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N233 > General Anesthetics > Flashcards

General Anesthetics Flashcards

1
Q

what are general anesthetics (GA)?

A

drugs that produce unconsciousness and lack of responsiveness to all painful stimuli

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2
Q

what are the two groups GA can be separated into?

A
  • inhalent anesthetics

- IV anesthetics

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3
Q

what is the definition of analgesia?

A

loss of sensibility of pain

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4
Q

what is the definition of anesthesia?

A

refers to not only the loss of pain, but to the loss of all sensations and consciousness

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5
Q

what would the properties be if an ideal anesthetic existed?

A

-unconsciousness
- analgesia
- muscle relaxation
- amnesia
- adverse effects would be minimal
DOES NOT EXIST

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6
Q

what is balanced anesthesia?

A

combining drugs to accomplish what we cannot achieve with an inhalation anesthetic alone

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7
Q

what are the common drugs that are combined to make the ideal anesthesia?

A
  • propofol and short-acting barbiturates
  • neuromuscular blocking agents
  • opioids and nitrous oxide
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8
Q

what is the action of inhalant anesthetics?

A

enhance transmission at inhibitory synapses and by depressing transmission at excitatory synapses

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9
Q

what is the action of nitrous oxide?

A

enhances GABA receptors

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10
Q

what is the definition of minimum alveolar concentration (MAC)?

A

the minimum concentration of drug in alveolar air that will produce immobility in 50% of patients exposed to painful stimulus

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11
Q

what does the MAC tell us?

A

approx. how much anesthesic the inspired air must contain to produce anesthesia

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12
Q

what does a low MAC indicate?

A

high anesthetic potency

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13
Q

in order to produce GA in all patients - what must the inspired anesthetic concentration be?

A

1.2-1.5 times the MAC

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14
Q

what are the principal determinants of anesthetic concentration?

A
  • uptake from the lungs

- distribution to the CNS and other tissues

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15
Q

what are factors that determine the anesthetic uptake?

A
  • amount inspired
  • pulmonary ventilation
  • solubility of the anesthetic in blood
  • blood flow through the lungs
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16
Q

what is distribution determined by?

A

regional blood flow

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17
Q

in what tissues does anesthesia rapidly rise in?

A

brain, kidney, liver, and heart - tissues that receive the greatest amount of blood

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18
Q

in what tissues is anesthesia distribution slower?

A
  • skin and skeletal muscle

- fat, bone, ligaments

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19
Q

where are inhaled anesthetics generally eliminated?

A

in the lungs…

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20
Q

what same factors that influence uptake also influence _____?

A

elimination

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21
Q

why does anesthesia leave the brain the fastest after administration has stopped?

A

because blood flow is high here - brain will wake before body

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22
Q

what are 6 adverse effects of GA?

A
  • respiratory and cardiac depression
  • sensitization of the heart to catecholamines
  • malignant hyperthermia
  • aspiration of gastric contents
  • hepatotoxicity
  • toxicity to operating room personel
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23
Q

what do almost all patients require when under GA d/t resp depression?

A

to be ventilated

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24
Q

what is malignant hyperthermia?

A
  • rare

- muscle rigidity and a profound elevation of temp

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25
Q

what can trigger malignant hyperthermia?

A

succinylcholine - a neuromuscular blocker

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26
Q

why does aspiration of gastric contents happen?

A

reflex that usually prevents this is absent

27
Q

what can aspiration of gastric contents cause?

A

bronchospasm and pneumonia

28
Q

what might be needed for aspiration?

A

endotracheal tube

29
Q

what are reactions of toxicity of OR personel?

A

headache, reduced alertness, and spontaneous abortion

30
Q

what drugs results in decreased anesthetic dosage?

A

opioids

31
Q

what drugs result in an increased anesthetic dosage?

A

CNS stimulants

32
Q

what are 3 reasons preanesthetic medications are administered?

A
  • reducing anxiety
  • producing preoperative amnesia
  • relieving pre/postoperative pain
33
Q

what are alpha adrenergic agonists given for?

A

adjuncts to anesthesia - both produce effects in the CNS

34
Q

what are anticholinergic drugs given for?

A

dec. the risk of bradycardia during surgery

35
Q

what are neuromuscular blocking agents given for?

A

relaxing skeletal muscle

36
Q

why are antiemetic given postoperatively?

A

may have some nausea as recovering from anesthesia

37
Q

why are muscarinic agonists given after surgery?

A

abdominal distention and urinary retention are possible post-operative complications

38
Q

who are the only two people who can do the dosing and administration of anesthetics?

A

anesthesiologist (physician), anesthetist (nurse)

39
Q

what are the two type of inhalation anesthetics?

A

gases and volatile liquids

40
Q

what are gases?

A

exist in gaseous state at atmospheric pressure

41
Q

what are volatile liquids?

A

exist in liquid form at atmospheric pressure but can easily be volatilized (turned to vapour)

42
Q

what is isoflurane?

A
  • volatile inhalation
  • high potency
  • emerge rapidly
  • respiratory irritant
43
Q

when do patients awake after ceasing isoflurane?

A

approx 20 min

44
Q

what is requires with isoflurane?

A

a strong analgesic and other muscle relaxant drug

45
Q

what might isoflurane inhibit during labour?

A

uterine contractions

46
Q

what are adverse effects of isoflurane?

A
  • hypotension

- resp depression

47
Q

what is nitrous oxide?

A
  • “laughing gas”
  • volatile liquid
  • high anesthetic potency
48
Q

is nitrous oxide ever employed as a primary anesthetic?

A

NO - impossible to produce surgical anesthesia alone

49
Q

why is nitrous oxide given?

A

to supplement the analgesic effects of the primary anesthetic

50
Q

what are adverse effects of nitrous oxide?

A

there are none - cannot cause CNS depression

51
Q

when are IV anesthetics used?

A

alone or to supplement an inhalent

52
Q

what is benzodiazepine used for?

A

to reduce anxiety and promote amnesia

53
Q

what is midazolam used for?

A
  • induction of anesthesia and to produce conscious sedation
54
Q

when used for induction, what is midazolam commonly combined with?

A

barbiturate

- unconscious in 80 sec

55
Q

what is propofol?

A
  • most widely ised IV anesthetic

- indicated for induction and maintenance of GA as part of balanced anesthesia technique

56
Q

what does propofol promote the release of?

A

GABA

57
Q

what is the onset of propofol?

A

less than 60 sec

58
Q

what is the duration of propofol?

A

3-5 mins

59
Q

how can extended sedation for propofol be achieved?

A

a continuous low-dose, not exceeding 4mg/kg/hour

60
Q

what does propofol put the patient at high risk for?

A

bacterial infections

61
Q

when are preoperative meds given?

A

30-60 mins before surgery

62
Q

what are nursing implications for preoperative meds?

A
  • calm patient
  • provide analgesia
  • counteract adverse effects of general analgesia
63
Q

what are nursing implications for postoperative patients?

A
  • know what frug they have been given in hospital

- know what drugs they are taking at home

N233 (6 decks)

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