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Lecture 2 - GA Flashcards

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1
Q

What was the first anesthetic?

A

ether

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2
Q

What is the theory behind how anesthetics work?

A

produced by changes in the physical properties of cell membranes

fails to explain how the proposed disturbance of the lipid bilayer would result in a dysfunctional membrane protein

how they actually work: make the receptors more sensitive to GABA so they activate at a lower threshold

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3
Q

How do barbituates differ from benzodiazepines in regard to anesthetic mechanism?

A

Both enhance GABA function

Barbiutates do so by increasing the lenght of time that chloride channels remain open

Benzos do so by increasing affinity of GABA to GABAa receptor

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4
Q

Ketamine and NO do what to the GABAa receptor and what to the NMDA receptor?

A

Ketamine and NO don’t do anything to the GABAa receptors but they do inhibit NMDA receptors

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5
Q

Etomidate, propofol, barbiutates, isoflurane, and secoflurance are anesthetics because they all do what?

A

enhance the GABAa receptor

increasing Cl- conductance

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6
Q

1 MAC

A

alveolar concentration that renders 50% of subjects exposed to noxious stimuli (such as surgical incision) immobile

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7
Q

___MAC is mild anesthesia

A

0.3

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8
Q

___MAC is amnesia

A

0.5

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9
Q

____% of pts fail to respond to a noxious stimulus at ____ MAC, and ___MAC the sympathetic responses to surgery are blunted and ____% of subjects are immobile

A

95% at 1.3 MAC

99% at 1.5 MAC

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10
Q

What MAC is often used for induction?

A

2.0

any higher than this dose can be fatal

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11
Q

MAC

A

minimal alveoli concentration

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12
Q

Which drug is more potent, MAC of 90 or MAC of 0.01?

A

MAC of 0.01

that means % of air needed to get to 1 MAC is much smaller

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13
Q

Go back through the examples in the slides/notes

A

do it

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14
Q

When are inhalation anesthetics used?

A

primarily used for maintenance

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15
Q

What does the blood:gas partition coefficient tell us about the drug?

A

solubility
the lower the solubility the quicker on/off (induction)

speed of induction is inversely proportional to the solubility of the agent in blood (blood:gas partition)

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16
Q

NO has a low solubility, what does this mean in regards to induction time?

A

fast

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17
Q

Methoxyflurane is highly soluble, what does this mean in regards to induction time?

A

slow

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18
Q

What is the order of drugs from fastest induction to slowest?

A 
NO
Isoflurane 
Enflurane
Halothane
Methoxyflurane

fastest to equilibrium

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19
Q

What does Fat:blood partition coefficient mean?

A

distribution of the anesthetic in different tissues

if the agent is more soluble in fat, equilibrium may take a long time (hours)

takes a long time to accumulate in fat, thus takes a long time to leave fat (d/t low blood flow of fat)

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20
Q

Where in the body does NO reach equilibrium first?

A

Lung and blood
then
brain, heart, kidney

then much later muscle
then even later fat

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21
Q

What makes an ideal anesthetic?

A

Low blood:gas coefficient
Low fat:blood partition coefficient
MAC –??
no metabolism

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22
Q

What properties does Halothane have?

A

high blood:gas (slow induction)

high fat:blood (there will be a difference between fat people and skinny people

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23
Q

What are the disadvantages of halothane?

A

halothane hepatitis - immune response evoking hepatitic necrosis, fever, nausea, rash and vomiting

malignant hyperthermia (volatile anesthetics)

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24
Q

What are the characteristics of enflurane?

