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33 Cards in this Set
- Front
- Back
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what are the 5 effects of a general anesthesic?
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1. analgesia
2. amnesia 3. loss of conciousness 4. loss of undesirable sensation and autonomic reflexes 5. skeletal muscle relaxation |
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what is balanced anesthesia?
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using combination of drugs to get all 5 effects of ideal anesthesia
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what are adjunct medications?
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pre-anesthesia medicine, local anesthesia, skeletal muscle relaxants
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which two anesthesic agents are inhaled?
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nitrous oxide
halogenated hydrocarbons |
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what is preoperative component?
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medication history, physiologic state of organs, psychologic state
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what is the final step in preoperative component?
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fast for 6 hours prior
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what is one potential complication of post-operative component?
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diffusion hypoxia - gases leave fast and decreased pressure gradient between lung and air
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what do you do to treat diffusion hypoxia?
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give them high partial pressure O2 during emergence
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what are the neurologic aspects of anesthesia?
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sedation -- hypnosis -- general anesthesia -- coma -- death
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how can death occur with too much anesthesia?
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respiratory failure and cardiovascular collapse
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what is stage I?
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analgesia - due to depression of the cerebrum
- can be achieved with hallucinatory drugs |
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what is stage II?
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Delirium - midbrain activity without central inhibition?
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what is dangerous in stage II and what to give?
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arrythmias, convulsions, vomiting , asthmatic attacks
- give IV anesthesic - propofol |
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what is stage III?
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surgical anethesia - progressive inhibition of hindbrain and spinal cord
- 4 planes of respiratory depression |
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what is stage IV?
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overdose - medullary depression - respiratory failure and cardiovascular collapse
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what is Ferguson's principle?
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no tissue selectivity
no relationship between structure and action potency is directly proportional to solubility in liquid |
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what deter anesthetics speed of action?
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solubility in blood
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what deter anesthetics potency?
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solubility in fat
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what is the proposed mechanism of action of general anesthetics?
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reacting with a transmembrane protein of the glutamate receptor which interacts with the lipid enviroment
- glutamate - main excitatory NT in the brain |
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What is MAC?
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Minimum Alveolar concentration - partial pressure of inhaled anesthetic breathed in for 15 minutes and produces general anesthesia in 50% of population
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what determines the speed at which an anesthetic can exert its effect?
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solubility in the blood
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what increases induction time of anesthetic?
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more solubility in the blood - higher prolonged time
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how do you reduce induction times?
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- give a fast acting IV anesthetic
- administer high dose of inhalation anesthetic |
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what is another reason high solubility dangerous?
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distribution is more sensitive to changes in ventilation and cardiac output
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where do anesthetics go in order of tissues?
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1. brain, heart, kidney and lungs
2. muscle 3. bone, cartilage 4. fat |
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how do you clear inhaled anesthetics?
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exhalation from lungs
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what does the recovery time for inhaled anesthetics depend on?
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how fast it is cleared from the brain
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what is diffusion hypoxia?
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as anenthetics are exhaled, build of pp in the alveoli decreases the driving force for other gases (air) from entering the lungs
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what do you treat malignant hyperthermia from inhaled anesthetics?
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dantrolene
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what ions do halogen hydrocarbons have?
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chloride, fluoride and bromide
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how do IV general anesthetics get cleared?
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metabolism
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how are muscle relaxants cleared?
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kidney and liver metabolism
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how do you facilitate removal of inhibition of competitive Ach blockers?
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admin neostigmine (Ach esterase inhibitor)
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