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Chirurgie OMF > Substante anestezice > Flashcards

Substante anestezice Flashcards

1
Q

Substantele anestezice locale sunt de cate feluri?

A
  1. Aminoesteri (derivati aminici tertiari-aminoalcooli- ai acizilor aromatici)
  2. Amide (2 amine) - cu o grupare aminica NH2 pe lant intermediar
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2
Q

Ce actiune are radicalul aromatic si cum se mai numeste?

A
  • Componenta anionica H-
  • Confera caracterul lipofil-pt traversarea mb perinervoase axonale
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3
Q

Ce face gruparea aminica tertiara?

A
  • sunt derivati cuaternari de amoniu
  • blocheaza transmiterea sinaptica neuronala
  • realizeaza mediul alcalin care fav. puterea anestezica
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4
Q

De ce tesuturi nespecifice se mai leaga anestezicul?

A
  • grasime
  • tesut conjunctiv
  • fibre musculare
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5
Q

Ce altceva mai transporta AGP?

A
  1. betablocante - propranolol
  2. blocante de Ca - verapamil
  3. antiaritmice - chinidina
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6
Q

pH si masa moleculara lidocaina

A
  • 6,5 (5-7) simpla
  • 3,5 cu VC
  • masa 270,8
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7
Q

Metabisulfitul de sodiu din Xilina+VC la ce poate duce?

A
  • reactii severe la alergici
  • episoade astmatice la susceptibili
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8
Q

XILINA

  • Putere anestezica
  • Durata instalare
  • Durata anestezie
  • Toxicitate
  • Efect vasodilatator
A
  • x2 de procaina
  • 2-5 m-mai rapida decat la procaina
  • durata viabila dar redusa- 20-45 m
  • x2 mai mare decat procaina
  • mult mai slab decat al procainei, dar mai intens decat mepi si prilo
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9
Q

Un nivel plasmatic ridicat
de lidocaină poate induce? (3 efecte cardiovasculare)

A
  • modificări ale fracţiei
    de ejecţie cardiacă,
  • ale rezistenţei vasculare periferice
  • şi implicit ale tensiunii arteriale
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10
Q

Asupra
centrilor de control cardiovascular din sistemul
nervos central, lidocaina, are un efect?

A
  • Depresor
  • Apare usoara hipotensiune, deci, la doze uzuala fara VC
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11
Q

In ce proportie se leaga xilina de AGP?

A

70%

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12
Q

Metabolizare lidocaina

A
  • 90% hepatic
  • metaboliti+10% nemetabolizat–>eliminare renala
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13
Q

Peste ce limita apar manisfestarile sistemice, in cazul xilinei?

Ce influenteaza pragul la care apar?

A
  • lidocaina nelegata de peste 6,0 micrograme/ml
  • acidoza, substante stimulatoare/depresoare pe SNC
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14
Q

Perioada injumatatire lidocaina si ce afectiuni o influenteaza

A
  • 90 minute
  • afectiuni hepatice (x2/x3)
  • cele renale nu o influenteaza, ci doar duce la acumulare metaboliti
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15
Q

Posologia xilinei

A
  • 2%…20 mg clorhidrat lido…1 ml solutie
  • +- adrenalina 1:100.000…0,010 mg adrenalina
  • doza uzuala= 20-100 mg
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16
Q

Doza terapeutica maxima xilina

A
  1. 2% simpla–3,2 mg/kg corp —maxim 400 mg
  2. 2% +adrenalina= 7mg/kg corp—maxim 400 mg/zi
  3. Copii> 4 ani—>doz maxima= xilina simpla 2%–2-7mg/kg
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17
Q

Semne de neurotoxicitate centrala (x8)

A
  1. Agitatia
  2. Anxietate
  3. Tinitusul
  4. Ameteala
  5. Tulburari vedere
  6. Tremuraturi
  7. Stari depresive
  8. Somnolenta
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18
Q

Cu cine are interactiuni medicamentoase lidocaina?

A
  • IMAO/Antidepresive ciclice cu (nor)adrenalina—>hipertensiune severa persistenta
  • Fenotiazine/Butirofenone anuleaza efectul vc al adrenalinei
  • Medicatie vasopresoare–> hipertensiune/avc
  • Medicatie ocitocica ergotaminica–> hipertensiune/avc
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19
Q

Cum sunt manifestarile SNC in supradozaj lidocaina?

