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Pharmacology > Midterm-Anesthesia > Flashcards

Midterm-Anesthesia Flashcards

1
Q

a state of depressed CNS activity

A

anesthesia

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2
Q

are drugs which produce reversible loss of all sensation and consciousness

A

general anesthetics

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3
Q

cardinal feats of gen anesthesia

A
  • loss of all sensation, esp pain
  • sleep(unconsciousness) and amnesia
  • immobility and muscle relaxation
  • abolition of reflexes
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4
Q
  • orderly and systematic reduction of sensory and motor CNS functions
  • progressive depression of cerebral and spinal cord functions
A

mechanism of action of gen anest

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5
Q

the lowest concentration of the anesthetic in pulmonary alveoli needed to produce immobility in response to painful stimulus in 50 % individuals

A

minimum alveolar concentration (MAC)

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6
Q
  • unconsciousness
  • amnesia
  • immobility
A
  • thalamus
  • hippocampus
  • spinal cord
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7
Q

Guedel’s stages of anesthesia

A
  • Stage 1: Stage of Analgesia- from beg of inhalation to loss of consciousness, pain is progressively abolished, difficult yet minor procedures can be done
  • Stage 2: Stage of Delirium- from loss of consciousness to beg of regular respiration (excitement, struggling, breath-holding, jerky breathing, sympathetic stimulation) no procedure done
  • Stage 3: Surgical Anesthesia- from onset of regular respiration to cessation of spontaneous breathing. (divided into 4 planes, as anest becomes light to deep, dental carried at plane 1 or 2)
  • Stage 4: Medullary Paralysis- from cessation of breathing to failure of circulation and death
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8
Q

current levels of anesthesia

A
  • Induction: encompasses the admin of preoperative meds, adjunctive drugs to anesthesia, and the anesthetics required for surgery
  • Maintenance: begins when patient has achieved a depth of anesthesia sufficient to allow the surgery to begin and ends upon the completion of the surgical procedure
  • Recovery: termination of surgical procedure and continues throughout the postop recovery period until the patient is fully responsive to his or her environ.
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9
Q

gases or vapors that diffuse rapidly across pulmonary alveoli and tissue barriers.

A

inhalation anesthetics

  • induction and recovery depend on the rate of PP in the brain
  • transfer of anesthetic bet the lung and brain depends on a series of tension gradients (alveoli blood brain)
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10
Q

factors affecting the PP of anesthetics attained in brain:

A
  1. PP of anesthetic in the inspired gas (the higher inspired tension, ^anesthetic transferred to blood, hastening induction)
  2. Pulmonary ventilation (hyperventilation will bring in more anesthetic per min, hasten induction)
  3. Alveolar exchange (GA diffuse freely across alveoli & blood will be delayed-induction/recovery slowed)
  4. Solubility of anesthetic in blood (most impt property, drugs w/ low blood solubility induce quickly)
  5. Solubility of anesthetic in tissues (anesthetics w/ ^lipid sol cont to enter adipose tiss for hrs, & also leave it slowly)
  6. Cerebral blood flow (CO2 inhalation w/c causes cerebral vasodilation accelerates induction/recovery
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11
Q

properties of IDEAL anesthetic

  • for patient
  • for surgeon
  • for anesthetist
A
  • pleasant, non-irritating, shudnt cause nausea or vomiting
  • provide adequate analgesia, immobility/muscle relaxation, not inflammable/nonexplosive for cautery
  • admin easy, controllable, versatile, wide margin of safety, low conc, rapid adjustment in depth of anesthesia shud b possible, cheap, stable, easily stored, not react w/ rubber tubing or soda lime)
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12
Q

Gen anest

-inhaled anesthetics

A
  • gas: nitrous oxide
  • volatile liquids:
    • enflurane(ethrane)
    • halothane (fluothane) -isoflurane(Forane) -methoxyflurane(penthrane) -sevoflurane(ultane) -desflurane
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13
Q

Gen anest

-injectable anesthetics: used as an adjunct

A
  • etomidate(Amidate)
  • ketamine(Ketalar)
  • methohexital(Brevital)
  • propofol(Diprivan)
  • thiamyal (Surital)
  • thiopental(Pentothal)

*Adjunctive agents:
-Sedative-hypnotics: benzodiazepines, barbituates
-Opiods (narcotics):morphine, fentanyl, sufenfanil
-Neuromuscular blocking agents(NMBAs)
-Anticholinergics: atropine
-

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14
Q

indications and

*side effects

A

-to produce: unconsciousness, skeletal/smooth muscle relax
-rapid onset, quickly metabolized
-

  • vary according to dosage and agent used
  • sites affected: heart, peripheral circulation, liver, kidneys, respiratory tract
  • myocardial depression is commonly seen
  • malignant hyperthermia
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15
Q

Nitrous oxide

A
  • primary part of dental office “conscious sedation”: technique in w/c drugs are used to produce a state of CNS depression (not unconsc) allows for surgery and communication w/ patient
  • maintains a patent airway throughout
  • good analgesic but poor muscle relaxant
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16
Q

Ether (diethyl ether)

A
  • highly volatile liquid, irritating vapors w/c are inflammable and explosive
  • highly soluble in blood: induction prolonged and unpleasant w/ struggling (atropine must be given to prevent patient from drowning in his own secretions)
  • post anesthetic nausea/vomiting
  • cheap
17
Q

Halothane (Fluothane)

A
  • Volatile liquid w/ sweet odor
  • nonirritant, noninflammable
  • intermediate solubility in blood-induction quick/pleasant
  • potent
  • recovery smooth quick
  • coughing suppressed-preferred for asthmatics
  • causes direct depression of myocardial contractility
  • cardiac output is reduced
18
Q

isoflurane(Sofane)