Study These Flashcards
A

blood:gas relatively high –slow induction

25
What are the disadvantages of enflurane?
CV depression d/t decrease in contractility seizures - no permanent damage uterine muscle relxant
26
What is the most commonly used inhalation anesthetic in the US?
isoflurane
27
What are the characteristics of Isoflurane?
blood:gas relatively low - somewhat fast induction | 1MAC = 1.4%
28
What are the advantages of isolflurane?
CO maintained systemic vessels dilate causing small decrease in BP arrhythmias uncommon potent coronary vasodilator
29
What are the disadvantages of isoflurane?
more pungent than halothane | progressive respiratory depression
30
What are the characteristics of sevoflurane?
low blood:gas - fastest induction
31
What are the advantages of sevoflurane?
can be used for outpatient anesthesia because of its rapid recovery profile
32
What are the disadvantages of sevoflurane?
some reports of toxicity
33
What are the characteristics of desoflurane?
very low blood:gas very fast induction very fast emergence (5-10 min)
34
What are the advantages of desoflurane?
use for outpatient surgery - rapid onset, rapid recovery not very soluble in fat
35
What are the disadvantages of desoflurane?
more irritating to airway can provoke coughing, salivation, and bronchospasm low volatitily - requires use of specially heated vaporizer may evoke tachycarida
36
What are the characteristics of methoxyflurane?
very high blood:Gas | highly soluble in RUBBER (means you need more specialized equipment)
37
What are the advantages of methoxyflurane?
very potent
38
What are the disadvantages of methoxyflurane?
extensive metabolism | may produce renal failure and nephrotoxicity (rarely ever used)
39
What are the characteristics of NO?
1 MAC = 105% blood:Gas low --rapid induction and emergence analgesic (not anesthesia) 70-80% in O2 is typical usage
40
What are the advantages of NO?
powerful analgesic rapid induction/recovery little toxicity analgesia before anesthesia
41
What are the disadvantages of NO?
weak agent hypoxia --may occur upon d/c --give 100% o2 closed air spaces may expand since NO exhanges with N2 --not to be used in pts with bowel obstructions or middle ear obstructions
42
Malignant hyperthermia
a rare heritable disorder triggered by volatile anesthetics (halothane) and by some nueromuscular blockers (succinlycholine) caused by an inability of sarcoplasmic retiuculm to sequester a2+ the triggering agents cuase a sustained and prolonged release of Ca2+ and massive muscle contraction, lactate production and increased body temperature treat with dantrolene to reduce intracellular Ca2+ release
43
What is the treatment for malignant hyperthermia?
dantrolene to reduce intracellular Ca2+ release
44
Which IV anesthetics are primarily used for INDUCTION?
barbiturates propofol etomidate ketamine
45
What are the characteristics of IV anesthetics?
rapid onset (seconds) rapid awakening (minutes) danger of OD due to irrevocability of IV injection redistribution determines duration of action
46
Which barbiturate is used in anesthesia?
sodium thiopental
47
What are the advantages of sodium thiopental?
``` little post-anesthetic excitement or vomiting water soluble (makes it easier to use) ```
48
What are the disadvantages of sodium thiopental?
respiratory and CV depression no antagonist slow recovery no analgesia
49
What are the advantages of propofol?
rapid metabolism and recovery little accumulation "milk of amnesia: as it produces a hypnotic and forgetful rest
50
What are the disadvantages of propofol?
``` not water soluble no antagonist no analgesia cardiorespiratory depression can elicit pain upon initial injection ```
51
Ketamine advantages
analgesia no respiratory depression --may increase BP produces hypnotic state - dissociative anesthesia this is more commonly used in kids than adults
52
What are the disadvantages of ketamine?
increased muscle tone and incidence of involuntary movements hallucination adverse effects are less common in children
53
What are the advantages of etomidate?
antagonist available anterograde amnesia CV stability --primarily used for pts at risk for hypotension
54
What are the disadvantages of etomidate?
accumulates - slow recovery no analgesia pain on injection
55
What preanesthetic medications are used?
``` Benzos Antihistamines Antiemetics Opioids Antimuscarinics Muscle relaxants ```
56
Why are benzos used preanesthetically?
to reduce anxiety induce amnesia ex. medazolam, diazepam (valium)
57
Which anesthetic would you use for a pt at risk for hypotension?
etomidate
58
Why are antimuscarinics given?
amnesia prevent bradycardia and fluid secretion ex. scopolamine, atropine

Pharm 2 (6 decks)

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