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NEURO PHARM > Inhalational Anesthesia > Flashcards

Inhalational Anesthesia Flashcards

1
Q

Analgesia

A

relief of pain w/out intentional production of altered mental state

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2
Q

Anxiolysis

A

decreased apprehension w/ no change in awareness

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3
Q

Conscious-sedation

A

dose dependent, protective reflexes are maintained, can still breathe independently, responds to stimulation

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4
Q

Deep sedation

A

profound effects w/ loss of one more functions maintained in conscious-sedation

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5
Q

General Anesthesia

A

sensory/mental/reflex/motor blockade

- concurrent loss of all protective reflexes

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6
Q

General anesthetics

A

drugs that produce reversible depression of neuronal fucntion w/ loss of ability to perceive pain/sensation

  • must maintain airways
  • offer more immediate minute to minute control over depth and duration of unconsciousness
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7
Q

what is MAC

A

min concentration required to anesthetize 50% of pts

- the more lipophilic a drug is the lower the MAC (Meyer Overton Hypothesis)

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8
Q

What all areas do anesthetics affect?

A
  • decrease cortical interactions

- modulate ascending pathways to CNS and descending pathways to peripheral tissues

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9
Q

What are Guedel’s stage of anesthesia?

A
  1. initial admin = period of delirium, exaggerated respiration, increased BP/muscle tone, pupil dilation, vomiting
    Plane 1 - dental and thoracic surgery - decreasing vitals, constriction
    Plane 2 - abdominal surgery = decreasing vitals and tone, pupils constricted less
    Plane 3 - deep abdominal surgery = decreasing vitals, loss of light reflex, dilated eye
    Plane 4 - no surgery -
    Medullary paralysis/death
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10
Q

What is the order of neuronal function loss w/ anesthesia?

A

Memory then awareness then movement in response to pain, and finally autonomics
- important to give anlagesia to ensure pt is pain free

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11
Q

What is the normal structure of inhalational anesthetics?

A

volatile structure that is mediated by adding halogens. Racemic mixture may alter potency.

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12
Q

What components are the inhalational anesthetics given?

A
  • as gases w/ partial pressres

- usually give N20 at 70%, O2 at 25%, and the agent at 5%

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13
Q

How are the inhalational anesthetics distributed?

A

they must diffuse through the lung and get dissolved in the blood

  • drug is equilibrated when the PP is the same in the alveoli and the blood
  • but the mass of the drug may differ btw the blood and gas in different tissues
  • GOAL: PP is the same but drug concentration is different.
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14
Q

What inhalational drugs will have a faster onset of action?

A
  • those w/ low blood:gas partition will have a faster onset
  • they also decrease action quicker b/c they get redistributed out of the high flow organs and into the skeletal muscle and fat
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15
Q

Which anesthetics have a high blood:gas partition?

low?

A

High Halothane > isoflurane > enflurane
Low: Xenon < Desflurane < N20 < Sevoflurane
- —> these also have very low metabolites as well!

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16
Q

What are all the factors that affect uptake of inhalational drugs?

A 
concentration of inspired gas  -- this is the only thinged that can be altered by doctors 
RR
Solubility
rate of blood flow to lungs
CO
tissue distribution
17
Q

What are the respiratory effects of inhalational agents?

A

increased RR w/ decreased Tidal volume

  • results in regular rhythmic shallow breathing
  • reflex response to PaCO2 blocked by all except N20 - very good benefit of N20
18
Q

What effects does N20 have on the heart?

A
  • no effects on CV

- depression if used w/ opioid suggests a sympathomimetic action

19
Q

What are some potential ways that anesthetics affect CV depression?

A
  • decrease sympathetic outflow
    -peripheral ganglion blockade
  • decreased adrenal catecholamine release
  • baroreceptor attenuation
  • decrease Ca flux
    Vagal stimuation
20
Q

What inhalational agent has irritating odor?

A

enflurane, isoflurane, desflurane

21
Q

What inhalational agent has pain relief?

A

N20

22
Q

What inhalational agent has muscle relaxation?

A

Enflurance and isoflurance

23
Q

What inhalational agent has loss of reflexes?

A

all except N20

24
Q

What inhalational agent has arrhythmia?

A

Halothane

25
Q

What inhalational agent has liver toxicity?

A

Halothane

26
Q

What inhalational agent has seizures?

A

enflurane

27
Q

What are some concerns of N20?

A
  • neurologic deficits in infants due to myelin sheath degeneration upon chronic use
  • inhibitor of vit B12 synthetase
  • increased spontaneous abortion??
  • rapid uptake of gas from alveoli b/c of high volume of N20 in combo
  • must administer O2 to maintain oxygenation in the immediate post-anesthetic phase
  • very soluble so it can cause pneumothorax, gas bubbles in bowel and middle ear

NEURO PHARM (10 decks)

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