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PHAR222 > L21 anaesethesisa > Flashcards

L21 anaesethesisa Flashcards

1
Q

Anaesthesia

A

without sense / loss of sensation

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2
Q

Anaesthetic

A
  • a drug that produces anaesthesia
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3
Q

Local anaesthesia

A
  • loss of sensation to a small part of the body
  • e.g., dental procedure
  • awake
  • voltage-gated sodium channel GABA(A)
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4
Q

Regional anaesthesia

A
  • loss of sensation to a large part of the body
  • e.g., epidural for labour
  • can be awake
  • voltage-gated sodium channel GABA(A)
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5
Q

General anaesthesia

A
  • total lack of sensation
  • unconsciousness
  • e.g., major surgery
  • GABA(A) receptor, NMDA receptor or two-pore domain K+ channels
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6
Q

nitrous oxide (N2O)
diethyl ether
chloroform
Coefficients (all inhaled)

A
  • N2O - low Blood:gas and low Oil:gas
  • diethyl ether - mod Blood:gas and mod Oil:gas
  • chloroform - mod Blood:gas and high Oil:gas
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7
Q

blood:gas partition coefficient

A
  • solubility of inhaled general anaesthetics in blood relative to air
  • onset of and recovery from anaesthetic effect
  • lower b:g partition coefficient → fast onset of effect
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8
Q

oil:gas partition coefficient

A
  • solubility of inhaled general anaesthetics in lipid relative to air
  • higher oil:gas partition coefficient → higher potency of the anaesthetic
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9
Q

MAC (minimum alveolar concentration) def

A
  • the concentration at which 50% of subjects do not react to skin incision
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10
Q

MAC (minimum alveolar concentration) info

A
  • the concentration at which 50% of subjects do not react to skin incision
  • expressed as a % at 1 atm
  • measure potency of a volatile anaesthetic; inverse proportional to the oil:gas
    partition coefficient
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11
Q

issues of Early inhalation anaesthetics

A
  • slow onset of action and recovery - diethyl ether and
    chloroform
  • flammable - diethyl ether
  • hepatotoxicity and cardiac toxicity - chloroform
  • undesirable postoperative effects - nausea, vomiting
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12
Q

diethyl ether issues

A
  • slow onset of action and recovery
  • flammable
  • undesirable postoperative effects - nausea, vomiting
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13
Q

Chloroform issues

A
  • slow onset of action and recovery
  • hepatotoxicity and cardiac toxicity
  • undesirable postoperative effects - nausea, vomiting
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14
Q

an ideal inhalation anaesthetic

A
  • nonflammable and nonexplosive
  • minimal interactions with other drugs
  • lack of unwanted effects on respiratory and cardiovascular systems
  • high lipid solubility
  • low blood solubility
  • no hangover effects
  • nontoxic, nonirritant to the airways
  • analgesic
  • inexpensive; long shelf life
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15
Q

Stage 1 of general anaesthesia

A
  • Analgesia
  • without amnesia → analgesia with amnesia; remain conscious
  • breathing: slow and regular
  • pupil diameter - normal and responsive to light
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16
Q

Stage 2 of general anaesthesia

A
  • Excitation
  • excitation and delirium; amnesia; unconscious
  • breathing: irregular
  • pupil diameter - normal and responsive to light
  • not desirable
17
Q

Stage 3 of general anaesthesia

A
  • Surgical anaesthesia
  • subdivided into four levels of increasing depth
  • breathing: regular → progressively weaker
  • pupil diameter - gradual dilation, unresponsive to light
18
Q

Stage 4 of general anaesthesia

A
  • Medullary depression
  • loss of spontaneous respiration and progressive depression of cardiovascular reflexes
  • breathing: respiratory cessation
  • pupil diameter - complete dilation
  • Not good
19
Q

Anaesthetics - concentration-response curves

A

consciousness → unconsciousness occurs over a narrow concentration range (propofol)

20
Q

simple, short surgical anaesthetic procedure

A
  • a single anaesthetic can be used on its own
21
Q

complex surgical procedure anaesthetic

A
  • ‘balanced anaesthesia’ - an array of drugs are given at various times throughout the procedure to deliver the following effects as required
    – sedation
    – analgesia
    – muscle relaxation
  • MR- necessary for abdominal and thoracic surgery; mechanical ventilation is required
22
Q

‘balanced anaesthesia’

A
  • an array of drugs are given at various times throughout the procedure to deliver the following effects as required
    – sedation
    – analgesia
    – muscle relaxation
23
Q

Anaesthsia timeline

A

premedication (benzodiazepines like diazepam)
↓
induction (I.V anaesthetic)
↓
muscle relaxation & intubation (neuromuscular block)
↓
maintenance of anaesthesia (IV or inhaled ana)
↓
analgesia (opioid)
↓
reversal (anticholinesterase to inhibit ACh breakdown)

24
Q

Modern general anesthetics (3)

A

Inhaled
* -flurane (volatile liquid)
* N2O (gas)
IV
* propofol
* thiopental

25
Q

-flurane main molecular targets

A
  • GABA(A) receptor: ↑
  • NMDA: ↓ (drug inhibit)
  • two-pore domain K+ channels: ↑
26
Q

thiopental main molecular targets

A

Gaba(A): ↑
–both synaptic and extrasynaptic

27
Q

propofol main molecular targets

A

Gaba(A): ↑
–both synaptic and extrasynaptic

28
Q

General anesthetics - main molecular targets

A
  • GABAA receptor - both synaptic and extrasynaptic
  • NMDA receptor - excitatory
  • two-pore domain K+ channels - resting membrane potential
29
Q

Inhaled Anaesthetics - adverse effects

A
  • Respiratory depression
  • cardiovascular depression (↓ blood pressure and heart rate)
  • postoperative nausea and vomiting
  • malignant hyperthermia
  • respiratory tract irritation
30
Q

malignant hyperthermia

A
  • Adverse from inhaled anaesthetic
  • defect in the ryanodine receptor (RYR1)
  • excessive Ca2+ release from sarcoplasmic reticulum → heat production in skeletal muscles
31
Q

Intravenous Anaesthetics - adverse effects

A
  • Respiratory depression
  • cardiovascular depression (↓ blood pressure and heart rate)
  • postoperative nausea and vomiting
  • pain at injection site
32
Q

blood:gas partition coefficient simple

A
  • onset of and recovery from anaesthetic effect
33
Q

oil:gas partition coefficients simple

A
  • potency of an anaesthetic
34
Q

pharmacokinetics: Modern inhalation anaesthetics

A
  • mostly eliminated in expired air
  • alveolar ventilation
  • cardiac output
35
Q

sevoflurane

A
  • Low B:G
  • HigG
  • fast induction and recovery
  • least respiratory irritation
36
Q

thiopental
Induction, recovery & notes

A
  • fast
  • slow
  • pain injection site, respiratory depression, not for continuous infusion = accumulation
37
Q

Propofol
Induction, recovery & notes

A
  • fast
  • fast
  • pain injection site, respiratory depression
  • continuous infusion
38
Q

total intravenous anaesthesia

A

the anaesthetic is used for both induction and maintenance of anaesthesia

39
Q

Thiopental not continuous infusion why

A
  • highly lipophilic
  • goes to liver and brain first
  • Hangover effect: blood concentration drops slowly, saturable metabolism
  • Stored and then will slowly be released to systemic circulation and show effects after anaesthetic is needed.

PHAR222 (25 decks)

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