General Anesthetics - 8/22 Kruse Flashcards
What anesthetics can increase HR?
Desflurane
Isoflurane
What are the primary inhibitory channels of anesthetic action?
Cl (GABA and Gly)
K+
What anesthetic(s) have dramatic increase in context-sensitive half-life with prolonged infusion?
Diazepam
Thiopental
What agents have high blood solubility?
What does this mean abut their onset of action?
What about high arterial pressure?
Halothane
Slow onset
Reaches high P slowly
What are the effects of inhaled anesthetics on the cardiovascular system?
Decrease MAP in direct proportion to the [alveolar]
Increase RA pressure via depression of myocardial function
What may cause hepatitis?
Halothane
MOA of Propofol?
Metabolized how?
Rate of onset?
GABAa agonist and potentiates Cl current
Liver (phase I and II)
Rapid
What are the types of barbiturates?
MOA?
Cause what?
Effect on CYP450 enzymes?
Thiopental (prototype)
Methohexital
GABAa agonist
Respiratory depression
Inducers
Etomidate MOA?
Produces what?
Metabolized how?
GABA receptors
Rapid loss of consciousness w/less recovery time than Propofol
Liver and plasma
Are agents more soluble in the blood or brain?
Brain
Do gaseous anesthetics have a high or low vapor pressure?
BP?
What form at room temp?
High vp
Low BP
Gas
Do volatile anesthetics have a high or low vapor pressure?
BP?
What form at room temp?
Low vp
High BP
Liquid
Ketamine MOA?
What side effects?
NMDA antagonist
Lacrimation and salivation
What properties do benzodiazepines have?
Potent anticonvulsant
What adjunct may be preferred for short ambulatory procedures due to its rapid elimination?
Methohexital
What are the effects of inhaled anesthetics on the CNS?
Decrease BMR of the brain
Increase cerebral blood flow
What is the prodrug of Propofol?
What is the onset and recovery like?
Describe its administration
Adverse side effects?
Fospropofol
Prolonged onset and recovery
Less pain on admin
Parasthesias and pruritus
What anesthetic produces a state characterized by catatonia, amnesia, analgesia, w/or w/out loss of consciousness and may induce a euphoric state?
Ketamine
What is the blood:gas partition coefficient equal to?
Blood solubility
High blood:gas coefficient means what?
High solubility, slow onset of action
What are the benzodiazepines?
MOA?
When are they used?
Diazepam, lorazepam, midazolam
GABAa agonist
Perioperatively
How can benzodiazepines actions be terminated?
Flumazenil
What agents have low blood solubility?
What does this mean abut their onset of action?
What about high arterial pressure?
NO, desflurane
Rapid onset
Reaches high P rapidly
What is the most commonly used parenteral anesthetic in the U.S.?
Propofol
CNS effects of etomidate?
Endocrine effects?
Cerebral vasoconstrictor
Adrenocortical suppression (inhibits 11B-hydroxylase)
What are the opioid analgesic adjuncts?
MOA?
MRFS
Morphine, remifentanil, fentanyl, sufentanil
Opiate agonist
What are common side effects of inhaled anesthetics?
Nausea and vomiting
What is described by MAC?
Anesthetic potency which is required to prevent a response to a surgical incision
Succinylcholine combined with inhaled volatile anesthetics causes what?
What is the antidote?
Malignant hyperthermia
dantrolene
Partial pressure in the alveoli equation?
What does a ratio of 1 mean?
FA/FI
Fastest anesthesia will occur during inhalation
What are the effects of inhaled anesthetics on the respiratory system?
Respiratory depression
Depression of mucociliary function
Dexmedetomidine MOA?
Affect on Cerebrovascular system?
Used commonly for what?
alpha-2 agonist
Decrease HR
Decreases systemic vascular resistance and BP
Short-term sedation of intubated patietns
What is the only IV anesthetic to produce profound analgesia, stimulation of the SNS, bronchodilation, and minimal respiratory depression?
Ketamine
What anesthetic can cause bradycardia?
Halothane
1 MAC of idol furans is what volume %?
Halothane?
1.4 volume %
.75 volume %
What benzodiazepine is the drug of choice for parenteral administration?
Midazolam
What agents metabolized to produce fluoride ions may cause renal toxicity?
Enflurane
Sevoflurane
What agent has useful antiemetic action and can cause hypotension?
Propofol
Inhaled anesthetics may cause pooling of mucus and postoperative respiratory infections due to interaction of what system?
Depression of what fx?
Respiratory system
Mucociliary fx
What are the main excitatory ion channels of anesthetic action?
How?
nAChR and mAChR
AMPA, NMDA, and serotonin (5-HT)
