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48 Cards in this Set

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Who came up with stages of anesthesia?
Guedel
-used ether
stage 1 of anesthesia
stage 1: analgesia
-loss of consciousness
-high response to stimulus
stage 2 of anesthesia
stage 2: delerium/excitement
-increase sympathetic tone
-struggling with eyes open
-try to avoid this stage
-vomiting, defecation, urination
-wait to intubate
stage 3 of anesthesia (4 planes)
plane 1: light anesthesia
plane 2: surgical anesthesia (slow palpebral reflex but strong corneal reflex, ventro-medial eyes, slow nystagmus in horses)
plane 3: deep anesthesia (weak corneal reflex, flaccid jaw)
place 4: resp failure, severe cardiac depression and hypotension)
stage 4 of anesthesia
resp arrest, then cardiac arrest, then death
nitrous oxide
doesn't produce surgical anesthesia alone
-good analgesia, little muscle relaxation
-minimal cardio-respiratory depression
diffusion hypoxia
-occurs when N2O is discontinued
-gas leaves blood and dilutes other gases in alveoli (decreases stimulus to breathe)
-prevent by giving 100% O2
nitrous oxide in ruminants, horses?
not used because it increases gas spaces (mainly in GIT)
nitrous oxide congenital effects
only occurs with prolonged use
methoxyflurane (potency, cardiac effects, induction speed)
most potent inhalation
-depresses myocardial contractility
-slow induction/recovery
halothane
-rapid induction/recovery
-keep CO2 levels low to prevent increase in intra-cranial pressure
-sensitizes myocardium to catecholamines
-decreases hepatic and renal blood flow
post-anesthetic halothane-induced hepatitis
hepatic necrosis due to prolonged halothane anesthesia
-goats are most sensitive
malignant hyperthermia
genetic mutation on calcium receptors
-all inhalation anesthetics can trigger
-treat with dantrolene
-pigs most susceptible
isoflurane
-most popular
-CNS depression
-better for high-risk CNS patients
-respiratory depression
-minimal effects on liver, kidney
-better muscle relaxation
-respiratory elimination
safest inhalation anesthetic for hypotensive patient
halothane
safest inhalation anesthetic for heart-compromised patient
isoflurane
enflurane
not popular due to CNS stimulation
-muscle twitching at anesthetic depth
-contraindicated in epileptic animals
desflurane
-higher vapor pressure (needs special vaporizor)
-respiratory depression
-bad odor, may irritate airways (not good for mask induction)
compare respiratory depression of inhalation anesthetics from highest to lowest
des > iso > halo
sevoflurane
-least airway irritation
-similar to iso and halo
-reacts with CO2 absorbant to form compound A (renally toxic)
-use higher O2 flow rate and caution in patients with renal compromise
diethyl ether
-highly flammable
-used mainly for lab animals
-profound muscle relaxation
blood solubility ranking from highest to lowest (inhalation anesthetics)
ether > methoxy > halothane > iso > des, sevo, N2O
which anesthetic has most/least increase in heart rate?
halothane - least
enflurane - most
which anesthetic has most/least decrease in cardiac output?
halothane - most
iso - least
which inhalation anesthetic decreases peripheral resistance most?
isoflurane
factors that increase MAC (temp and salt)
hyperthermia, hypernatremia,
factors that lower MAC
pregnancy, higher age
trace levels of anesthetic should be below ___?
2ppm
E-tank
holds 750L of O2 (1,600L of N2O)
-service pressure is 2200 psi (750 psi for N2O)
H-tank
holds 7000L of O2 (16,000L of N2O)
-service pressure is 2,200 psi (750 psi for N2O)
Oxygen should be up/down stream from other gases?
always down-stream
non-precision vaporizer
not agent-specific
-patient's exhaled air carries anesthetic (instead of O2)
-no compensation for temp, flow or pressure
-used with low vapor pressure anesthetics
precision vaporizer
-agent specific
-compensation for flow, pressure and temp
which 2 anesthetics have preservative that doesn't vaporize?
halothane and methoxyflurane
rebreathing bag should be __x the patient's tidal volume?
6x
CO2 absorbant
soda lime or barium hydroxide lime
-turns purple and hard when used
hypothermia more likely with closed (rebreathing) system or open?
open (non-rebreathing) due to high O2 flow rate and loss of heat
local anesthetic MOA
-interferes with sodium channels
-slows rate of depolarization
-action potential isn't propagated
local anesthetics (esters)
procaine, chlorprocaine, tetracaine
-tetracaine is most potent, chlorprocaine has most rapid onset
most rapid onset local anesthetic (amides)
lidocaine has most rapid onset
metabolism of ester local anesthetics
hydrolysis by cholinesterase in plamsa
-some by liver also
metabolism of amide local anesthetics
hepatic metabolism (microsomal emzymes)
why use vasoconstrictor (like epi) with local anesthetics?
decreases systemic absorption, toxicity
-prolongs duration
local anesthetic toxicity of CNS vs cardiovascular
CNS most sensitive
-signs: twitching, seizures,
what species is very sensitive to lidocaine?
goat
treatment for systemic toxicity of local anesthetic
oxygen hyperventilation
-anti-seizure drug
cardiotoxicity of amide local anesthetics
bupivicaine most cardiotoxic
-lidocaine least
CV signs of systemic lidocaine toxicity
profound hypotension
-reflex tachycardia