A
  • potent fluorinated
  • less sol in blood-rapid induction/recovery
  • fall in BP, ^HR
  • respiratory depression prominent
  • post anesth nausea/vomit low
  • preferred for neurosurgery
19
Q

desflurane

A
  • high volatility
  • lower oil:gas partition coefficient
  • very low sol in blood-induction/recovery very fast
  • post anest cognitive/motor impairment short lived
  • less potent than isoflurane
  • higher concentration for induction must be used
  • irritates air passage
  • pungent odor
20
Q

sevoflurane

A
  • properties between isoflurane and desflurane
  • induction fast
  • pleasant and adminstrable through face mask
  • acceptable by pediatric patients
  • recovery smooth, quick as w/ desflurane
  • used for outpatient and inpatient surgery
  • expensive
21
Q

thiopentone sod

A
  • ultrashort acting thiobarbiturate
  • highly sol in H2O yielding alkaline sol
  • must be prep’d freshly befor injection
  • consciousness regained in 6-10min
  • poor analgesic
22
Q

methohexitone sod

A
  • more potent, shorter acting

- patients become roadworthy earlier

23
Q

propofol

A
  • oily liquid as a 1% emulsion for IV induction and short duration anesthesia
  • unconsciousness in 15-45 sec and lasts 10 min
24
Q

benzodiazepines

A
  • poor analgesic
  • preferred for endoscopies, cardiac catheterization, angiographies, conscious sedation for dental, fracture setting
  • rapidly reversed by flumazenil
    1. diazepam
    2. Lorazepam
    3. Midazolam
25
Q

ketamine

A
  • “dissociative anesthesia”-profound analgesia, immobility, amnesia w/ light sleep and feeling of dissociation one’s own body and surrounding
  • for dental and head/neck surgery, in asthmatics, patients who’ve bled, who don’t want to lose consciousness, short operations, burn dressing
  • danger for hypertensives, but good for hypovolemic
26
Q

fentanyl

A
  • short acting potent opioid analgesic
  • remains drowsy but conscious and can be commanded
  • nausea, vomiting, itching at recovery
  • naloxone counteract persisting respiratory depression
27
Q
  1. patients on antihypertensives-BP may fall markedly
  2. neuroleptics, opioids, clonidine, monoamine oxidase inhibitors potentiates anesthetics
  3. w/ corticosteroids, give hydrocortisone
  4. insulin need ^ during GA
A

drug interactions

28
Q
  • used to render a specific portion of the body insensitive to pain
  • interfere w/ nerv impulse transmission to specific areas of body
  • no loss of consciousness
A

local anesthetics

  • topical
  • parenteral
29
Q

types of local anesthesia

A
  • epidural
  • infiltration
  • nerve block
  • spinal
  • topical
30
Q
  • lidocaine(xylocaine)
  • mepivacaine(carbocaine)
  • procaine(Novocain)
  • tetracaine(pontocaine)
  • bupivacaine(Marcaine)
  • ropivacaine(Naropin)
A

parenteral anesthetic agents

31
Q
  • autonomic activity is lost
  • pain and other sensory functions are lost
  • motor activity is the last to be lost
  • as local agents wear off, do so in reverse (motor, sensory, then autonomic restored)
A

drug effects of local anest

32
Q
  • used for surgical, dental, and diagnostic procedures, tx for certain types of pain
  • infiltration anest
  • nerve block anest
A

indications of local anest

33
Q
  • minor surgical and dental procedures
  • injection of anest intradermally, subcutaneously, submucosally across the path of nerves supplying the target aread
  • may be given in circular pattern around the operative area
A

infiltration anesthesia

34
Q
  • used for surgical, dental, diagnostic procedures
  • therapeutic management of pain
  • agent is injected directly into or around the nerve trunks or nerve ganglia that supply the area to be numbed
A

nerve block anesthesia

35
Q
  • prevent nerve transmission in certain muscles, resulting in paralysis of the muscle
  • used w/ anesthetics during surgery
  • when used during surgery, artificial mechanical ventilation is required
A

Neuromuscular Blocking Agents

36
Q
  • succinylcholine is the only one
  • works similarly to acetylcholine, causing depolarization
  • metabolism is slower than Ach, so as long as succinylcholine is present, repolarization cannt occur
  • result: flaccid muscle paralysis
A

NMBAs: depolarizing agent

37
Q
  • prevent Ach fr acting at the neuromuscular junctions
  • nerve cell membrane isn’t depolarized, muscle fibers aren’t stimulated
  • skeletal muscle contraction doesn’t occur
  • Short acting: mivacurium (mivaron)
  • Intermediate acting: atracurium (tracrium), rocuronium(Zemuron)
  • Long acting: pancuronium(Pavulon), d-Tubocurarine(dTC)
A

NMBAs: nondepolarizing agent

38
Q
  • 1st sensation felt is weakness
  • followed by total flaccid paralysis
  • small, rapidly moving muscles are affected first(fingers,eyes), then limbs, neck, trunk
  • intercostal muscles and diaphragm, result in cessation of respirations
  • maintaining controlled ventilation during surgical procedures
  • endotracheal intubation (short acting)
  • to reduce muscle contraction in area that needs surgery
  • diagnostic for myasthenia gravis
  • require prolonged mechanical ventilation
A

NMBA

*indications

39
Q
  • combo of IV benzodiazepine and an opiate analgesic used
  • anxiety/sensitive to pain reduced, patient cant recall
  • preserves ability to maintain own airway and respond to verbal commands
  • used for diagnostic procedures and minor surgical procedures that don’t require deep anesthesia
  • topical anesthesia
  • rapid recovery,greater safety than GA
A

NMBAs: moderate sedation

Pharmacology (5 decks)

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