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68 Cards in this Set
- Front
- Back
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Who is the old school guy we'd only see in 3rd world countries?
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Halothane
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Who preceded halothane?
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Ether
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Why was halothane so good?
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Low blood solubility (high potency)
Non-flammable Non-pungent Minimal post-op N&V |
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Why did we have to go back to the drawing board?
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Halothane Hepatitis
Cardiac Irritability in presence of Epi |
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Who came next?
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Isoflurane
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Down side to Iso?
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Pungent
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Who are the two new guys that rule the world?
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Sevoflurane
Desflurane |
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Who are the IV agents?
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Thiopental
Ketamine Etomidate PROPOFOL |
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What are the goals of General Anesthesia?
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Amnesia
Analgesia Loss of Consciousness Skeletal Muscle Relaxation |
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What happens along with the other 4 that we don't necessarily want to happen?
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Loss of Autonomic Tone (i.e. BP drops)
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What's with the concept of Balanced Anesthesia?
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No single drug can do it all so we use a balanced combo
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General Mechanics of Inhalational Anesthetics?
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Halogenated Hydrocarbons
Volatile Liquids Liquids at room temp |
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Who needs to be heated and pressurized?
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Des
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Who is a gas at room temp?
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Nitrous Oxide
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How many stages of anesthesia are there?
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4
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What are the characteristics of Stage 1
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Analgesia is on the rise
No Amnesia Resp normal Minimal Cardiac Depression Near end, amnesia starts |
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What are the characteristics of Stage 2?
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Amnesia
Somewhat Delirious Resp irregular Pt struggles Pt may become incontinent We try to shoot though this one |
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What are the characteristics of Stage 3?
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The Money Zone for surgery
Regular Resp Returns Pt Calm and Motionless Extends till Resp stop Broken down into 4 planes of pupil response |
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What is the most commonly used pupil sign used?
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The Lash Reflex
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What is the importance of the lash reflex?
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We don't administer positive pressure ventilation till its gone
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What are the characteristics of Stage 4?
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Medullary Depression
Resp Ceases Circ Depression begins MUST have ventilation support Only takes 2-3 minutes to get here now |
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What is MAC?
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Minimal Alveolar Concentration
Its the [ ] of a agent that immobilizes 50% of pts |
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What is important about MAC curve?
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Its Steep
so 1.2 MAC will knock out 95% 1.3 will knock out everyone |
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What is important about combining MAC's?
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They additive
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What are the 4 main properties of Pharmacokinetics for General Anesthesia
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Solubility
Concentration of Inspired Gas Pulmonary Ventilation Pulmonary Blood Flow |
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What kind of solubility --> fastest onset?
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Low solubility
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So who is the fastest?
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Desflurane
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What do we use to measure solubility?
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Blood:Gas Partition Coefficient
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What is important about Pulmonary Ventilation?
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The rate and depth of ventilation will determine the rate of build up of anesthetic in the alveoli.
So Hyperventilate them to speed it up |
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Who determines rate of Elimination? Which type of value is fastest?
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Solubility
The Lower the solubility the faster the elimination So Des wins again |
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As far as metabolism goes, what is ideal?
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MINIMAL METABOLISM so there is not organ issues
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Who are least metabolized?
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Iso and Des
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What is up with Sevo metabolism?
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Compound A is a known toxic metabolite caused by degradation of Sevo in the CO2 absorber.
Can cause renal damage |
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What is the Mechanism of Action of the Inhalants?
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NOBODY KNOWS FOR SURE
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How do the big 3 affect Circ?
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DD Drop in MAP
CO is preserved BP drops secondary to drop in systemic resistance Increased HR |
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How is MAP controlled?
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1. by managing dose of inhalant
2. surgical stimulation helps keep it up |
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Who increases the HR the least?
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Sevo
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What kind of effects does NO have?
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mild sympathomimetic effects
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How does NO affect circ?
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Barely any change in MAP or CO
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How do the big three affect resp?
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DD increase in Resp Rate
DD decrease in Tidal Volume Result is Net decrease in Minute Ventilation |
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How can NO be used in relation to Circ and Resp?
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If combo'd it can help offset effects of the other inhalants
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Affects of Anesthesia on Ventilation
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Depressed ciliary fxn
Supressed protective airway reflexes decreased response to hypoxia increase apneic threshold to CO2 (none of which are good) |
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Affects on Airway Resistance
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They produce bronchodilation (sevo=most prominent)
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Affects on Cardiac Rhythm?
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halothane + epi was only issue ever with cardiac rhythm
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Cerebral Effects?
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Dec Cerebral Metabolism
Dec Cerebral Vascular Resistance Inc Cerebral Blood Flow All--> inc ICP |
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Renal Effects?
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BAD
Decrease flow and GFR Fluoride and Cmpd A toxicity |
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Liver Effects?
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Decrease Blood flow to liver...that's about it
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On to the IV Anesthetics...who are they again?
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Thiopental
Ketamine Etomidate Propofol |
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What classification is Thiopental?
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Barbituate
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Thiopental
Mech? |
Enhances GABA
Depresses RAS |
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Effects of Thiopental?
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Complete Apnea at induction doses
Drop in BP due to drop in SVR |
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CNS effects of Thiopental?
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Potent Cerebral vasoconstrictor
Decreases Cerebral blood flow Good for pts with inc ICP |
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Where does Ketamine come from?
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its a Phencyclidine derivative (PCP)
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Effects of Ketamine?
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INCREASES BP!
Powerful analgesic Increases ICP (so bad for neuro) Can cause delirium |
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Ketamine MOA?
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NMDA receptors
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How fast does Etomidate knock you out?
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30 seconds
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Etomidate's MOA?
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enhance GABA
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Why is Etomidate used?
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it has great Cardiovascular Stability
Modest drop in BP, minimal change in HR and CO Also less Resp Dep |
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Disadvantages of Etomidate?
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Pain at injection
post-op N&V |
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Who is the money IV agent?
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Propofol
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Why is Propofol so great?
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Most rapid and complete awakening
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Propofol's MOA?
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decrease rate of dissociation of GABA from its receptor
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Disadvantages of Propofol?
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Worst (of IV guys) effects on Cardiovascular system (dec MAP, SVR)
So used mostly in "healthy" people DD dec in ventilation Must be used in areas where general anesthesia is easily started |
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Other way to administer Propofol?
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Propofol Pump-->moderate sedation
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CNS effects of Propofol?
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similar to Thiopental
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Who's the big bad wolf of Anesthesia?
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Malignant Hyperthermia
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Mortality rate of MH?
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over 50%
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What is the antidote?
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Dantrolene
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