Intravenous and Inhalational Anesthesia

Question 1

What is the triad of anesthesia

Answer 1

Analgesia
Amnesia
Skeletal Muscle Reaction

Question 2

Significance of no anasthesia specific antagonists

Answer 2

Rely on metabolism of the drugs

Question 3

What are the four stages of anesthesia

Answer 3

1 - Analgesia
2 - Disinhibition (Delirium and Excitement)
3 - Surgical Anesthesia
4 - Medullary Depression (Resp + CV depression)

Question 4

Minimum Alveolar Concentation is…

Answer 4

Minimum alv. conc. that stops movement in 50% of patients in response to painful stimulus.
Used to define potency of inhalational anesthetics

Question 5

Relationship of N20 and mac

Answer 5

itself – 104%

combinew ith others to lower the MAC of other anesthetics

Question 6

Some non-drug factors that lower MAC

Answer 6

Increasing Age
Hypothermia
CNS depression/Drugs
Acute OH intox
Pregnancy
Alpha Adrenergic (clonidine)

Question 7

Things that increase MAC requirements

Answer 7

Hyperthermia
Chronic Ethanol Abse
Increase CNS neurotransmitters (MAO inhib.)

Question 8

Blood-Gas Partition Coefficient is a measure of…

Answer 8

the relative solubility of a drug in blood vs air. Determines the uptake from the alveoli

Question 9

______ Blood Solubility will cause slow induction? Rapid Induction?

Answer 9

Low Solubility – Rapid Induction

High Solubility – Slow Induction

Question 10

Important Nitrous Oxide details

Answer 10

Insoluble,
Analgesia + Sedation
Second Gas Effect

Question 11

Adverse effects of Nitrous Oxide

Answer 11

Oxidizes Cobalt in B12
Expansion in Closed Spaced
Diffusion hypoxia on emergence

Question 12

Important Diethyl Ether facts

Answer 12

Flammable, easy to administer
Respirator Irritant
Complete Anesthetic (Relax, unconscious, analgesia)

Question 13

Advantages of Halothane

Answer 13

Sweet odor, smooth inhalation
Fair analgesia, muscle relaxation
Excellent hypnosis

Question 14

Disadvantages of Halothane

Answer 14

CV, respiratory depression
Catecholamine Sensitization (ventricular arrythmia)
Hepatotoxicity (genetic predisp., massive necrosis)

Question 15

Important Enflurane details

Answer 15

Rapid Induction and Recovery
Good Analgesia/relaxation/hypnosis
No catecholamine effect
Bad odor, CNS stim (seizures), CV depression

Question 16

Important Isoflurane details

Answer 16

Rapid Induction/Emergence
Good analgesia/sedation
Pungent odor, drops BP, coronary steal

Question 17

Important Sevoflurane details

Answer 17

Rapid Induction
Non irritating
Non-flammable
CANNOT USE WITH LOW FLOW ANES.

Question 18

Important Desflurane details

Answer 18

Rapid achievement of anesthesia, recovery/awakening
Uterine relaxant
Drops in CO, BP

Question 19

CV effects of Anes.

Answer 19

Drop MAP (HE drops CO, others drop SVR)
Alter HR (Halo decreases via vagal, other increase)

Question 20

Resp. effects of anethetics

Answer 20

decrease TV, increase rate
impaired mucociliary apparatus
Bronchodilation (esp. Halothane)

Question 21

CNS effects of anes.

Answer 21

Lower CNS metabolic rate
May increase intracerebral pressure
Enflurane can trigger seizures

Question 22

Renal effects of anes.

Answer 22

Decrease GFR, RPF, inc. filtration frac.

Enflurane, Sevoflurane, Methoxyflurane can be nephrotoxic

Question 23

Most potent anesthetic given

Answer 23

Methoxyflurane

Question 24

Important detail on cycloflurane

Answer 24

Explosive

Question 25

Important details on Malignant Hyperthermia

Answer 25

• Ca+ in SR released –> HTN, Tachy, hyperthem, acidosis, hyperkalemia
• Trigger by Halogenated agent or succinylcholine
• Treat w/ IV Dantrolene Sodium

Question 26

Important Sedative Hypnotics for this exam

Answer 26

Barbiturates
Ketamine
Propofol
Etomidate
Benzos

Question 27

Clinical Uses of Barbiturates

Answer 27

Induction of anesthesia
Treatment of Increased ICP
Decreased Cerebral Blood Volume
Decrease Cerebral Metabolism

Question 28

5 most common Barbs in anesthesia

Answer 28

Sodium Pentathal (Thiopental)
Methohexital
Thiamylal
Secobarbital
Pentoparbital

Question 29

Important Sodium Pentothal details

Answer 29

Sedation+Hypnosis+Anesthesia
IV adinistration
Rapid onset, short duration
NO muscle relaxation, antanalgesic
Resp depression, cough, bronchospasm

Question 30

Important Ketamine details

Answer 30

PCP derivative, NMDA antag.
Rapid Onset, Short Duration
Profound anterograde amnesia for 1 hr, analgesia
Copious salivation
Increases Intracranial Pressure, Don’t give w/ head injury

Question 31

Relationship of Ketamine to autonomics

Answer 31

Sympathomimetic (blocks reuptake)

Smooth muscle relaxant

Question 32

Details about Ketamine Emergence Delirum

Answer 32

Auditory Hallucinations
Vivid Dreams
Reduced by benzos

Question 33

Important propofol details

Answer 33

IV, rapid onset, short duration hypnosis
Sedation, hypnosis, anesthesia, antiemetic
No analgesia.
Pain on injection, hypotension, drop in SVR

Question 34

Important details on Etomidate

Answer 34

NON - Barb, analgesic
Pain on injection, myoclonus
Adrenal suppression w/ chronic
N/V

Question 35

Mechanism of Benzos in anesthesia

Answer 35

increased C- GABA activity
Diminished Reticular Activating System
Antagonized by Flumenazil

Question 36

Common Benzos in anesthesia

Answer 36

Diazepam (Vallium)
Lorazepam
Midazolam (versed)

Question 37

Important details on Diazepam (Vallium)

Answer 37

Rapidly absorbed from GI
Minimal CV depression
Protein binding paralleling lipid solubilty

Question 38

Clinical uses of Diazepam

Answer 38

Preoperative
Induction of anesthesia (w/ large dose)
IV sedation
anticonvulsant/muscle relaxant
delirum tremens

Question 39

Important details of Midazolam (versed)

Answer 39

More rapid, potent than valium
50% first pass effect
Elimination half time = 1-4 hrs
Excellent anterograde amnesia

Question 40

Midazolam downside

Answer 40

CV depression (esp. w/ narcotics)

Question 41

Lorazepam details

Answer 41

More potent amnestic than diazepam
Slow onset, long duration, slow dissociation
Minimal effects on muscle, CV, pulm
Pharmacologically inactive metabolites