Hupka Iv And Inhalation Anesthetics

Front 1

Describe the concept of MAC

Back 1

Minimal Alveolar Concentration
that will block movement in response to incision in 50% of patients

Front 2

What does MAC correlate best to?

Back 2

It correlates inversely with the lipid/gas partition coefficient (i.e. the greater the lipid solubility, the less anesthetic is needed)

Front 3

How is MAc expressed?

Back 3

AS a % of inspired air

Front 4

Which inhaled anesthetic has the highest MAC? Lowest MAC?

Back 4

Highest = Nitrous Oxide

Lowest = Halothane

Front 5

What is the only inhaled analgesic that has significant anesthetic?

Back 5

NITROUS OXIDE

Front 6

What will give a fast induction/recovery time for an analgesic? Examples 2

Back 6

LOW blood solubility
Desflurane and Nitrous Oxide

Front 7

What will give a long induction/recovery time?

Back 7

HIGH blood solubility
Ethyl Ether

Front 8

What is the primary inhalation anesthetic that is used?

Back 8

Sevoflurane

Front 9

What is the suspected mechanism of general and IV anesthetics?

Back 9

Direct or Indirect action on the GABA receptor.

Front 10

Descirbe the indirect action of anesthetic on the GABA receptor?

Back 10

They indirectly act to enhance the GABA effect to increase the chloride conductance at lower concentrations, causing hyperpolarization

Front 11

Describe the direct action of anesthetics on the GABA receptor?

Back 11

Function as direct AGONISTS, causing opening of the chloride channel, and thus hyperpolarization

Front 12

For surgical anesthesia, what will you see for Stage 3 phase 3 in:
Respiration:
Ocular movement:
Pupil Size:
Eye Reflexes:
Muscle Tone:
Resp. Response to Incision:

Back 12

Respiration: Reduced
Ocular movement: None
Pupil Size: Constricted Miosis
Eye Reflexes: Pupillary Light Reflex
Muscle Tone: Reduced
Resp. Response to Incision: None

Front 13

For surgical anesthesia, what will you see for an anesthetic overdose?
Respiration:
Ocular movement:
Pupil Size:
Eye Reflexes:
Muscle Tone:
Resp. Response to Incision:

Back 13

Respiration: None
Ocular movement: None
Pupil Size: DILATED
Eye Reflexes: None
Muscle Tone:FLACCID
Resp. Response to Incision: None

Front 14

What are the 5 main IV anesthetics?

Back 14

Thiopental
Etomidate
Propofol
Ketamine
Midazolam

Front 15

For etomide, what is its relative induction and recovery time?
What is its mechanism of action?

Back 15

Fast onset and fast recovery

Enhance the efficacy of GABA at the GABAa chloride ionophore

Front 16

What is the potential adverse effect of etomide?

Back 16

Excitatory effects during induction and recovery.
ADRENAL CORTICAL SUPRESSION

Front 17

For ketamin what is its relative induction and recovery time?
What is the mechanism of action?

Back 17

SLOW onset and recovery

Acts as a glutamate antagonist, binding noncompetatively to the NMDA receptor site to inhibit the excitatory NT glutamate

Front 18

What is the potential adverse side effect of ketamin?

Back 18

Psychomimetic effects, nasuea, vomiting, and salivation.

Front 19

For propofol what is its relative induction and recovery time?
What is the mechanism of action?

Back 19

Fast onset, fast recovery

Enhance the efficacy of GABA at the GABAa chloride ionophore

Front 20

What is the potential adverse side effect of propofol?

Back 20

Cardiovascular and respiratory supression

Front 21

What is the recovery/induction time for midazolam?
What is the mechanism of action?

Back 21

SLOWEST ONSET OF ALL AGENTS

Enhance the efficacy of GABA at the GABAa chloride ionophore

Front 22

What is a potential side effect of midazolam?

Back 22

MINIMAL CV and Resp effects

Front 23

Of the IV anesthetics, which one has Analgesic properties?

Back 23

Ketamine

Front 24

Of the IV anesthetics, which one has an antiemetic effect?

Back 24

Propofol

Front 25

Of the IV anesthetics, which one produces adrenal cortical supression?

Back 25

Etomidate

Front 26

Of the IV anesthetics, which one has bronchodilatory effects?

Back 26

Ketamine

Front 27

Of the IV anesthetics, which one has a high likelyhood of producing Post operative Nasuea and Vomiting?

Back 27

Ketamine

Front 28

Of the IV anesthetics, which one has a high likelyhood of producing myoclonic movements during induction or emergence?

Back 28

Etomidate

Front 29

Of the inhaled anesthetics, which one is hepatotoxic?

Back 29

Halothane

Front 30

What drug will produce dissaciative anesthesia?

