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52 Cards in this Set
- Front
- Back
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When you give anesthetics, what are you looking to achieve?
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Unconsciousness
Amnesia Analgesia Intact, stable autonomics Muscle relaxation Prompt reversal/recovery |
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What is the definition of minimum alveolar concentration?
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The minimum concentrationof anesthetic needed to abolish specified painful stimulus in 50% of subjects
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What is the relationship between MAC and potency?
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1/MAC = potency
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Why is the MAC not the end all be all of anesthesia?
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Because you can alter ventilatory rate, dosing, etc.
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What's the relationship between solubility and activity in inhaled anesthetics?
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More soluble in water, slower induction: the blood isa giant sink
More soluble in lipids: faster induction |
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What's the main route for the elimination of inhaled anesthetics?
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Elimination of the drug unchanged from the lungs
Some drugs undergo slight hepatic/renal elimination |
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What is the mechanism fortheinhaled agonists?
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GABAa receptor
Hyperpolarizing the nerve membranes by activating K channels |
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What are some examples of inhaled volatile halogenated hydrocarbons?
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Desflurane
Halothane Sevoflurane Enfurane Isoflurane |
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What is the mac value for the inhaled hydrocarbons?
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Below 6% - they're potent!
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What is the therapeutic index for the inhaled hyalogenated hydrocarbons?
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Very low.
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What's the general flow for inducing balanced anesthesia?
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1. Induce anesthesia/sedate patient using IV agents
2. Give NMB for intubation/intraop skeletl muscle paralysis 3. Administer and maintain anesthesia -Inhaled/IV anesthetics -Paindrugs -Oxygen 4. Allow recovery spontaneously, use drugs (as needed) to reverse skeltal muscle paralysis/ventilatory depression |
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What are some common DDIs affecting halogenated hydrocarbon anesthetics?
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Catecholamines
Beta blockers, Ca channel blockers Opioids Nondepolarizing NMJ blockers Succinycholine |
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What is the effect of giving catecholamines with halogenated hydrocarbons?
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Increased arrhythmogenicity
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What's the effect of giving beta blockers or calcium channel blockers with halogenated hydrocarbons?
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Increased cardiac depression
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What's the effect of giving opioids with halogenated hydrocarbons?
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Respiratory depression
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What's the effect of giving nondepolarizing NMJ blockers with halogenated hydrocarbons?
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Prolonged muscle paralysis
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What's the effect of giving succinylcholine with halogenated hydrocarbons?
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Increased malignang hyperhtemia
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Compared to halothane, isoflurane has a decreased risk of what?
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Catecholamine sensitization of the heart
QT prolongation Malignant hyperthermia Hepatotoxicity, nephrotoxicity |
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What is the effect of isoflurane on CO? BP?
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CO: stable
BP falls in a dose dependent fashion due to peripheral vasodilation. You get reflex tachycardia |
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What's the solubility of desflurane?
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Very insoluble in blood
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How is desflurane eliminated?
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In the expired air
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What are the drawbacks of desflurane?
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Smells horrid
Tachycardia is a concern |
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What are the causes of malignant hyperthermia?
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Any volatile-liquid anesthetic or NMB
Succinylcholine is the biggest offender |
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What's the mortality of malignant hyperthermia secondary to problems with succinylcholine?
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80%
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What makes someone succeptible to having malignant hyperthermia?
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Genetics.
They've got a problem with the ryanodine receptor, which regulates calcium release It's autosomal dominant with variable penetrance |
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What's the physiology of malignant hyperthermia?
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Decreased sarcoplasmic reticulum Ca uptake.
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What are the symptoms of malignant hyperthermia?
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Skeletal muscle contraction
Metabolic heat production-->fever Seizures Ventilatory impairment Hyperkalemia Myoglobin leakage |
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What's the treatment for malignant hyperthermia?
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Dantrolene+O2+decrease the temperature
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What are the effects of NO?
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Analgesia
No relaxation No loss of consciousness Some CV depression |
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What's the onset of NO?
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FAST!
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Do IV agents general provide anagesia? Skeletal muscle relaxation?
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No to both
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What are the different IV agents that are used for induction and/or maintenance?
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BZDs
Propofol Opioids Barbiturates Ketamine Etomidate |
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What should you never, ever, ever use for anesthesia to induce or maintain anesthesia?
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Local anesthetics
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What's the use of lidocaine during surgery?
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Reduce the risk of arrhythmias
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What is the use of IV Benzodiazepines during anesthesia?
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Rapid induction/sedation
Amnesia |
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What don't the BZDs do during anesthesia?
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No skeletal muscle relaxation
No analgesia |
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What is an example of an IV BZD used for anesthesia?
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Midazolam
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What is the use of IV propofol?
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Induction
Manintenance |
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What's the pharmacokinetcs of Propofol?
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Fast onset, fast duration
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What doesn't propofol do?
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Analgesia
Muscle relaxation |
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What are the effects of propofol on CV function? CNS function?
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Depresion
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What is the use of IV etomidate?
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Induction agent for people who are at risk of hypotension
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What is the onset and duration of action of etomidate?
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Fast onset
Short-acting |
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What does IV etomidate NOT do?
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Analgesia
Relax muscles Effect CV, respiratory systems |
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What are the risks with IV etomidate?
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Myoclonic seizures
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What are some of the ultra-short-acting IV barbiturates?
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Thiobarbiturates/methohexital
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What are the uses of the ultra-short-acting IV barbiturates?
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INduction of unconsciousness
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What are the risks of using the ultra-short-acting IV barbiturates?
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CV depression
Laryngospasm Decreased: ICP, CBF, CMR |
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Wha's the use of ketamine?
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Dissociative anesthetic: you know that things are happening, but aren't processing that it's happening to you
Also, used as an emergency anesthetic |
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What are the side effects of IV ketamine?
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Hallucinogenic
Activates SNS-->emergency anesthesia |
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What is the effect of ketamine on cerebral blood floow and ICP?
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Increases both
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What are some opioids that are used in anesthesia? What is their use?
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Fentanyl, Sufentanyl
Induction or maintenance |
