion.

In increasing half-life

A F

42
Q

What effect does propofol have on the cardiovascular system?

A

produces most pronounced decrease in systemic blood pressure due to profound vasodilation in both arterial and venous circulation leading to reduction in preload and afterload. CV effects are augmented by inhibition of normal baroreflex response

43
Q

This IV anesthetic is a potent respiratory depressant and generally produces apnea after an induction dose. It can cause a greater reduction in upper airway reflexes than thiopental making it well suited for instrumentation of the airway such as placement of a laryngeal mask airway.

A

Propofol

44
Q

which anesthetic is a prodrug for propofol?

A

Fospropofol. have similar affects as propofol but has longer onset and recovery.

45
Q

Which IV anesthetic is known to have a endocrine effect such that causes adrenocortical suppression and thus its use is limited for continous infusion

A

Etomidate

46
Q

What receptor does ketamine bind to? is it an agonist or antagonist?

A

Ketamine is a NMDA receptor antagonist

47
Q

this anesthesia is known to produce a dissociative anesthetic state characterized by catatonia, amnesia, and analgesia with or without loss of consciousness.

A

Ketamine

48
Q

which anesthetic is known to cause increased cerebral blood flow as well as CMRO2, and is not recommended for use in patients with intracranial pathology esp increased ICP. It also has some unpleasant CNS effect such as vivid colorful dreams, hallucination, out of body experiences.

A

Ketamine

49
Q

_ is an alpha 2 adrenergic agonist that produces hypnosis presumably from stimulation of a2 receptor in the locus caeruleus and analgesic effects at the level of the spinal cord. The sedative effects resemble natural sleep.

A

Dexmedetamidine. used for short term sedation of intubated and ventilated patients in an ICU setting or as an adjunct to general anesthesia

50
Q

What are some common anesthetic opioids used as adjunct to general anesthesia?

A

fentanyl, sufentanil, remifentanil, morphine. used as premedication for anesthesia.

51
Q

_ and _ are barbiturates that which are used as anesthetic adjuncts which causes dose dependent CNS depression ranging from sedation to general anesthesia (no analgesia)

A

Thiopental and methohexital

52
Q

Differentiate the MOA of these:

A. Etomidate
B. Barbiturates
C. Benzodiazepines

A

They all work on GABA-A.

A. Etomidate enhances action of GABA on GABA-A receptor.

B. Barbs act on GABAA receptor to increase the duration of channel opening (allosteric agonist) and enhances inhibitory neurotransmitter

C. Acts on GABA-A receptor to increase receptor sensitivity to GABA (agonist) and enhance inhibitory neurotransmission

53
Q

A new halogenated gas anesthetic has a blood:gas partition coefficient of 0.5 and a MAC value of 1%. Which prediction about this agent is most accurate?
(A) Equilibrium between arterial and venous gas tension will be achieved very slowly
(B) It will be metabolized by the liver to release fluoride ions
(C) It will be more soluble in the blood than isoflurane
(D) Speed of onset will be similar to that of nitrous oxide
(E) The new agent will be more potent than halothane

A

D. The partition coefficient of an inhaled anesthetic is a determinant of its kinetic characteristics. Agents with low blood:gas solubility have a fast onset of action and a short duration of recovery. The new agent described here resembles nitrous oxide but is more potent, as indicated by its low MAC value. Not all halogenated anesthetics undergo significant hepatic metabolism or release fluoride ions.

54
Q

Which statement concerning the effects of anesthetic agents is false?
(A) Bronchiolar smooth muscle relaxation occurs during halothane anesthesia
(B) Chest muscle rigidity often follows the administration of fentanyl
(C) Mild, generalized muscle twitching occurs at high doses of enflurane
(D) Severe hepatitis has been reported after the use of methoxyflurane
(E) The use of midazolam with inhalation anesthetics may prolong postanesthesia recovery

A

D. Hepatitis after general anesthesia has been linked to use of halothane, although the incidence is very low (1 in 20,00–35,000). Hepatotoxicity has not been reported after administration of methoxyflurane or other inhaled anesthetics. However, fluoride release from prolonged use of methoxyflurane has caused renal insufficiency.

55
Q

A 23-year-old man has a pheochromocytoma, blood pressure of 190/120 mm Hg, and hematocrit of 50%. Pulmonary function and renal function are normal. His catecholamines are elevated, and he has a well-defined abdominal tumor on MRI. He has been scheduled for surgery. Which one of the following agents should be avoided in the anesthesia protocol? (A) Desflurane
(B) Fentanyl (C) Isoflurane (D) Midazolam (E) Sevoflurane

A

C. Isoflurane sensitizes the myocardium to catecholamines, as does halothane (not listed). Arrhythmias may occur in patients with cardiac disease who have high circulating levels of epinephrine and norepinephrine (eg, patients with pheochromocytoma). Other newer inhaled anesthetics are considerably less arrhythmogenic.