Back 30

Ketamine.
It will put the patient in a trance, but not knock them out. It will also stimulate the CV system

Front 31

For Isoflurane, what is the
Recovery Time:
Extent of Metabolism:
Heart Rate effect:
Respiratory Irratation:

Back 31

Recovery Time:Moderate
Extent of Metabolism:0.2%
Heart Rate effect:INCREASE HR
Respiratory Irratation:SIGNIFICANT

Front 32

For desflurane, what is the
Recovery Time:
Extent of Metabolism:
Heart Rate effect:
Respiratory Irratation:

Back 32

Recovery Time: VERY FAST
Extent of Metabolism: 0.02%
Heart Rate effect: INCREASED
Respiratory Irratation: SIGNIFICANT

Front 33

For Sevoflurane, what is the
Recovery Time:
Extent of Metabolism:
Heart Rate effect:
Respiratory Irratation:

Back 33

Recovery Time: Fast
Extent of Metabolism: 3-6%
Heart Rate effect: STABLE
Respiratory Irratation: NONE

Front 34

Which inhaled anesthetic/s is most likely to produce emergence delerium in children?

Back 34

Desflurane and Sevoflurane

Front 35

What substance of abuse if Ketamine related to?

Back 35

PCP's

Front 36

What is the most commonly used induction agent?

Back 36

PRopofol (Diprivan = MJ's drug)

Front 37

Why does propofol have a brief duration of CNS effects?

Back 37

Rapid redistribution and clearence from plasma by metabolism (glucoronidation)
Considered safe for preggo, but does have cardiorespiratory depression effects

Front 38

Aside for supression of adrenal cortical function, what does Etomidate do that can help with intracranial pressure?

Back 38

Direct cerebral vasoconstriction

Front 39

Why can low T.I. inhaled anesthetics be used to safely produce anesthesia?

Back 39

They have a high degree of potency which allows them to anestasize at low concentration

Front 40

What is an imcomplete anesthetic? Example?

Back 40

Cant produce all stages of analgesia w/o producing hypoxia (Nitrous oxide)

Front 41

what are the effects on blood pressure and heart rate by propofol, etomidate, and ketamine?

Back 41

Propofol
Decrease BP and HR
Etomidate
NO CHANGE
Ketamine
INCREASE BP and HR

Front 42

What is the purpose of preanestheitic medication?

Back 42

Decrease anxiety
Facilitate induction
Provide perioperative amnesia
Minimize effects of anesthetics

Front 43

What are the most commonly used preanesthetic medication?

Back 43

Benzodiazopines (MOST COMMON! induce amnesia)
Antihistamines (sedation)
Opiod Analgesics (sedation)
Phenothiazines (anitemetic)
Anticholinergics (inhibit secretion)
GI drugs (antiemetic=odansetron)

Front 44

What is malignant hypertension?

Back 44

Life threatening hyperthermia (+110)
Muscle rigidity
Metabolic acidosis

Front 45

What drug can trigger malignant hyperthermia?

Back 45

SUCCINYLCHOLINE

Front 46

What inhaled anesthetic will NOT trigger MH?

Back 46

Nitrous Oxide (N2O)

Front 47

What drug can be used to reverse MH?

Back 47

IV dantroline

Front 48

What is meant by irregular descending anesthesia?

Back 48

Despite the normal order of neural control regions, The heart (and respiratory centers) are often the last aspect to be completely shut down by anesthetics

Front 49

What IV anesthetic would Flumazenil be used to fix an overdose?

Back 49

Midazolam (versed)

Front 50

What are the advantages of the inhalation anesthetic Isoflurane?

Back 50

No significant systemic toxicities and maintinance of CO due to vasodilation

Front 51

What are the disadvantages of isoflurane?

Back 51

Pungent Odor
Airway Irritant
May trigger MH

Front 52

What are the advantages of desflurane?

Back 52

No significant systemic toxicities
Fast uptake

Front 53

What are the disadvantages of desflurane?

Back 53

Airway irritant
May trigger MH

Front 54

What are the advantages of sevoflurane?

Back 54

Nonpungant

Front 55

What are the disadvantages of sevoflurane?

Back 55

May trigger MH

Front 56

What are the advantages of N2O?

Back 56

Analgesic
Fast uptake/elimination
Nonpungant

Front 57

What are the disadvantages of N2O?

Back 57

High Concentration Required
Teratogenic

Front 58

Based on the lipid/gas coefficient, what anesthetic agent is most potent?

Back 58

HALOTHANE

Front 59

Based on blood/gas solubility, which anesthetic would give effect the fastest?

Back 59

Desflurane
Remember, the less soluable, the faster it effects the brain

Front 60

What is the mechanism of action for Dexmedetomidine? Advantages?

Back 60

It is a centrally acting Alpha 2 agonist with profound sedation and anxiolytic and analgesic properties.
Unlike other analgesics, this will put the patient into actual sleep, and they will not wake up groggy