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22 Cards in this Set

  • Front
  • Back
NMB - depolarizers
1. succinylcholine
2. initially stim cholinergic receptor bu then slowly seperate
3. reversed by cholinesterase enzyme
4. pseudocholinesterase deficiency take 3-5d to recover while typicallyon takes 5min, seen pregnant women and liver dz
5. SE: fasciculations, prolonged paralysis, increased intraocular pressure, bradycardia, and elevated serum K tiggering malignant hyperthermia
NMB - nondepolarizers
1. -cur drugs prevent Ach from stimuliating nicotinic receptors
2. standard reversal: neostigmine (cholinesterase inhibitor) and glycopyrrolate (antimuscarinic) to prevent Ach induced bradycardia
- also atropine but cross BBB, glycopyrrolate does not
inhalation anesthetic drugs
1. enflurane
2. isoflurane
3. deslurane
4. sevoflurane
5. halothane
MAC
1. MAC of 1 = dose prevents movement of pt 50% of the time to painful stimuli
2. MAC of 1.3 = dose prevents movement of pt 100% of time to painful stimuli
3. higher levels needed: young, chronic alcoholics, hypernatremic ppl, cocaine users
4. lower elvels needed: pregnant ppl, elderly, hyponatremic ppl, anemic pppl, ppl taking lithium or clonidine
Factors governing uptake volatile anesthetics
1. cardiac output: higher CO causes high anesthetic uptake which slows rise alveolar partial pressure and induction is delayed
2. solubility: low bld solubility mean quicker uptake
3. uptake = (lambda x CO x (Pa-Pv))/B.P.
-B.P. = barometric pressure, lambda = solubility
nitrous oxide
1. used aid general anesthesia, not strong enough to be used alone
2. SE: N/V
3. inhibits B12 dependent enzyme methionine synthase and thymidilate synthase causing megaloblastic and pernicious anemia and peripheral neuropathies
halothane
1. highly potent
2. good pediatric induction - odor isnt pungent
3. SE: halothane hepatitis which why no longer used
4. under anaerobic/hypoxic conditions, is reduced and releases Fl- causing hepatitis
isoflurane
1. slowest recovery but also cheapest
2. potent with pungent odor
sevoflurane
1. MAC of 2%, nonflammable
2. good for pediatric induction, odor isnt pungent
desoflurane
1. quickest recovery due low solubility
2. useful in outpatient setting
3. reaches steady state quickest
inhalation anesthetics
1. 3 uptake factors: solubility, CO, partial pressure difference
2. unitary hypothesis - all are GABAa modifiers
3. MAC is guide dosing, varies based age, meds, and health state
Adjuvants in anesthesia/IV anesthetics
1. thiopental
2. methohexital
3. propofol
4. etomidate
5. ketamine
-short acting induction agents
-rapid onset
-no analgesic or muscle relaxant activity
thiopental
1. barbiturate analog phenobarbital
2. high potency, high lipid solubility - for short surgery
3. rapidly redistributed to fat and tissue terminating effect
methohexital
1. shorter duration than thiopental
2. given rectally to kids
propofol
1. #1 induction agent, non-barbiturate
2. quicker recovery time than barbiturates, good for oupatient
3. CV depression, large drop BP
4. administered in lipid emulsion
5. potentiates GABAa
6. some post-op anti-emetic properties
etomidate
1. non-barbiturate imidazole
2. ultrashort acting
3. little resp and CV depression - good elderly
ketamine
1. drug of abuse - PCP analogs act dissociative anesthetics
2. block NMDA receptors
3. CV stimulant - increased HR, BP, and CO
4. intense analgesia
benzodiazepiens
1. safer than barbiturates - higher therapeutic index
2. reduce anxiety, some amnesia w/out significant CV and resp depression
3. pre-anesthetic, little to no analgesia
4. bind GABAa opening Cl channel and hyperpolarizes
5. reversal - flumazenil (selective antagonist)
6. midazolam replacing diazepam
opioids/narcotics
1. morphine - MS-6 is active, renal elimination
2. fentanyl - given intra-operative, less histamine release
3. hydromorphone - give post-op, 5X potent morphine
4. meperidine - 1/10th potent morphine, lot SE, not used
5. sufentanil - 1000x more potent than morphine
6. remifentanil - can give liver or kidney fx
-analgesics supplement volatile anesthetics
-contribute to overal MAC
Post-Op N/V
avoid:
1. opioids and hypnotics
2. nitrous oxide
3. high does reversal agents (neostigmine)
-increase O2 and hydration, decrease air into stomach
-caused by central and peripheral (GI - CNX) pathways
- propofol is protective anti-emetic
anti-emetic agents
1. ondansetron: post-op prophylaxis
2. metoclopraminde
3. droperidol - DA antagonist, risk fatal arrhythmia
anti-nausea agents
1. anticholinergic - scopalamine, cross BBB, sedation
2. anti-histamine - dimenphenhydrinate, block H1
3. anti-serotinergics - no sedation, extrapyramidal rxns,
central and peripheral effects, -setron drugs
4. propofol
5. steriods - dexamethasone, acute SE flushing and perineal itching
6. dronabinol - legal marijuana, helps chemo associated nausea, SE can be nausea