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143 Cards in this Set
- Front
- Back
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anesthesia
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involves loss of memory and awareness along with insensitivity to painful stimuli during a surgical procedure
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no single agent does what
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achieves all effects safely and rapidly
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what is balanced anesthesia
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using several different agents to produce effect
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what are the premedicants for anesthesia
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anticholinergics, antihistamines, barbiturates, antimetics, benzodiazpines, opiods
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what is the function of premedicants for anesthesia
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calm, relieve pain, reduce undesirable effects
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what are the paralytic agents
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succinylcholine, atracurium, pancuronium, vecuronium
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what is the function of the paralytic agents
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facilitate intubation, suppress muscle tone
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what is the function of the anticholinergics
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prevent bradycardia and excess fluid secretion
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what is the function of the antihistamines
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prevent allergic reactions, reduce gastric acidity
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what is the function of the barbiturates
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relieve anxiety, facilitate amnesia
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what is the function of antiemetics
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prevent or treat nausea/vomiting
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what is the function of benzodiazepines
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amnesia, sedation
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what is the function of the opioids
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analgesia
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what are the potential side effects of general
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autonomic instability, hypothermia, cardiac dysrhythmias, nausea/vomiting, delirium
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what organ function must be considered in selecting agents
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liver and kidney, lungs, heart, CNS
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what are the stages of anesthesia
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induction, maintenance, recovery
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what is first depth of anesthesia
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loss of pain
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what is second depth of anesthesia
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combative behavior
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what is third depth of anesthesia
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surgical anesthesia
where we want to be |
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what is fourth depth of anesthesia
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medullary paralysis and death
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what are IV agents used for in anesthesia
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induce anesthesia
supplement anesthesia |
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what are inhaled agents used for in anesthesia
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maintence of anesthesia
longer procedures |
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what varies the depth of anesthesia with inhaled agents
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partial pressure
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inhaled agents are measured in what
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MAC (mean alveolar concentration)
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what is MAC multiplied by to achieve 100% clinical efficacy
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1.3
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what is wash-in
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replacement of normal lung gases with the anesthetic mixture
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wash in is inversely proportional to what
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ventilation rate
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how do you reduce the effect of CO on rate of induction
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use agents with lower solubility
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when does washout happen
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occurs upon discontinuation of anesthetic
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what factors determine washout
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same factors that determine steady state
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what do you do to attain partial pressure of an inhaled agent in the brain
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use an IV agent first
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what is MOA of inhaled anesthetics
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nonselective, alters function of receptors for neurotransmitters GABA and glutemate
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what are the inhaled halogenated agents
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halothane, methoxyflurane, enflurane, isoflurane, desflurane, sevoflurane
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what are the non-halogenated agents
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nitrous oxide
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the prototypic inhaled agent
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halothane
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halothane is a strong what and a weak what
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strong anesthetic and weak analgesic
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do not do what with halothane therapy
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repeat within 2-3 wks
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enflurane can cause what
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tachycardia, sensitize heart to catecholamine induced arrhythmias, potentiation of paralytics, causes CNS excitation
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enflurane is contraindicated in what
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renal disease
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2% of enflurane is metabolized to what
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flouride ion
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isoflurane is isomer of what
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enflurane
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isoflurane does not do what
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sensitize myocardium to catecholamines
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why is isoflurane popular
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preserved cardiovascular stability and low incidence of untoward effects
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what is most potent inhaled anesthetic
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methoxyflurane
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methoxyflurane is limited for what
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use in induction
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how does methoxyflurane contrast to halothane
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it maintains blood pressure better
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metabolism of methoxyflurane can result in what
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fluoride production and levels can reach those causing renal tubular dysfunction
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desflurane is popular for what
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outpatient
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why is desflurane popular for outpatient
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quickly establishes partial pressure and rapid recovery
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desflurane irritates what
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respiratory tract
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desflurane not preferred for what
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induction
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when is desflurane more useful
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as a maintence agent
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what are side effects of desflurane
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decreased blood pressure and tachycardia
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sevoflurane is great for whom
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kids
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what are side effects of sevoflurane
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hypotension and decreased CO
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sevoflurane is useful in whom
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patients with myocardial ischemia because it does not cause tachy
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nitrous oxide AKA
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laughing gas
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nitrous oxide does what
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produces anesthesia without decreasign blood pressure or CO
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what level of nitrous oxide produces maxium analgesic effects
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25%
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nitrous oxide is often used with what
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oxygen
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which halogen causes arrhythmias
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halothane
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which halogens increase sensitivity to catecholamines
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halothane and enflurane
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which halogens decrese CO
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halothane and isoflurane
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what halogens decrease blood pressure
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halothane and isoflurane
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what halogens decrease respiratory reflexes
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halothane and enflurane
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what halogen increased respiratory reflexes
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isoflurane
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what halogens increase hepatotoxicity
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halothane and enflurane
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what are IV drugs used for
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rapid induction of anesthesia
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how are IV drugs maintained
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inhaled anesthetics
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what is recovery from IV drugs due to
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redistribution from the CNS
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how do you calculate dose for IV drugs
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lean body weight
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when do you decrease doses of IV drugs
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low CO states
