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32 Cards in this Set
- Front
- Back
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What occurs in the 4 stages of anesthesia?
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Stage 1:
Analgesia; dec'd awareness of pain Stage 2: Disinhibition: delirium, excitation, enhanced reflexes, incontinence, irregular respiration Stage 3: Surgical Anesthesia Unconscious, no pain reflexes, regular respiration, BP maintained Stage 4: Medullary Depression: respiratory and CV depression requiring ventilation and pharmacologic support (occurs when you've gone too far) |
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Midazolam:
Anesthetic Class Advantages Solubility Procedures Used |
INDUCTION AGENT
More potent than diazepam, lorazepam Induction slow, recovery prolonged Minimal cardiac f/x, water soluble Used for short procedures: Colonoscopies |
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This anesthetic can depress ventilation when used with narcotics.
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Midazolam
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What is the goal of anesthetic induction?
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Amnesia
Lack of awarness Blunt hemodynamic response to intubation (tach, HTN) |
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What are the 2 most common drugs to induce anesthesia?
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Thiopental (barbiturate)
Propofol (used the MOST); barbiturate |
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Barbiturate vs Benzodiazepam:
Potency |
Barbiturates are much more potent and can lead to coma
Bendodiazepams aren't as strong |
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Thiopental:
Drug Class Solubility AEs |
Barbiturate
Water soluble Dose-dependent CNS suppression |
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Etomidate:
MOA ADvantages |
Direct CNS depressant and GABA agonist
Features redistribution Least likely to produce cardiac depression |
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Which anesthetics feature redistribution? What is redistribution?
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Thiopental, Etomidate, Propofol
Gain initial anesthesia upon first injection, but quickly (within 5 mins) redistributes to muscles, fat and anesthetic effect is lost. i.e., you have 5 minutes to intubate the patient. |
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This anesthesia is associated with cortisol suppression.
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Etomidate
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This anesthetic increases HR, BP, and CO.
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Ketamine
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What is dissociative anesthesia and which drug employs this?
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Interruption of cerebral assocn pathways
Ketamine |
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This anesthetic can result in hallucinations.
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Ketamine (prevent by priming with benzodiazepam--induces amnesia)
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What are the advantages of inhalation anesthetics?
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Vapor general anesthetics have rapid onset and offset.
Accumuln due to disease states not a significant issue. |
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What is the minimum alveolar concentration?
What MAC is required to prevent movement clinically? |
Dose at which 50% of humans will not move in response to standard surgical incision; it's the standard for comparing potency of anesthetics.
Need 1.3 MAC to prevent movement clinically |
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Movement ______ confirm awareness.
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DOES NOT CONFIRM awareness
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What effect does solubility have on time required for anesthesia to work?
Give an example of a soluble and insoluble drug. |
Less soluble-->faster saturation-->faster onset and offset of anesthesia
Ether: very soluble N2O: not very soluble |
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This drug sensitizes myocardium to catecholamines, predisosping to ventricular arrhythmias.
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Halothane
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Effect of general anesthetics on pulmonary system.
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Inc RR, dec TV, inc PaCO2
BRONCHODILATE |
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Effect of general anesthetics on cardiovascular system.
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Dec'd CO, inc'd CV pressure, Dec'd BP, Dec'd SVR
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Which drugs enhance GABA effect on GABA receptors?
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Inhaled anesthetics
Barbiturates Benzos Etomidate Propofol |
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Which drugs activate K+ channels?
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N2O, ketamine
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Which drugs inhibit NMDA (glutamate) receptors?
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N2O, ketamine, high dose barbiturates
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Curare:
MOA |
Blocks nicotinic ACh receptors to induce skeletal muscle paralysis
Does not cause sedation. Pt still aware of surroundings! |
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Succinylcholine:
Drug Class |
DEPOLARIZING muscle relaxant--binds ACh and keeps channel open
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Pancuronium:
Drug class Suffix |
-rium, -nium:
Pancuonium Vecuronium Atacurium Rocouronium NONDEPOLARIZING muscle relaxant |
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Which muscle relaxant has fast onset and rapid elimination via plasma pseudocholinesterase?
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Succinylcholine (Sux)
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Which muscle relaxant has a long duration? Mode of elimination?
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Pancuronium
RENAL elimntn |
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Which muscle relaxant has a fast onset of relaxation? Mode of elimination?
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ROCUronium
hepatic |
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How do you reverse muscle relaxants? AE's?
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Acetylcholinesterase inhibitors (to increase ACh levels for competition)
Carries risk of bradycardia, bronchospasm, inc'd airway secretions |
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Atropine:
MOA Use |
Antimuscarinic agent
Muscle relaxant reversal MAY PENETRATE CNS |
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Glycopyrrholate:
MOA Use |
Antimuscarinic agent
Muscle relaxant reversal |