56
Q

Which statement concerning nitrous oxide is accurate?
(A) A useful component of anesthesia protocols because it
lacks cardiovascular depression
(B) Anemia is a common adverse effect in patients exposed
to nitrous oxide for periods longer than 2 h
(C) It is the most potent of the inhaled anesthetics
(D) There is a direct association between the use of nitrous
oxide and malignant hyperthermia
(E) Up to 50% of nitrous oxide is eliminated via hepatic
metabolism

A

A. Anemia has not been reported in patients exposed to nitrous oxide anesthesia for periods as long as 6 h. Nitrous oxide is the least potent of the inhaled anesthetics, and the com- pound has not been implicated in malignant hyperthermia. More than 98% of the gas is eliminated via exhalation.

57
Q

Which statement concerning anesthetic MAC (minimum anesthetic concentration) value is accurate?
(A) Anesthetics with low MAC value have low potency
(B) MAC values increase in elderly patients
(C) MAC values give information about the slope of the
dose–response curve
(D) Methoxyflurane has an extremely low MAC value
(E) Simultaneous use of opioid analgesics increases the
MAC for inhaled anesthetics

A

D. MAC value is inversely related to potency; a low MAC means high potency. MAC gives no information about the slope of the dose–response curve. Use of opioid analgesics or other CNS depressants with inhaled anesthetics low- ers the MAC value. As with most CNS depressants, the elderly patient is more sensitive, so MAC values are lower. Methoxyflurane has the lowest MAC value of the inhaled anesthetics.

58
Q 
If ketamine is used as the sole anesthetic in the attempted reduction of a dislocated shoulder joint, its actions will include
(A) Analgesia
(B) Bradycardia
(C) Hypotension
(D) Muscle rigidity
(E) Respiratorydepression
A

A. Ketamine is a cardiovascular stimulant, increasing heart rate and blood pressure. This results in part from central sympathetic stimulation and from inhibition of norepinephrine reuptake at sympathetic nerve endings. Analgesia and amnesia occur, with preservation of muscle tone and minimal depression of respiration.

59
Q

Postoperative vomiting is uncommon with this intravenous agent, and patients are often able to ambulate sooner than those who receive other anesthetics.
(A) Enflurane
(B) Etomidate (C) Midazolam (D) Propofol (E) Thiopental

A

D. Propofol is used extensively in anesthesia protocols, including those for day surgery. The favorable properties of the drug include an antiemetic effect and recovery more rapid than that after use of other intravenous drugs. Propofol does not cause cumulative effects, possibly because of its short half-life (2–8 min) in the body. The drug is also used for prolonged sedation in critical care settings.

60
Q

The chemical with which blood:Gas partition coefficient will reach the highest concentration in the brain the fastest? (assume brain:blood partition coefficients are equal)

A. 0.42
B. 0.47
C. 069
D. 1.4
E. 1.8
A

A. 0.42

61
Q

Two inhaled anesthetics have the following MAC values: X: MAC - 2%; Y:MAC= 100%. based on this info, which statement is true?
A. Drug X has a longer duration of action than drug y
B. X is more soluble in blood than Y
C. Y causes greater general analgesia and skeletal muscle relaxation than drug X
D. the concentration of drug in inspired air that is needed to cause adequate anesthesia is higher for drug Y than for drug x
E. The time to onset of adequate anesthesia is 50x longer for drug Y than for drug X

A

D. Since MAC for Y is higher, it means that you’ll need more of Y to get the same affect. Since X has a lower MAC, it means its more potent.

62
Q

68 y/o hospitalized female general malaise, fever, nausea, vomiting, jaundice, and skin rash 4 days after undergoing surgery to remove an uterine myoma. Emergency lab exam shows the following pertinent results. AST: 240; ALT: 380

The pt's condition rapidly deteriorates and coma ensues. which of the following drugs most likely caused pt's syndrome? 
A. Fentanyl
B. Halothane
C. Isoflurane
D. NO
E. Thiopental
A

B. Halothane. The liver enzymes are elevated, of the ones listed, halothane causes hepatic toxicity.

63
Q

19 year old female is admitted to the ambulatory surgery center for strabismus surgery to correct misalignment of her extraocular muscles. She is other wise healthy and all lab values are normal. Which IV induction agent may be used that is rapid in both onset and recovery and has antiemetic actions?

A. halothane
B. NO
C. Procaine
D. Propofol
E. Sevoflurane
A

D. Propofol. referred to ask ‘milk’

Neuro II Final (12 decks)

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