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Anesthesiology > Lecture 2 Intro to General Anesthesia > Flashcards

Lecture 2 Intro to General Anesthesia Flashcards

1
Q

The four goals of anesthesia:

A

A controlled reversible state of - Amnesia (w/ loss of consciousness) - Analgesia - Akinesia (skeletal muscle relaxation) - Autonomic and sensory reflex blockade

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2
Q

Define general anesthesia:

A
  • State of reversible coma intentionally induced by drugs where the pt is not arousable even with painful stimuli
  • requires intervention to support patency of the airway
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3
Q

What is balanced anesthesia

A

General anesthesia + several agents that can be mix of inhalational and IV meds:

  • potent inhalational agent
  • nitrous oxide
  • neuromuscular blocking agents
  • opioids
  • benzodiazepines
  • IV anesthetics for induction (sedative/hypnotics)
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4
Q

What is regional anesthesia?

A
  • Basically, the use of local anesthetics to numb a particular region of the body, and it can be supplemented with sedation
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5
Q

What are combined techniques?

A
  • Use of regional anesthesia combined with general anesthesia w/ the goal of using a lower dose of general
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6
Q

What is sedation?

A
  • Pt remains arousable through use of IV agents for analgesia, anxiolysis, and amnesia
  • Surgeon usually provides local anesthesia or a regional block has been done
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7
Q

What is another term for sedation?

A
  • MAC: Monitored Anesthetic Care
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8
Q

What is ASA I?

A
  • No medical problems
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9
Q

What is ASA II?

A
  • One or more systemic diseases under good control which do not limit function
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10
Q

What is ASA III?

A
  • One or more systemic diseases which are not in perfect control or limit function to some extent
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11
Q

What is ASA IV?

A
  • A systemic condition which is a constant threat to life
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12
Q

What is ASA V?

A
  • Expected to die within a day; surgery is an act of desperation
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13
Q

What is ASA VI?

A
  • Dead patient organ harvesting
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14
Q

What does the E at the end of an ASA status mean?

A
  • Emergency
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15
Q

What are the steps of a generic general anesthesia plan?

A
  • Anesthesia preoperative eval, consent, and counseling - IV - Premedications ( benzodiazepine) - OR: attach monitors and preoxygenate - IV induction (combo of IV anesthetics/opioids) - Neuromuscular Blocking Agent - Intubation - Maintenance of anesthetic (combo gas and IV drugs) - Emergence (reversal agents if necessary) - Extubation - Recovery
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16
Q

What are some reasons for delayed emergence?

A
  • Normal variation in elimination of antibiotics
  • Relative overdose of anesthesia
  • Hypoxia, extreme hypercarbia
  • Shock/poor perfusion
  • Hypoglycemia or other electrolyte disturbances
  • Hypothermia
  • Increased ICP/Stroke/Air or fat embolism
  • Hysteria
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17
Q

What are the different types of IV anesthetics?

A
  • Sedative-hypnotics, opioids, dissociative anesthetics
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18
Q

What are 4 kinds of IV induction agents?

A
  • Barbiturates, etomidate, propofol, benzodiazepines
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19
Q

What class drug is thiopental?

A
  • Barbiturate
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20
Q

Does thiopental cross the BBB?

A
  • Yes, and rapidly
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21
Q

True or false: thiopental take a long time to take effect

A

False, it is short acting, but the elimination half life is several hours

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22
Q

Does thiopental cause apnea?

A
  • Yes
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23
Q

What are some considerations for cerebral perfusion regarding thiopental?

A
  • It reduces CMRO2 (cerebral metabolic rate) and CBF (cerebral blood flow)
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24
Q

What is etomidate?

A
  • Carboxylated imidazole
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25
Q

What are the pros of etomidate?

A
  • Minimal CV effects
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26
Q

What are the cons of etomidate?

A
  • Might cause adrenocortical suppression
  • Myoclonic movements
  • Nausea/vomiting
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27
Q

What’s the most popular induction agent and why?

A
  • Propofol
  • Has the least residual sedation
  • It’s easier to store in carts
28
Q

What is propofol, and what class of drugs is it similar to?

A
  • Phenol derivative; similar effects to barbiturates b but also has anti-emetic effects
29
Q

What are benzodiazepines used for?

