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614 General Principles Of Anesthesia > Week 8- General Anesthesia > Flashcards

Week 8- General Anesthesia Flashcards

1
Q

Anesthesia, by the definition, is a change in the responses of an ____ _____ to ____ _______. Making a definitive link between anesthetic effects observed in vitro and the anesthetic state observed and defined in vivo is difficult.

A

intact animal

external stimuli

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2
Q

T/F: There are multiple molecular mechanism that can produce clinical anesthesia.

A

True!

No structure-activity relationships are apparent among anesthetics. A wide variety of structurally unrelated compounds, ranging from steroids to elemental xenon, are capable of producing clinical anesthesia.

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3
Q

Anesthetics work at very high concentrations in comparison to drugs, neurotransmitter and hormones; this implies that the have a very _____ ______ to the receptor and do not stay bound for long.

A

low affinity

this makes it much more difficult to observe and characterize than high affinity bonding. They stay bound to the receptor for very short periods of time.

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4
Q

broadly defined as a drug-induced reversible depression of the CNS resulting in the loss of response to and perception of all external stimuli.

A

General Anesthesia

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5
Q

Anesthesia is a collection of “component” changes in behavior or perception.
The components of an anesthetic state: (5)

A

A. unconsciousness
B. amnesia
C. analgesia
D. immobility
E. attenuation of autonomic responses to noxious stimuli

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6
Q

One of the reasons why defining anesthesia is difficult?

A

our understanding of the mechanism of consciousness is amorphous

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7
Q

T/F: MAC is additive.

A

True

** example running nitrous with sevo

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8
Q

In order to study the pharmacology of anesthetic action, qualitative measures of anesthetic potency must be measure (T/F)

A

False!! quantitative

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9
Q

why is there some difficulty in defining anesthesia?

A

MOA is not fully understood at this time

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10
Q

General anesthesia is a collection of “component” changes in _______ & ___________

A

behavior & perception

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11
Q

___________measures of anesthetic potency must be measured

A

Quantitative

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12
Q

what is MAC (minimum alveolar concentration)

A

partial pressure of gas at which 50% of humans do not respond to surgical stimulation

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13
Q

MAC = _____: Represents the average response of ___________, not the response of a single subject

A

Dose;

the whole population

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14
Q

________ concentration of gas provides an index of the “free” concentration of drug required to produce anesthesia

A

end-tidal

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15
Q

how does end-tidal concentration provide an index of the “free” concentration of drug required to produce anesthesia

A

the end-tidal gas concentration is in equilibrium with the free plasma concentration and BIS monitoring

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16
Q

MAC only refers to the___________ of agent. NOT the _________ of other adjuncts that we have given

A

concentration

amount

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17
Q

_________ has also become a standard of care in general anesthesia

A

BIS monitoring

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18
Q

There is a linear relationship between the oil/gas partition coefficient and anesthetic potency (MAC)- theories regarding protein binding also satisfy the

A

Meyer-Overton Rule

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19
Q

Unitary theory of anesthesia:

A

Since a wide variety of structurally unrelated compounds obey the Meyer-Overton Rule, it has been reasoned that all anesthetics are likely to act at the same molecular site.

Genetic data plainly demonstrates that the this unitary theory of anesthesia is not correct; no single mechanism is responsible for the effects of all general anesthetics

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20
Q

More than 100yrs ago Meyer and Overton observed that the potency of gases as anesthetics was strongly correlated with their solubility in olive oil- this idea led to:

A

The unitary theory of anesthesia

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21
Q

Anesthetic agents must disrupt the function of neurons mediating ________, __________, & __________

A

behavior, consciousness & memory

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22
Q

Anesthesia alters neuronal communication by:

A
  1. altering neuronal excitability- create a more negative rmp (resting membrane potential) = hyperpolarize the neuron which decreases the action potential.
  2. synaptic transmission- widely considered to be the most likely subcellular site of general anesthetic action

**evidence suggest that some voltage gated calcium channels are sensitive to anesthetics and some sodium channels subtypes are inhibited by volatile anesthetics. This effect may be responsible for a reduction in neurotransmitter release at some synapses.

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23
Q

widely considered to be the most likely subcellular site of general anesthetic action

A

synaptic transmission

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24
Q

T/F: Many anesthetics potentiate GABA in CNS

A

True.

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25
Q

GABA receptors are probable targets of anesthetics along with what other sites?

A
  • Glycine
  • Neuronal nicotinic receptors
  • 5-HT3 receptors.
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26
Q

Relevant targets for Amidate & Propofol

A

GABA activated ION Channels

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27
Q

Where in the CNS do Anesthetics work?

