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FA2 Anesthesiology > Lecture 4 8/28/24 > Flashcards

Lecture 4 8/28/24 Flashcards

1
Q

What is the goal of anesthetic induction?

A

transition from a state of consciousness to unconsciousness while minimizing undesirable effects

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2
Q

What are the benefits of injectable induction?

A

-smooth transition
-no waste gas

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3
Q

What is the disadvantage of injectable induction?

A

cannot be immediately controlled or eliminated once administered

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4
Q

What are the two main ways that injectable induction agents work?

A

-GABA binds to receptor, allowing Cl- to enter and hyperpolarize cell to inactivate it
-glutamate is inhibited so that sodium cannot enter the cell, preventing an action potential

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5
Q

What are the primary uses of benzodiazepines?

A

-sedation
-amnesia
-muscle relaxation

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6
Q

Which drugs fall into the benzodiazepines category?

A

-midazolam
-diazepam
-zolazepam

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7
Q

What are the characteristics of midazolam?

A

-water soluble
-can be given IM, SQ, IV
-mixes well with other drugs
-does not adhere to syringe
-does not cause precipitants

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8
Q

What are the characteristics of diazepam?

A

-lipid soluble
-given IV only
-mixes only with ketamine

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9
Q

What are the CNS effects caused by benzodiazepines?

A

-decreased cerebral metabolic rate
-decreased cerebral blood flow
-decreased intracranial pressure
-anti-convulsant
-mild, patient-dependent sedation

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10
Q

What are the cardiovascular and respiratory effects caused by benzodiazepines?

A

minimal CV and resp. effects

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11
Q

What are the GI effects caused by benzos?

A

-appetite stimulant in cats
-causes hepatic failure after PO admin. in cats

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12
Q

In which patients are benzos a good pre-medication selection?

A

-debilitated small animals and small ruminants (ASA 3-5)
-neonates
-geriatrics

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13
Q

Why are benzos only used along with a dissociative drug for induction in healthy adult patients?

A

they lead to excitement when used alone

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14
Q

What is the mechanism of action for propofol?

A

potentiates GABA

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15
Q

What is the main use of propofol?

A

-rapid, smooth induction
-unconsciousness
-immobility
-muscle relaxation

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16
Q

What are the characteristics of propofol?

A

-formulated in lipid emulsion
-not shelf stable
-used for CRIs; do not want the side effects of the preservative in the shelf stable version

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17
Q

What are the characteristics of propofol 28?

A

-stable for 28 days
-benzyl alcohol preservative

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18
Q

What are the physiologic characteristics of propofol?

A

-short duration of action
-must be given IV
-narrow therapeutic index/possible to overdose
-mainly hepatic metabolism
-extra-hepatic metabolism possible, allowing for safe use in patients with liver failure

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19
Q

What are the CNS effects associated with propofol?

A

-decreased cerebral metabolic rate
-decreased cerebral blood flow
-anti-convulsant
-decreased intracranial and intraocular pressures

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20
Q

What are the resp. effects associated with propofol?

A

-resp. depression
-apnea

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21
Q

What measures should be taken to ensure proper resp. support when using propofol?

A

-pre-oxygenate
-avoid use if intubation and ventilation is not feasible

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22
Q

What are the cardiovascular effects associated with propofol?

A

vasodilation and hypotension with no compensatory increase in heart rate

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23
Q

What are the other potential effects of propofol?

A

-occasional pain on injection
-rapidly metabolized by fetus
-heinz body anemia and hemolysis in cats
-vomiting in cats

24
Q

What are the clinical uses of propofol?

A

-induction of anesthesia
-partial intravenous anesthesia
-total intravenous anesthesia

25
Q

What is the mechanism of action for alfaxalone?

A

GABA agonist

26
Q

What is the main use of alfaxalone?

A

-unconsciousness
-immobility
-muscle relaxation

27
Q

What are the physiologic characteristics of alfaxalone?

A

-IV or IM administration
-rapid induction
-short duration around 10 minutes
-hepatic metabolism

28
Q

What are the CNS effects associated with alfaxalone?