A
  • Anxiolytic/amnestic effects for preop and intraop sedation
30
Q

What’s the most popular benzodiazepine and why?

A
  • Midazolam
  • Has a short half life
  • Water soluble
31
Q

What’s the specific antagonist for all benzodiazepines?

A
  • Flumazenil
32
Q

True of false: Opioids can be used as induction agents at high doses?

A
  • True, due to their CV stability
33
Q

What are some side effects of opioids?

A
  • Respiratory depression
  • chest wall rigidity
  • pruritis
  • nausea/vomiting
  • urinary retention
  • sedation
34
Q

What are some common synthetic opioids?

A
  • Fentanyl
  • Sufentanil
  • Remifentanil
35
Q

What’s a specific antagonist for opioids?

A
  • Naloxone
36
Q

What’s the difference between fentanyl and morphine?

A
  • Fentanyl is 100x more potent
  • More lipophilic and crosses BBB faster
  • More rapid onset and short duration of action
37
Q

What is the effect of fentanyl on blood pressure?

A
  • No vasodilation or myocardial depression, no hypotension
38
Q

What is the effect of morphine on blood pressure?

A
  • Hypotension via the release of histamine
39
Q

What street drug is ketamine related to?

A
  • PCP
40
Q

What is ketamine used for?

A
  • Analgesia and dissociation
41
Q

What are the side effects of ketamine?

A
  • Nightmares (which can be avoided with benzos) and sympathomimetic effects
42
Q

What are some qualities of an ideal anesthetic gas?

A
  • low blood solubility
  • minimal metabolism
  • compatible w/ Epi
  • doesn’t irritate the airway
  • doesn’t cause myocardial depression
43
Q

What is a partition coefficient?

A
  • Describes blood solubility of inhalational anesthetic

- Distribution ratio between 2 phases at equilibrium

44
Q

What is a blood:gas partition coefficient?

A
  • it is the distribution ratio between blood and gas phases because blood is an inactive reservoir for anesthetic
45
Q

What is the order of blood: gas partition coefficient from least to greatest of the inhalational anesthetics?

A

Des < N2O < Sevo < Iso < (Hal)

46
Q

What is the order of anesthetic gas metabolism from greatest to least?

A

Hal > Sevo > Iso > Des

47
Q

What is the minimum alveolar concentration?

A

MAC is the steady state concentration of an inhalational agent that maintains immobility in 50% of subjects exposed to a noxious stimulus

48
Q

True or false: MAC values are not additive.

A

False, they are additive

49
Q

What is a MAC Awake?

A

0.35 - 0.4 MAC (50% can be awakened)

50
Q

What level MAC will cause 95% of patients to ignore incisions?

A

1.5 MAC

51
Q

What is MAC-BAR?

A

1.5 - 2 MAC (50% blocked autonomic reflexes at incision)

52
Q

Which inhalational anesthetics are bronchodilators?

A

All of them

53
Q

Which inhalational anesthetics have greater bronchodilatory effects?

A

Sevo and Hal

54
Q

Which inhalational anesthetics are the least irritating

A

Sevo and Hal

55
Q

What effect do inhalational agents have on TV and RR

A
  • Decreased TV, increased RR (decrease in minute vent)
56
Q

How do inhalational agents affect MAP

A
  • MAP decreases (dose dependent( but newer agents decrease SVR
57
Q

HOw does halothane predispose to ventricular arrhythmias?

A
  • Sensitizes myocardium to catecholamines
58
Q

What is stage 1 of anesthesia

A

Analgesia

59
Q

What is stage 2 of anesthesia

A

Excitement (delirium)

60
Q

What is stage 3 of anesthesia

A

Surgical anesthesia

61
Q

What is stage 4 of anesthesia

A

Medullary depression

62
Q

What factors affect delivery of inhalational agents from machine to alveoli?

A
  • inspired concentration

- minute ven

63
Q

What factors affect delivery of inhalational agents from lungs to blood?

A
  • Blood: gas partition coefficient

- Cardiac outptut

64
Q

What factors affect delivery of inhalational agents from blood to brain?

A
  • Brain: blood partition coefficient

- cerebral blood flow

65
Q

What is malignant hyperthermia?

A
  • altered calcium metabolism/membrane physiology

- treated w/ dantrolene

Anesthesiology (10 decks)

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