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60 Cards in this Set

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Describe the concept of MAC
Minimal Alveolar Concentration
that will block movement in response to incision in 50% of patients
What does MAC correlate best to?
It correlates inversely with the lipid/gas partition coefficient (i.e. the greater the lipid solubility, the less anesthetic is needed)
How is MAc expressed?
AS a % of inspired air
Which inhaled anesthetic has the highest MAC? Lowest MAC?
Highest = Nitrous Oxide

Lowest = Halothane
What is the only inhaled analgesic that has significant anesthetic?
NITROUS OXIDE
What will give a fast induction/recovery time for an analgesic? Examples 2
LOW blood solubility
Desflurane and Nitrous Oxide
What will give a long induction/recovery time?
HIGH blood solubility
Ethyl Ether
What is the primary inhalation anesthetic that is used?
Sevoflurane
What is the suspected mechanism of general and IV anesthetics?
Direct or Indirect action on the GABA receptor.
Descirbe the indirect action of anesthetic on the GABA receptor?
They indirectly act to enhance the GABA effect to increase the chloride conductance at lower concentrations, causing hyperpolarization
Describe the direct action of anesthetics on the GABA receptor?
Function as direct AGONISTS, causing opening of the chloride channel, and thus hyperpolarization
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:
Respiration: Reduced
Ocular movement: None
Pupil Size: Constricted Miosis
Eye Reflexes: Pupillary Light Reflex
Muscle Tone: Reduced
Resp. Response to Incision: None
For surgical anesthesia, what will you see for an anesthetic overdose?
Respiration:
Ocular movement:
Pupil Size:
Eye Reflexes:
Muscle Tone:
Resp. Response to Incision:
Respiration: None
Ocular movement: None
Pupil Size: DILATED
Eye Reflexes: None
Muscle Tone:FLACCID
Resp. Response to Incision: None
What are the 5 main IV anesthetics?
Thiopental
Etomidate
Propofol
Ketamine
Midazolam
For etomide, what is its relative induction and recovery time?
What is its mechanism of action?
Fast onset and fast recovery

Enhance the efficacy of GABA at the GABAa chloride ionophore
What is the potential adverse effect of etomide?
Excitatory effects during induction and recovery.
ADRENAL CORTICAL SUPRESSION
For ketamin what is its relative induction and recovery time?
What is the mechanism of action?
SLOW onset and recovery

Acts as a glutamate antagonist, binding noncompetatively to the NMDA receptor site to inhibit the excitatory NT glutamate
What is the potential adverse side effect of ketamin?
Psychomimetic effects, nasuea, vomiting, and salivation.
For propofol what is its relative induction and recovery time?
What is the mechanism of action?
Fast onset, fast recovery

Enhance the efficacy of GABA at the GABAa chloride ionophore
What is the potential adverse side effect of propofol?
Cardiovascular and respiratory supression
What is the recovery/induction time for midazolam?
What is the mechanism of action?
SLOWEST ONSET OF ALL AGENTS

Enhance the efficacy of GABA at the GABAa chloride ionophore
What is a potential side effect of midazolam?
MINIMAL CV and Resp effects
Of the IV anesthetics, which one has Analgesic properties?
Ketamine
Of the IV anesthetics, which one has an antiemetic effect?
Propofol
Of the IV anesthetics, which one produces adrenal cortical supression?
Etomidate
Of the IV anesthetics, which one has bronchodilatory effects?
Ketamine
Of the IV anesthetics, which one has a high likelyhood of producing Post operative Nasuea and Vomiting?
Ketamine
Of the IV anesthetics, which one has a high likelyhood of producing myoclonic movements during induction or emergence?
Etomidate
Of the inhaled anesthetics, which one is hepatotoxic?
Halothane
What drug will produce dissaciative anesthesia?
Ketamine.
It will put the patient in a trance, but not knock them out. It will also stimulate the CV system
For Isoflurane, what is the
Recovery Time:
Extent of Metabolism:
Heart Rate effect:
Respiratory Irratation:
Recovery Time:Moderate
Extent of Metabolism:0.2%
Heart Rate effect:INCREASE HR
Respiratory Irratation:SIGNIFICANT
For desflurane, what is the
Recovery Time:
Extent of Metabolism:
Heart Rate effect:
Respiratory Irratation:
Recovery Time: VERY FAST
Extent of Metabolism: 0.02%
Heart Rate effect: INCREASED
Respiratory Irratation: SIGNIFICANT
For Sevoflurane, what is the
Recovery Time:
Extent of Metabolism:
Heart Rate effect:
Respiratory Irratation:
Recovery Time: Fast
Extent of Metabolism: 3-6%
Heart Rate effect: STABLE
Respiratory Irratation: NONE
Which inhaled anesthetic/s is most likely to produce emergence delerium in children?
Desflurane and Sevoflurane
What substance of abuse if Ketamine related to?
PCP's
What is the most commonly used induction agent?
PRopofol (Diprivan = MJ's drug)
Why does propofol have a brief duration of CNS effects?
Rapid redistribution and clearence from plasma by metabolism (glucoronidation)
Considered safe for preggo, but does have cardiorespiratory depression effects
Aside for supression of adrenal cortical function, what does Etomidate do that can help with intracranial pressure?
Direct cerebral vasoconstriction
Why can low T.I. inhaled anesthetics be used to safely produce anesthesia?
They have a high degree of potency which allows them to anestasize at low concentration
What is an imcomplete anesthetic? Example?
Cant produce all stages of analgesia w/o producing hypoxia (Nitrous oxide)
what are the effects on blood pressure and heart rate by propofol, etomidate, and ketamine?
Propofol
Decrease BP and HR
Etomidate
NO CHANGE
Ketamine
INCREASE BP and HR
What is the purpose of preanestheitic medication?
Decrease anxiety
Facilitate induction
Provide perioperative amnesia
Minimize effects of anesthetics
What are the most commonly used preanesthetic medication?
Benzodiazopines (MOST COMMON! induce amnesia)
Antihistamines (sedation)
Opiod Analgesics (sedation)
Phenothiazines (anitemetic)
Anticholinergics (inhibit secretion)
GI drugs (antiemetic=odansetron)
What is malignant hypertension?
Life threatening hyperthermia (+110)
Muscle rigidity
Metabolic acidosis
What drug can trigger malignant hyperthermia?
SUCCINYLCHOLINE
What inhaled anesthetic will NOT trigger MH?
Nitrous Oxide (N2O)
What drug can be used to reverse MH?
IV dantroline
What is meant by irregular descending anesthesia?
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
What IV anesthetic would Flumazenil be used to fix an overdose?
Midazolam (versed)
What are the advantages of the inhalation anesthetic Isoflurane?
No significant systemic toxicities and maintinance of CO due to vasodilation
What are the disadvantages of isoflurane?
Pungent Odor
Airway Irritant
May trigger MH
What are the advantages of desflurane?
No significant systemic toxicities
Fast uptake
What are the disadvantages of desflurane?
Airway irritant
May trigger MH
What are the advantages of sevoflurane?
Nonpungant
What are the disadvantages of sevoflurane?
May trigger MH
What are the advantages of N2O?
Analgesic
Fast uptake/elimination
Nonpungant
What are the disadvantages of N2O?
High Concentration Required
Teratogenic
Based on the lipid/gas coefficient, what anesthetic agent is most potent?
HALOTHANE
Based on blood/gas solubility, which anesthetic would give effect the fastest?
Desflurane
Remember, the less soluable, the faster it effects the brain
What is the mechanism of action for Dexmedetomidine? Advantages?
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