General Anesthetics I and II Flashcards
What is the mechanism of Nitrous Oxide?
NMDA receptor antagonist
What is the therapeutic use of Nitrous Oxide?
Mask induction in children
What are important side-effects of Nitrous Oxide?
Post-operative nausea and vomiting, inactivates vit B (leading to abnormal embryonic development, abortion), accumulates in closed air-containing spaces (bowel, middle ear, pneumothoraces, air emboli) because N2O very insolube in blood
The anesthesiologist wants to use an anesthetic that causes muscle relaxation. Which anesthetic won’t she choose?
N2O because it does not relax muscles
What is the gold standard for maintenance of anesthesia?
Isoflurane
What are the 3 volatile anesthetics?
Isoflurane, Desflurane, and Sevoflurane
Which volatile anesthetic is the most potent?
Isoflurane
Which volatile anesthetic is the least soluble and and least potent? What is its benefit?
Deslurane; Allows for patients to rapidly emerge from anesthesia
In what therapeutic interventions is Sevoflurane used?
Mask induction in children and adults
What are common side effects of Isoflurane, Desflurane, and Sevoflurane use?
Dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure, dose dependent decrease in systemic BP, decrease in respiratory function, skeletal muscle relaxation, increase in HR, malignant hyperthermia
The most pungent of the volatile anesthetics
Desflurane
Which of the volatile anesthetics can be metabolized into inorganic F- resulting in potential nephrotoxicity and form carbon monoxide when exposed to strong bases present in dry CO2 absorbers (canister fires!)?
Sevoflurane
What is the class of methohexital?
Barbiturate
Mechanism of Methohexital and what is the clinical use?
GABAa receptor binding producing hypnosis and sedation; Clinically used to induce general anesthesia
How is Methohexital dosed? How does it redistribute? How is it metabolized?
Dose based on lean body mass; Redistributes from brain to muscle and fat; Metabolized by the liver
What is the drug class of propofol?
Alkylphenol
What is the mechanism of propofol?
GABAa receptor agonist, NMDA-glutamate receptor antagonist, some a2 receptor activity, overall rapid onset and offset
What are the therapeutic uses of propofol?
Anti-emesis (at low doses), induction/maintenance of general anesthesia, ICU sedation, procedural sedation
What is a potentially severe side effect of propofol?
Propofol infusion syndrome after several days of administration (metabolic acidosis, myocardial failure, rhabdomyolysis, hyperkalemia, renal failure, lowered BP, bradycardia, death
When administering propofol, what should the anesthesiologist be cognizant of at the injection site?
The site is painful and supports bacterial growth
What in the patient’s history is a contraindication for propofol use?
Because propofol is administed in a yummy egg and soy emulsion, egg/soy allergies would contraindicate propofol use.
What class of anesthetic is Etomidate?
Carboxylated imidazole