A

excitatie si/sau inhibitie corticala

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20
Q

Prin ce sunt caracterizate manifestarile snc ale lidocainei din supradozaj? x15

A
  1. Senzatie frig/caldura
  2. parestezii
  3. fotofobie
  4. nervozitate
  5. euforie
  6. confuzie
  7. ameteala
  8. tinitus
  9. somnolenta
  10. vedere dubla/neclara
  11. greata+voma
  12. Tremuraturi
  13. convulsii
  14. Stare de inconstienta
  15. Chiar Stop Cardio-Respirator
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21
Q

Care este semnul clinic pt nivel plasmatic ridicat de lidocaina?

A

Somnolenta

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22
Q

Manifestari cardiace pt supradozaj lidocaina?

A

Cardiodepresoare

  • bradicardie
  • hipotensiune
  • rar–>colaps cv+stop cardio-resp
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23
Q

Cu ce vasoconstrictori se asociaza mepivacaina?

A
  • adrenalina
  • noradrenalina
  • levonordefrin(neocorbefrin)
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24
Q

mepivacaina

  • Putere anestezica
  • Durata instalare
  • Durata anestezie
  • Toxicitate
  • Efect vasodilatator
A
  • x2
  • scurta- 2-3 minute
  • in functie de tesut
  • 1,5-2 toxicitate fata de procaina
  • ef.vasodilatator slab
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25
Q

Durata mepivacaina

A

In functie de tesut:

  • 20-40 minute la pulpa
  1. 20 minute la plexala
  2. 40 m la tronculara periferica
  • 45-90 m pt parti moi
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26
Q

De ce e eficienta mepivacaina si fara VC?

A

Pt ca are efect vasodilatator slab

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27
Q

In ce procent se leaga mepi de proteine plamatice?

A

60-78%

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28
Q

Une are loc metabolizarea si eliminarea metabolitilor in cazul mepi?

A
  • metabolizare hepatica completa, prin demetilare
  • metaboliti excretati renal (>90%)…in aprox 30 de ore
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29
Q

Perioada 1/2 mepi

A
  • 2-3 h adult
  • 8-9 h copil mic
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30
Q

Posologie mepi

A
  • 3%…30 mg clorhidrat de mepi…1 ml sol
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31
Q

DOZE MAXIME MEPI

A
  • 4 mg/kg corp…maxim 300….adult normal
  • 3 mg/kg corp…copil de peste 4 ani, de 20 kg
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32
Q

Contraindicatii Mepivacaina

A
  1. HS la anestezice amidice
  2. celelalte atentionari de la lidocaina
  3. In tulb grave de conducere si ritm cardiac (blocuri de ram II/III, bradicardie)
  4. Insuf cardica severa
  5. Hipotensiune art severa
  6. Epilepsie necontrolata
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33
Q

Cat timp sa evite pacientul sa conduca dupa adm de mepi?

A

4-6 ore

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34
Q

In ce procent trece mepi de bariera feto-placentara?

A

30%

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35
Q

Cu ce medicamente interactioneaza mepicavaina?

A
  • Aprindina- antiaritmic cls I–sumare efect toxic cu mepi
  • Antitrobotice, AINS, anticoagulante–crescc risc hemoragic
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36
Q

Manifestari SNC pt mepi? (x6)

A
  1. nervozitate
  2. agitatie
  3. tremor
  4. nistagmus
  5. cefalee
  6. logoree
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37
Q

Manifestari C-V ale mepivacainei?

A
  • efect inotrop negativ
  • hipotensiune art
  • tulb conducere (BAV), bradicardie, aritmii ventriculare, vasodilatatie si colaps—doar la doze mari
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38
Q

Manifestari respiratorii Mepi

A
  • Tahipnee
  • Apnee
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39
Q

Manifestari alergice mepivacaina

A
  1. cutanate
  2. prurit
  3. edeme
  4. reactii anafilactice
  • sunt rare
41
Q

Care e particularitatea articainei?

A

Ca are o grupa amidica si una esterica

42
Q

ARTICAINA

  • Potenta
  • Toxicitate
  • Durata instalare
  • Durata anestezie
A
  • 4-5 comparativ cu procaina (2 fata de lidocaina)
  • 1-1,5 tox fata de procaina
  • 2-3 m instalarea
  • durata anestezie:
  1. 45 m pt articaina normala
  2. 75 m pt articaina forte
43
Q

Peak plasmatic articaina?

