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Pharmacology & Anesthesiology > IV General Anesthetics > Flashcards

IV General Anesthetics Flashcards

1
Q

T/F general anesthetics produce unconsciousness and inhibit pain signal propagation

A

F; they produce unconsciousness but do not inhibit pain signal propagation

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2
Q

why do we administer an analgesic with a general anesthetic

A

to stop pain signal generation from stimulating the RAS to the point that the patient wakes up

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3
Q

how and why do we reduce the dose of induction anesthetic

A

using premedication (opioids, benzodiazepines); to reduce the incidence of agent-specific adverse effects

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4
Q

what are the 4 stages/planes of anesthesia that a patient passes through during induction

A

1) stage of analgesia
2) stage of excitement
3) stage of surgical anesthesia
4) stage of medullary depression (AVOID)

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5
Q

why is it better to induce with an injectible vs inhalant

A

inducing with an inhalant is pretty slow, so healthy patients will experience a prolonged stage of excitement and struggle; in contrast inducing with an injectable is quick so the excitement phase is essentially bypassed

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6
Q

T/F we do not induce healthy animals with inhalants

A

T

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7
Q

what routes can we give propofol

A

IV only

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8
Q

what is the duration of propofol

A

2-8 min, often only 30s for full anesthetic effect

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9
Q

what is propofol used for

A

induction or very short sx procedures

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10
Q

T/F propofol is associated with a bad recovery

A

F; very smooth

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11
Q

what is propofol MoA

A

slows the dissociation of GABA from its receptor -> Cl flow into channel -> inhibition of APs

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12
Q

how is propofol metabolized

A

redistributes from CNS to fat and muscle; hepatic metabolism as well as extrahepatic (lung, kidney) metabolism

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13
Q

what are some pros of propofol

A

1) smooth induction (and can top up for > 5 min without accumulation as well as titrate to effect without excitation
2) rapid smooth recovery (20 min)
3) can be administered as a CRI

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14
Q

what are the CVS effects of propofol (2)

A

depresses myocardial contractility and causes peripheral vasodilation -> get dose-dependent drop in BP

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15
Q

with propofol, the degree of hypotension is worse with ________

A

rapid injection

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16
Q

propofol should be used with caution in:

A

hypotensive patients, those with myocardial disease, geriatrics

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17
Q

what are the respiratory effects of propofol

A

inhibits in a dose-dependent manner; may see transient cyanosis; apnea for 30-60s if you give a bolus

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18
Q

what is a blood consideration with propofol and what species is especially prone

A

damages Hb -> Heinz bodies; cats prone

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19
Q

what is the contamination risk with propofol

A

many hospitals use multi-dose propofol vials, which can become contaminated and lead to wound infection

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20
Q

how long should you use multi-dose propofol vials for and what is the catch?

A

28 days; need to sterilize with alcohol for up to 60 seconds

21
Q

some single and multi-dose vials of propofol contain __________, which is toxic to cats

A

benzyl alcohol (however, they do not appear to cause toxicity in the concentrations and quantities involved in induction - cannot use for a CRI)

22
Q

what are some other adverse effects of propofol

A

1) pain
2) anorexia
3) diarrhea
4) myoclonus in dogs
5) toxicity in cats (daily doses for more than 2-3 days causes accumulation)
6) excitement if used alone in horses

23
Q

ketamine produces a dream-like state of pseudo-consciousness known as

A

dissociative anesthesia

24
Q

what does dissociative anesthesia associated with sole ketamine use look like

A
  • intense muscle rigidity
  • eyes open
  • hear normally
  • swallow reflex intact
  • hallucinogenic
25
Q

how do we use ketamine while avoiding dissociative anesthesia

A

by administering pre- or co-medications

26
Q

what is ketamine’s MoA

A

blocks NMDA receptors; also blocks opioid and GABA receptors, which causes CNS overstimulation and CVS effects

27
Q

ketamine produces ______________ if unpremedicated and ______________ if premedicated

A

hyperthermia; hypothermia

28
Q

T/F patients induced with ketamine may move in response to pain

A

T

29
Q

what are the CV effects of ketamine

A

increases RR and HR (due to CNS stimulation)

30
Q

what are some other effects of ketamine

A
  • can precipitate seizures
  • can cause excitement in dogs if used alone
  • very rough recovery if used alone
31
Q

how do we give ketamine in small animals for:
- heavy sedation or GA in cats
- induction

A
  • heavy sedation or GA in cats: ketamine IM + an opioid, alpha-2 or benzodiazepine
  • induction: ketamine IV + diazepam
32
Q

how is ketamine used for induction in large animals

A

ketamine + xylazine

33
Q

alfaxalone is a __________ __________

A

neuroactive steroid

34
Q

what is alfaxalone’s MoA

A

facilitates GABA

35
Q

what do we use alfaxalone for

A

induction

36
Q

what is special about administration and effect of alfaxalone

A

greater effect when administered slowly

37
Q

how does the induction and recovery of alfaxalone differ from propofol

A

both have smooth induction and fast recovery, but alfaxalone can induce a rough recovery if used alone

38
Q

what are the CVS effects of alfaxalone

A

BP may fall only slightly with little or no change in HR or contractility

39
Q

what does rapid injection of alfaxalone do to the CVS

A

faster drop in BP, may see reflex increase in HR

40
Q

if administered as a bolus, what are the respiratory effects of alfaxalone vs propofol

A

longer apnea with alfaxalone (100s in dogs, 60s in cats)

this is longer than with propofol

41
Q

T/F as with propofol, alfaxalone contains nutrients that support bacterial growth, so re-use of single vials is not recommended

A

T

42
Q

what is the MoA of barbiturates

A

inhibit the dissociation of GABA from its receptor

43
Q

why do barbiturates have a low therapeutic index

A

1) slow hepatic metabolism by p450 enzymes
2) more intense depression

44
Q

what are the 2 clinical uses of barbiturates today

A

1) euthanasia
2) to stop a seizure when diazepam fails

45
Q

what barbiturate is used for euthanasia

A

pentobarbital sodium

46
Q

what are the 2 reasons why you should ALWAYS place a catheter before giving pentobarbital

A

1) excitement if less than half the calculated dose given (do not want to lose vein)

2) convulsions if accidentally injected into carotid

47
Q

what are the 6 steps for euthanasia with pentobarbital

A

1) sedate animal
2) place IV catheter
3) flush catheter
4) induce with propofol
5) give 1.5x dose of pentobarbital
6) confirm death

48
Q

what is the post-mortem indication of barbiturate overdose

A

spleen enlarged 4-5 fold

49
Q

what is the euthanasia drug used by humane societies, since no license is required

A

T-61

Pharmacology & Anesthesiology (22 decks)

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