A

-decreased cerebral metabolic rate
-decreased cerebral blood flow
-decreased intracranial and intraocular pressures
-myoclonus

29
Q

What are the cardiovascular effects associated with alfaxalone?

A

dose-dependent vasodilation and decreased contractility in sick patients

30
Q

What are the respiratory effects associated with alfaxalone?

A

dose-dependent apnea and cyanosis

31
Q

What are the clinical uses of alfaxalone?

A

-IM sedation
-induction of anesthesia
-PIVA
-TIVA

32
Q

What is the mechanism of action for etomidate?

A

potentiates GABA

33
Q

What are the main uses of etomidate?

A

-unconsciousness
-immobility

34
Q

Why must etomidate be combined with a benzo?

A

because etomidate does not induce adequate muscle relaxation

35
Q

Why is it important that etomidate is formulated in propylene glycol?

A

-causes pain on injection
-can cause hemolysis with large doses or if used for infusion

36
Q

What are the physiologic characteristics of etomidate?

A

-IV admin. only
-rapid and rough induction
-short duration

37
Q

What are the resp. effects associated with etomidate?

A

resp. depression and possible apnea

38
Q

Why is etomidate useful?

A

it has nearly no cardiovascular effects and is therefore safe for patients with CV disease

39
Q

What are the CNS effects associated with etomidate?

A

-decreased cerebral metabolic oxygen rate
-decreased cerebral blood flow
-decreased intracranial pressure
-myoclonus possible

40
Q

Why is it important that etomidate causes immunosuppression and decreased cortisol production?

A

-should not be used for CRIs or repeat injections
-should be avoided in Addison’s patients

41
Q

What are the characteristics of etomidate clinical use?

A

-for use in patients with clinically significant cardiac disease
-not for routine patients
-not for CRIs
-combined with a benzo to provide muscle relaxation and smoother induction

42
Q

Which drugs fall into the dissociative category?

A

-PCP derivatives
-ketamine
-tiletamine formulated with zolazepam (telazol)

43
Q

Why are dissociatives combined with benzos?

A

dissociatives do not achieve muscle relaxation on their own

43
Q

What is the main use of dissociatives?

A

-dissociation of thalamus and limbic system to produce a cataleptoid state
-unconsciousness
-analgesia

44
Q

What is the mechanism of action for dissociatives?

A

NMDA antagonist

45
Q

What are the characteristics of dissociative use for analgesia?

A

-work through NMDA antagonism and opioid receptor interactions
-adjunct agent as a CRI
-causes hyperalgesia good for chronic pain and neuropathic pain

46
Q

How can dissociatives be administered?

A

-IV
-IM
-SQ
-OTM

47
Q

What are the CV effects associated with dissociatives?

A

-increased sympathetic output
-tachycardia
-hypertension
-increased cardiac output

48
Q

Which cardiac disease patients should not receive dissociatives?

A

those with hypertrophic cardiomyopathy

49
Q

What are the resp. effects associated with dissociatives?

A

-apneustic breathing/inhaling and holding breath
-bronchodilation
-laryngeal reflexes maintained

50
Q

What are the CNS effects associated with dissociatives?

A

-increased cerebral metabolic rate
-increased cerebral blood flow
-increased intracranial pressure

51
Q

What are the clinical uses of ketamine?

A

-IM for heavy sedation/immobilization
-induction of anesthesia
-PIVA
-TIVA

52
Q

What are the characteristics of telazol clinical use?

A

-duration of action around 30 minutes
-expensive but used in small volumes
-used in fractious animals/zoo animals

53
Q

What is the use of guafenesin?

A

disrupts nerve impulse transmission in the CNS to cause muscle relaxation

54
Q

What are the adverse effects of guafenesin?

A

-hypotension
-resp. depression
-necrosis if administered peri-vascularly
-thrombophlebitis

55
Q

What are the clinical uses of guafenesin?

A

-equine induction
-TIVA and PIVA

FA2 Anesthesiology (23 decks)

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