44
Q

1/2 articaina

A

100-110 minute

45
Q

Procent in care se leaga articaina de proteinele plasmatice?

46
Q

Cum se metabolizeaza articaina?

A
  • Cea mai mare parte e hidrolizata de colinesteraza plasmatice
  • Restul se metab. hepatic
47
Q

In cat timp si in ce proportie are loc eliminarea articainei?

A
  • in 12-24 h
  • in urina- 95% ca metaboliti
  • -2-5% ca articaina nemetabolizata
48
Q

Posologie articaina

A
  • 1 ml…40 mg cl de articaina…0,005 mg adrenalina—-simpla (4%)
  • ………………………………………..0,010 mg adrenalina—-forte(4%)
49
Q

Doze terapeutice maxime Articaina

A
  • adult normal/adolescenti—-7 mg/kg corp…maxim 500 mg
  • doza redusa la minim pt cardiaci, hepatici, renali
  • CI- copii <4 ani
  • copii >4 ani–doza minima recom (doza maxima =7mg /kgcorp
50
Q

Contraindicatii articaina, legate de conservanti

A
  1. Hs amidice/conserv
  2. pac . cu bronhospasm
  3. deficit de colinestereaza plasm
  4. tulb. conducere A-V (BAV II/III)
  5. bradicardie marcata
  6. Insuficienta cardiaca congestiva acuta
  7. Hipotensiune art severa
  8. porfirie acuta recurenta
  9. pac epileptici fara tratament
51
Q

Contraindicatii articaina, legate de adrenalaina

A
  1. Glaucom unghi inchis
  2. Hipertiroidism netratat
  3. Aritmii grave (tahicardie paroxistica)
  4. IM recent 3-6 luni
  5. by-pass coronarian recent 3 luni
  6. feocromociton
52
Q

Interactiuni medicamentoase Articaina

A

Intensificare efect simpatomimetic al adrenalinei prin:

  • antidepresive ciclice
  • IMAO
  • specifici pt MAO A
  • specifici pt MAO B
53
Q

Precautie asociere articaina cu ce medicamente?

A
  • Antihipertensive de tip simpaticolitic-Guanetidina
  • Betablocante non-cardioselective(Propranolol, alte ol)–crestere TA
  • Anestezice inhalatorii-Halotan-sensibilizeaza cordul la catecolamine—aritmii in aneste gen dupa cea locala cu vc
54
Q

Cele mai dese reactii toxice, in cazul articainei apr prin ce mecanisme?

A
  • Conc plasmatice crescute de arti
  • inj iv
  • supradozaj
55
Q

Manifestari SNC Articaina

A
  • Frecvent: parestezie, cefalee, ameteli
  • Doze mari—SNC initial stimulat-excitatie psihomotorie-agitatie, nervozitate, stupor—se ajunge la pierderea constiintei, coma, spasme musculare, convulsii generalizate
56
Q

Manifestari cardio-vasculare articaina

A
  1. tahicardie
  2. hipotensiune arteraila
  3. bradicardie
  4. insuficienta cardiaca
  5. soc
57
Q

Manifestari respiratorii articaina

A
  1. Tahipnee
  2. bradipnee
  3. apnee
58
Q

Manif gastro-int Articain

A
  • Greata
  • varsaturi
59
Q

Efecte adverse tardive ale articainei?

A
  1. Risc crescut necorza locala (forte inj rapid)
  2. Tulb persistente sensibilitate pe traiectul nervului anesteziat remitere in 8 sapt)
  3. methemoglobinemie la doze mari, la pac. cu metheglob. subclinica
60
Q

Care e riscul la supradozajul cu Prilocaina?

A

methemoglobinemie

61
Q

Daza maxima prilocaina

A

6 mg/kg corp…maxim 400 kg

62
Q

Unde e folosit mai des Bupi?

A

in anestezie epidurala

63
Q

Durata instalare BUPI

A

2-10 minute

64
Q

Cat se mentine eficient Bupi

65
Q

Toxicitati Bupi

A
  • cardiotoxicitate crescuta
  • toxicitate SNC in supradozaj
66
Q

Doza macima bupi

A

9-18 mg

0,5% pt OMF (cu/fara adrenalina)

67
Q

Din ce e derivata adrenalina?