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what factors decrease the ability of the patient to clear IV drugs
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elderly and low body mass
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what is the onset/recovery of thiopental
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rapid and rapid
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what is onset and recovery of midazolam
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slow and slow
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what is onset and recovery of fentanyl
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slow and slow
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what is onset and recovery of ketamine
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moderate and rapid
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what is onset and recovery of propofol
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rapid and rapid
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what is onset and recovery of etomidate
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rapid and fast
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what are the barbituates
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thiopental
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what is action of thiopental
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potent anesthetic and weak analgesic
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what is MOA for thiopental
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depress reticular activating system
suppress transmission of ACh Enhance transmission of GABA |
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what are the adverse effects of thiopental
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decrese cardiac contractility, ischemia
respiratory depression |
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when should thiopental be cautioned
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elderly and CAD
concern in asthmatics |
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other side effects of thiopental
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apnea and coughing
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what is the MOA of benzodiazepines
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benzos bind close to GABA receptor enhancing hyperpolorization and inhibition of further neuronal firing
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what are the actions of benzos
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reduce anxiety, sedation, anitconvulsant, muscle relaxation
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benzos have no what
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no antipsychotic or analgesic properties
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benzos cause what
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anterograde amensia
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what is the antagonist for benzos
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flumazenil
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what are the long acting benzos
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chlordiazepoxide, diazepam
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what are the intermediate acting benzos
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alprazolam, lorazepam, tamazepam
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what are the short acting benzos
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oxazepam, triazolam, midazolam
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what are the equivalent doses of diazepam, midazloam and lorazepam
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d=5mg
m=3mg l=1mg |
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which benzo has longest onset
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lorazepam 15-20min
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which benzo has longest elimination
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diazepam 21-37hr
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what is the MOA of opioids
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interact at opioid mu receptors in CNS and GI tract hyperpolarize nerve cells to inhibit firing and presynaptic NT rls
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what are the uses of opioids
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analgesia
treatment of diarrhea relief of cough |
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what are the disadvantages to opioids
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lack of amnestic
hypotension, respiratory depression, muscle rigidity, post anesthetic nausea/vomiting |
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what is reversal agent for opioids
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naloxone
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fentanyl is structurally similar to what
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meperidine
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when are peak effects of fentanyl and what is its DOA
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peak=5 min
doa=45 min |
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what is MOA of ketamine
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inhibits uptake of catecholamines back into postganglionic sympathetic nerve endings
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what is dissociative anesthesia
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patient appears awake yet is unconscious and does not feel pain
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who is ketamine mainly used in
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children
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what is MOA of propofol
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inhibits suspraspinal/spinal synapses via GABA to potentiate receptor effects
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what are the effects of propofol
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antiemetic, antipuritic, anxiolytic, anticonvulsant
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what is onset of propofol
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within 40 min
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what are clinical uses of propofol
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induction, maintenance, ICU sedation
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what are the side effects of propofol
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hypotension, respiratory depression, and allergic reactions
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propofol has no what
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antibacterial preservatives
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what is MOA of etomidate
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depresses the RAS/mimics the effects of GABA
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what are side effects of etomidate
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pain on injection, myoclonus, N/V, and adrenal suppression
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what are the advantages of etomidate
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minimal cardiovascular depression
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which form of local binds to Na channel
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ionized state
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what determines potency of LA
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lipid solubility
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what determines duration of action with LA
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protein binding
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what happens with CNS toxicity from LA
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unopposed excitatory fxn muscle twitching, visual disturbances, light-headedness, tongue numbing
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what should be avoided with LA
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intravascular injection
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what are the amide locals
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lidocaine, mepivacaine, bupivicaine, ropivicaine
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what are the ester locals
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procaine
chloroprocaine |
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what are the sedative agents
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benzodiazepines
barbiturates nonbarbiturate sedatives |
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what sedative property do opioids not have
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amnesia
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what sedative properties do benzos not have
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analgesia and respiratory depression
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what sedative properties does halperidol not have
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respiratory depression and amnesia
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what sedative properties do paralytics not have
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they have no sedative properties
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what is the MOA of benzos as a sedative
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reduce anxiety by inhibiting neuronal circuits in limbic system of brain
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higher doses of benzos can cause what
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hypnosis
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benzos are relatively safe in what situations
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overdose
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withdrawal symptoms for benzos may not occur until when
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not for a few days after discontinuation
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what are adverse effects of benzos
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drowsiness, confusion, ataxia,
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benzos should be cautioned with what
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liver disease
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what is MOA for barbiturates as a sedative
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interfere with NA/K transport across cell membranes leading to inhibition of RAS and potentiating GABA action on Cl entry
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how are barbiturates classified for sedatives
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based on duration of action
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what is DOA for thiopental
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30min
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what is DOA for phenobarbital
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>24hr
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what is DOA for amobarcital, secobarbital and pentobarbital
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3-8hr
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what are effects of barbiturates
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CNS depression, respiratory depression and enzyme induction
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what may happen with high dose of barbiturates
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hypnosis or coma
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what are adverse effects of barbiturates
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drowsiness, hangover effect, addiction, poisining
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when are barbiturates contraindicated
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in acute porphyria
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non barbiturate used for sedation
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haloperidol
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what are side effects of haloperidol
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extra pyrimdal symptoms, orthostatic hypotension, prolonged QT interval, neuroleptic malignant syndrome
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