induction and maintenance

Question 1

Volatile agents

• solubility
• MAC
• CO

Answer 1

Solubility: low solubility, more lipid, later in blood stream, quicker induction
MAC: alveolar conc at 1 atm that will prevent movement to surgical stimulus in 50% of patients.
Low solubility, needs higher mac
- increase alveolar ventilation, increased induction

Question 2

Volatile agents

• Halothane
• Isofluorane
• Sevofluorane
• Desfluorane
• NO

Answer 2

• from low to high mac
  1. increased ICP and BF, decreased BP, CO, HR and conduction
  2. decreased cerebral metabolic rate. increased ICP. resp depressin, decreased respiratory co2 reflexes, bronchodilation. decreased CO and BP, increased HR
  3. Increased ICP, resp depression. Less decrease of contrac. stable HR
  4. Increased ICP, reps depression, tachycardia etc
  5.

Question 3

Decrease MAC

Increase MAC

Answer 3

1. high age, pregnancy, acute alc, hypothermia,

2. hyperthyroid, chronic alc, hyperthermia, amphetamine, cocaine

Question 4

TIVA: 
Propofol
- action
- indication
- caution
- dosing
- special

Answer 4

Total IV anesthesia

• inhibitory at GABA synapse, decreased cerebral metabolic rate and blood flow, decrease ICP, decreased SVR, decreased BP, decreased SV
• induction, maintenance
• egg, soy, BP!!
• induc 2.5-3.0 mg/kg

Question 5

Thiopental

• action
• indication
• caution

Answer 5

Barbiturate

• decreased time cl- channels open, facilitate GABA and suppress glutamic acid
• decreased cerebral metabolism and BF, decreased CPP, decreased CO, decreased BP, decreased reflex tachy, depreased resp
• induction, convulsions
• allergy, hypotension, shock cardiac failure, porphyria, status asmathicus

Question 6

Ketamine

• action
• indication
• caution

Answer 6

• NMDA, opiate, other receptor
• increase HR, incease BPP, inc SVR, inc Coronary BP, increase myocard uptake, CNS and resp depression, bronch smooth muscle relaxation
• major trauma, hypovolemia, severe asthma
• allergy, TCA medication, psychosis, HTN
• emergency reacions- hallucinations etc.