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49 Cards in this Set

  • Front
  • Back
Most common method of general anesthesia
Combo of inhalational and I.V.
How is regional anesthesia accomplished?
Blockade of major nerves or plexuses
What is the MAC?
Minimum Alveolar Concentration

Concentration, @ 1 atm, that produces immobility in 50% of pts.
What variables cause an INCREASED MAC?
What variables cause a DECREASED MAC?
Alcohol intoxication

Increased age
What is stage 1 of anesthesia?

Interference w/ synaptic transmission in spinothalamic tract
What is stage 2 of anesthesia?
Disinhibition, excitement, incontinence, vomiting

Blockade of inhibitory pathways
What is stage 3 of anesthesia?
Unconsciousness, relaxation

Depression of ascending pathways in RAS
What is stage 4 of anesthesia?
Cardiorespiratory depression

Depression of the vital medullary centers
What is the goal of anesthesia?
(w/ regards to stages)
Make stage 2 as short as possible
Avoid stage 4 altogether
What is the Myer-Overton relationship?
Oil/gas partition coefficient seems to correlate w/ potency
What is the mechanism of halogenated ether inhaled anesthetics?
Activate GABA-A receptors
What is the mechanism of NO2 and Xe?
Primarily inhibit NMDA glutamate receptors
At what level is immobilization mediated?
Spinal cord
At what level is unconsciousness mediated?
What concentration is reached for virtually all inhaled anesthetics?
70 nM
(w/ chemical properites of olive oil)
How does solubility relate to onset of inhaled anesthetics?
Less solubility --> faster onset
Rank of solubilities of inhaled anesthetics from least to most
Desflurane, NO2 < Sevoflurane < Isoflurane < Halothane
What is driving force for partitioning inhaled anesthetics in the body?
Partial pressure
What is the driving force of transport for inhaled anesthetics in the body?
How long does uptake last in the brain, kidney, heart, and viscera?
5 - 15 minutes
(these areas get high flow per volume)
How do bones, cartilage, and ligament affect uptake?
They have NO EFFECT
How long does it take for fat to equilibrate?
Fat has the highest anesthetic solubility

It NEVER equilibrates
What are the relative potencies of the inhaled anesthetics?
ALL are similarly potent
What are the side effects of inhaled anesthetics?
Initial increase in respiratory rate, w/ decreased tidal volume
(Followed by a respiratory depression)
Decreased response to hypercapnia or hypoxia

Decreased BP
How does halothane affect BP?
Decreased cardiac contractility
(SO, it does NOT increase HR)
How do NO2, and iso-, sevo-, and desflurane affect BP?
Cause vasodilation (decrease PVR)
(Note: this, causes a reflex tachy)
Why may recovery from halothane/enflurane be slower?
Storage in the liver (can cause toxicity)
Which inhaled GA is suitable for mask inductions?
What are some side effects of desflurane?
Is irritating to airway --> can cause coughing

Can cause hypertension and tachycardia
Why are higher inspired concentrations of desflurane required?
It is less soluble
Thus, it has faster uptake
What is a serious side effect of NO2?
Inhibits methionine synthase
(SO, prolonged use can depress BM or fetal tissue)
What is the effect of NO2's high MAC?
NO2 requires use of other drugs for complete anesthesia
Mechanism for I.V. GAs
Activation of GABA-A receptors
What causes termination of GA effects?
(NOT elimination)
What niche does etomidate fill?
Rapid induction of anesthesia for pts. w/ IMPAIRED CV STATUS
(Causes less cardiac depression)
What are the main side effects of etomidate (3)?
Irritation on injection
Myoclonic jerking
Inhibition of synthesis of cortisol and aldosterone
What is the standard drug for induction of general anesthesia?
Which GA is closes to being a complete anesthetic?
Mechanism of ketamine
Blockade of NMDA receptors
What type of pain relief is ketamine good for?
Pain relief for superficial procedures

NOTE: blocks visceral pain poorly
Why is ketamine good for induction in hemodynamically unstable pts.?
Maintains or stimulates the CV system
What drug is ketamine related to?

SO, it can cause hallucinations
What drugs are used to block ketamine-induced hallucinations?
Nitrous-narcotic technique
When NO2 is combined w/ fentanyl (or related drug)

Together, the two drugs can produce complete anesthesia
What are pancuronium (and related drugs)?

What are they used for?
NM blocking agents

Enhance muscle relaxation in procedure where < MAC of an agent is employed

NOTE: when these are used, mechanical ventilation is required
What is ketorolac?

What is it used for?

Adjunctive analgesic
What is neostigmine?

What is it used for?
Cholinesterase inhibitor
(Remember, has some intrincic muscarinic activity)

Reverses the effect of paralyzing drugs
What is glycopyrrolate?

What is it used for?
Muscarinic blocker

Protective medication during anesthesia
Prevents excess salivation
Prevents neostigmine's effects such as bradycardia