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17 Cards in this Set

  • Front
  • Back
The 4 A's of gen. anesthesia?
Amnesia, Analgesia, Akinesia, Autonomic and sensory reflex block
What's MAC?
Minimum Alveolar Concentration: The steady-state min. alveolar conc. of an inhalational agent required for immobility in 50% of patients.
MAC values
0.5 MAC: MAC Awake: 50% pts can be awakened
1.0MAC: MAC: 50% pts will not move at surgical incision
1.3MAC: ED95: 95% pts will not move
1.5-2.0 MAC: MAC-BAR: 50% have blocked autonomic response
Inhaled anesthetics pharmacokinetics
Quicker action with the following: low plasma solubility, high inspired concentration, increased ventilation, DECREASED pulmonary blood flow, elimination only relevant for halothane.
Inhaled anesthetics pharmacodynamics
possibly action through ligand-gated Chloride channels gated by inhibitory GABAa receptors.
Inhaled anesthetics CV effects
most decrease MAP and vasc. resistance BUT Halothane sensitizes myocardium to catecholamines and may result in ventricular arrhythmias.
Inhaled anesthetics Respiratory effects
depressed, desensitization to CO2 so low response to hypoxia
Inhaled anesthetics Brain effects
decreased metabolic rate but INCREASED blood flow, which can be minimized by prior hyperventilation
Inhaled anesthetics kidney and liver effects
decreased blood flow
What's malignant hyperthermia?
a genetic susceptibility where succinycholine plus inhaled agent causes altered muscle tone, hyperthermia, CO2 productin, and acidosis. Treat with Dantrolene (a Ca blocker). Dx made with muscle biopsy only.
Inhalational drugs
halothane (high solubility, arrythmias), Isoflurane (most widely used in modern countries, airway irritation, decrease MAP, increase HR), Desflurane, Sevoflurane, Nitrous Oxide (non-halogenated gas, used as adjunct)
IV anesthetics: Barbiturates
via GABA action, Thiopental: most commonly IV for GA. Rapid onset and short lived.//
Issues: decrease in preload, MAP and CO results in HR increase (not good in pt in hypovolumic shock)NO ANALGESIA
IV anesthetics: Etomidate
via GABA action, good b/c no changes in Respiratory rate or Cardiac output. //
Issues: adrenocortical suppression with overuse, NO ANALGESIA
IV anesthetics:Propofolol
via GABA action, similar to barbiturates with slightly more rapid recovery, no compens. HR changes unlike barbiturates, has anti-emetic effects, useful in total intravenous anesthesia (TIVA). NO ANALGESIA
IV anesthetics: Opioids
via mu, kappa, delta receptors., minimal circulatory deteriation, dose dep. respiratory depression. I.E. sufentanil, remifentanil. Antagonized by Naloxone. ANALGESIC
IV anesthetics:Benzodiazepines
GABA mediated, anxiolytic/amnestic, e.g Midazolam. Inhibited by flumazenil
IV anesthetics: Ketamine
action through glutamic acid and NMDA receptor, produces state of DISSOCIATIVE anesthesia (catatonia, amnesia and ANALGESIA). Can be used for sedation and GA. Produces CV stimulation (via decreasing reuptake of catecholamines). If no catchecholamine then depresses CV. so ideal in hypovolumic shock pts. No change in resp. rate. Increase in cerebral flow and metabolic rate.