A
  • Suppress circuits in the spinal cord & brainstem
  • Induce immobility & disrupt autonomic homeostasis
28
Q

It is clear that all anesthetic effects cannot be localized to a specific anatomic site in the CNS. (T/F)

A

True

29
Q

T/F: Neurobiologic underpinnings of arousal and awareness are distributed across the brainstem, subcortical, and cortical structures. There is a single anatomic site responsible for anesthetic-induced unconsciousness.

A

False!

** There is no single anatomic site responsible for anesthetic-induced unconsciousness.

30
Q

Genetic data plainly demonstrates that the unitary theory of anesthesia is not correct because:

A

No single mechanism is responsible for the effects of all general anesthetics .

Nor does a single mechanism account for all effects of a single anesthetic.

31
Q

Anesthetics have powerful and widespread effects on

A

synaptic transmission

32
Q

Volatile anesthetics directly reduce excitatory synaptic transmission of______ neurons

A

spinal

33
Q

Propofol depresses activity in______ horn neurons via GABAergic mechanism

A

ventral

34
Q

_______ suppresses interneurons of central pattern generators involved in coordinated movements

A

Isoflurane

35
Q

Anesthetics can alter descending, afferent, efferent & modulating limbs of ______ ______ for reacting to noxious stimulation

A

reflex arcs

36
Q

It is clear that all anesthetic actions cannot be localized to a specific site in the CNS- much evidence allows that different components of the anesthetic state are mediated by actions at ______ anatomic sites!

A

disparate

37
Q

Anesthetics exert profound effects on cardiopulmonary & thermoregulatory homeostatic circuitry without autonomic centers in the______ & _______

A

brainstem

hypothalamus

38
Q

Inspiratory neurons in the________ drive phrenic motor neurons to activate diaphragmatic contraction

A

medulla

39
Q

______ suppresses the spontaneous activity of the inspiratory neurons to activate the diaphragm

A

Halothane

40
Q

Anesthetics also have an effect on the cardiovascular reflexes mediated by nuclei in the______

A

brainstem

41
Q

the __________ is a plausible target for suppression of memory formation

A

hippocampus

causes amnesia

42
Q

Is a diffuse collection of brainstem neurons that mediate arousal

A

RETICULAR ACTIVATING SYSTEM (RAS)

43
Q

Is the major site for generating awareness of the external environment; primary sensory areas

A

cerebral cortex

**Disruption feedback by anesthetics may contribute to impaired consciousness

44
Q

T or F: extubtion of trachea is a benign procedure

A

F - NOT benign

45
Q

Extubating Criteria: (8)

A
  • secretions cleared
  • 5-sec head lift/sustained hand grasp
  • adequate pain control
  • minimal expiratory concentration of IA
  • Vc > or = 10 ml/kg
  • Negative inspiratory pressure >20 cmH20
  • Vt > 6 cc/kg
  • sustained tetany
46
Q

PACU report should include (7)

A
  • List ABX given
  • Amount of narcotic
  • Make sure RN comfy with pt
  • Pt allergies
  • Any med rxns (reactions)
  • Report before you leave
  • Airway difficulties (intubation/extubation)
47
Q

most stimulating part of D&C

A

dilation

48
Q

during D&C, when can you usually turn off N2O

A

when they begin suction

49
Q

Suction D&C for a woman that had a missed AB at 10weeks but has reflux; and a BMI of 48 – what position

A

Lithotomy position in steep Trendelenburg

50
Q

LMA should not be used if?

A
  • Prone surgery
  • Muscle relaxants used
  • Sx over 2 hours
  • Insufflated belly (ex. Lapararoscopic)
  • BMI > 50
51
Q

Designed a classification system used to define relative risk prior to conscious sedation and surgical anesthesia

A

American Society of Anesthesiologists (ASA)

52
Q

Class I ASA

A

Class 1: Normal healthy patient

53
Q

Class II ASA

A

Patient with mild systemic disease (no functional limitations)

54
Q

Class III ASA

A

Class 3: Patient with severe systemic disease (some functional limitations)

55
Q

Class IV ASA

A

Class 4: Patient with severe systemic disease that is a constant threat to life (functionally incapacitated)

56
Q

Class V ASA

A

Class 5: Moribund patient who is not expected to survive without the operation

57
Q

Class VI ASA

A

Class 6: Brain-dead patient whose organs are being removed for donor purpose.

58
Q

E - ASA

A

If the procedure is an emergency the physical status is followed by an “E”

59
Q

SAB

A

Subarachnoid block (this is a spinal)

60
Q

PAW

A

PAW- peak airway pressure

61
Q

IntrathecaL

A

inside the dura

62
Q

Epidural

A

outside of the dura, In the epidural space (which is a potential space)

63
Q

GSW

A

gun shot wound

64
Q

BBSE

A

Bilateral breath sounds equal (a fast way to chart lung sounds that are clear

65
Q

One of the reasons why defining anesthesia is difficult?

A

our understanding of the mechanism of consciousness is amorphous

614 General Principles Of Anesthesia (14 decks)

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