General anethetics

Question 1

Inhaled anesthetics:

Cause heart negative inotropic effect

Answer 1

Enflurane
Halothane
(End Heart)

Question 2

Inhaled anesthetics:

Airway irritation

Answer 2

Desflurane
Isoflurane
(DIslike air)

Question 3

Inhaled anesthetics:

Kidney toxicity

Answer 3

Enflurane,
Methoxyflurane
(End Men’s kidney)

Question 4

Inhaled anesthetics:

Hepatotoxicity

Answer 4

Halothane

Question 5

Inhaled anesthetics:

Seizures

Answer 5

Enflurane

Question 6

What is MAC?

Answer 6

Concentration at which 50% don’t respond to anesthesia, lower the MAC the more potent the drug

Question 7

What is the blood gas partition coefficient?

Answer 7

Ratio of gas dissolved in blood over free gas; more soluble anesthetics take longer to reach the CNS; so the lower the better (faster onset of action 0.47 compared to 2.4)

Question 8

How in anesthesia terminated?

Answer 8

The REDISTRIBUTION of the drug from brain to blood.

Question 9

What are some properties of nitric oxide?

Answer 9

1. Only anesthetic gas used today; and least potent.
2. Used as component of balanced anesthesia w/ other agents.
3. Stimulates sympathetic nervous system and raises arterial BP by increasing sympathetic tone in periphreal and pulmonary venules (so contraindicated in pulm HTN)

Question 10

What are some side effects of NO?

Answer 10

1. Increases intracranial pressure by increases cerebral flow
2. Cause megaloblastic anemia by inhibiting methionine synthase

Question 11

CNS affects of the inhaled halogenic anesthetics?

Answer 11

1. Decrease brain metabolic rate
2. Increase cerebral blood flow
3. Increase intracranial pressure

Question 12

ADR of halothane?

Answer 12

Can sensitive the myocardium to epinephrine!

Question 13

Respiration changes in inhaled agents?

Answer 13

Decrease respiration (rapid and shallow)
Most are bronchodilators
Choice for underlying airway problems are halothane and sevoflurane

Question 14

Toxicity of inhaled halogenic agents?

Answer 14

1. Malignant hyperthermia: muscle rigidity, hyperthermia, rhabdomylosis, renal failure, hyperkalemia (tx w/ dantrolene)
2. Increase ICP
3. Hepatotoxicity (esp halothane)

Question 15

What are propofol and fentanyl used for?

Answer 15

Induction and maintenance for anesthesia, all others are used only for induction; IV.

Question 16

What are side effects/contraindications of IV anesthetics?

Answer 16

1. Decrease ICP; dilate peripheral vessel

2. Porphyrias due to inducing ALA synthase

Question 17

What is used for electroconvulsive therapy?

Answer 17

Methohexital because it is less anti-convulsant.

Question 18

Side effects of propofol?

Answer 18

May cause marked hypotension, and decrease ICP.

Question 19

What is propofol used for?

Answer 19

Act as barbituates; used for induction and maintenance of anesthesia, and is antiemetic.

Question 20

ADR of etomidate?

Answer 20

Pain and myoclonus on injection; cause adrenal suppression by inhibiting 11-b hydroxylase

Question 21

Where does ketamine act and what is it used for?

Answer 21

Antagonist of NMDA receptor; short duration for children who do not need intubation.

Question 22

Side effects of ketamine?

Answer 22

Cardiovascular stimulant (Increase HR, BP, and CO)
Increase ICP
Can cause vivid, unpleasant dreams after surgery (12 hrs later, emergency phenomenon)

Question 23

What are the IV opioids and what side effects do they cause?

Answer 23

Morphine and fentanyl; may cause chest wall rigidity (impair ventilation), respiratory depression, and increase ICP

Question 24

How do you reverse respiratory depression caused by IV opioids?

Answer 24

Nalaxone

Question 25

Where does Dexmedetomidine act and what is it used for?

Answer 25

Alpha-2 agonist; useful in ICU and causes no respiratory depression