A
  • fenilalanina
  • tirozina
68
Q

Din ce e derivata noradrenalina?

A

derivat de tirozina, rezultata din Dopamina

69
Q

in ce proportii se gaseste adrenalina?

A

de la 1/50.000 la 1/200.000

70
Q

Dezavantaje Noradrenalina?

A
  1. VC periferica intensa–> HTA
  2. VC la locul injectarii mult mai redusa
71
Q

Risc/Beneficiu noradrenalina

A

x9 mai mare pt noradrenalina DECI NA este nerecomandata

72
Q

Secretia de adrenalina endogena

A
  • 7 micrograme (repaus)- 280 micrograme (stres
  • x50 crestere daca nu se instaleaza anestezia
73
Q

Injectare 0,015 mg xilina+adrenalina iv

A

Creste TAS cu 50 mmHg

Extrasistola v

74
Q

Raport catecolamine exo/endo

75
Q

Doza maxima adrenalina pacient sanatos

A

0,2 mg sedinta/ 0,002mg (200micrograme)/kg corp

76
Q

Doza maxima adrenalina pt afectiuni c-v necontrolate?

A
  • 1/200.000, 0,04 mg/sedinta
  • 0,0005 mg/kg corp
77
Q

peak plasmatic adrenalina

A

10-20 minte

78
Q

Cine inactiveaza catecolaminele si cine elimina metab lor

A
  • catechol-o-metiltransferaza
  • renal
79
Q

Ce induce andrenalina dpdv c-v?

A
  • HTA (sistolica)
  • tahicardie
80
Q

Noradrenalina ce face dpdv c-v?

A
  • VC periferica generalizata
  • bradicardie-reflex compensator vagal
  • HTA marcata
  • DECI FARA TAHICARDIE
81
Q

Cine are efect mai simpatomimetic? na sau a?

82
Q

CIne prezinta raspuns local exagerat la vc?

A
  • Cei cu vasculopatii periferice
  • cei cu HTA
83
Q

Cui ii este contraindicata anestezia cu vc?

A
  1. Bronhospam in antedcedente
  2. diabetici
  3. alergici
  4. gravide in primul trimestru si ultimul trimestru
84
Q

Ce vc stii?

A
  • NA/A
  • Levonordefrin
  • Felipresina
  • Fenilefrina
85
Q

Ce potenta are levonordefrinul?

Pe ce receptori are efect?

A
  • 1/6, 15 % din A
  • alfa si beta
86
Q

Doze mari de levonordefrin?

A
  • HT
  • Tahicardie V
  • crize anginoase, la pacienti coronarieni
87
Q

Doza maxima levo?

A
  • 1 mg/sedinta
  • 20 ml/1:20.000
88
Q

Prin ce se caracterizeaza felipresina?

A
  • nu are efecte directe adrenergice pe miocard
  • are efect ocitocic —NU LA GRAVIDE
89
Q

De ce nu e indicata felipresina la apcientii cu risc hemoragic?

A

Pr ca favorizeaa sangerarea ulterioara prin stimularea directa a musculaturii netede vasculare locale

90
Q

Ce fel de VC e fenilefrina?

A

sintetic de tip simpatomimetic

91
Q

Pe cine are efect fenilefrina?

A

receptor alfa 1 agonist selectiv

92
Q

Care este cel mai stabil si slab VC?

A

Fenilefrina

93
Q

Efect vc fenilefrina/adrenalina

A

mai redus pt fenilefrina

dar de durata mai lunga

94
Q

Supradozaj fenilefrina?

A
  • cefalee
  • aritmii ventriculare
95
Q

In asociztie cu cine se foloseste

  • Levonordefrin
  • Felipresina
  • Fenilefrina
A
  • mepi 3%
  • prilocaina 3%
  • procaina 4%
96
Q

Efecte teratogene anestezice

A
  1. Lidocaina–clasa B
  2. Mepivacaina–clasa C
  3. Articaina–clasa C
  4. Prilocaina–clasa C
  5. Bupivacaina–clasa C
  6. NA/A—clasa C

Chirurgie OMF (16 decks)

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