Inhalation And Iv Anesthetics

Front 1

what is MAC? what does it correlate with

Back 1

minimal alveolar concentration: the minimum that will block movements in response to incision in 50% of patients
relative potency of anesthetic gases is expressed as MAC

correlates inversely with lipid solubility

Front 2

Indicate which of the inhalation anesthetics has significant analgesic properties.

Back 2

Only gas that has good analgesic properties is Nitrous Oxide

Front 3

Explain induction and recovery times and potency based upon physical properties of general anesthetics.

Back 3

speed of induction and emergence is determined by the rate of change of the partial pressure of the gas in the brain
-determined by the partial pressure of the gas in arterial blood- related to alveolar concentration
-concentration in brain is related to alveolar concentration

Front 4

MOA of inhalation anesthetics

Back 4

GABA chloride channel complex: common specific target for anxiolytics, hypnotics, anesthietcs, antiepileptics
actions to increase chloride conductance to produce hyperpolarization
-act indirectly to enhance GABA's effect to increase chloride conductance at lower concentrations
-act directly as agonists to open chloride channels

Front 5

physiological indices for surgical anesthesia

Back 5

no response to skin incision
pupils roughly normal
pupillary light reflex still present
diaphgramatic respiration present, intercostal lessened

Front 6

what are signs of anesthetic overdose?

Back 6

apnea
dilated pupils
flaccid muscle tone

Front 7

etomidate
ketamine
propofol
midazolam
which is analgesic?
antiemetic?
limited by cortisol synthesis inhibition?
produces bronchodilation?
produces PONV?
produces myoclonic movement?

Back 7

analgesic- ketamine
antiemetic-propofol
inihibits cortisol- etomidate
BD-ketamine
PONV-ketamine
myoclonus- etomidate

Front 8

MOA of midazolam, propofol, etomidate

Back 8

enhance GABA efficacy

Front 9

ketamine MOA

Back 9

glutamate antagonist (binds non-competitively at the NMDA receptor site

Front 10

balanced anesthesia

Back 10

no single anesthetic agent meets the ideal so a combination of drugs is used

Front 11

what is dissociative anesthesia? what produces it?

Back 11

no LOC but in a trance with eyes open and cataleptic; pt appears to be awake but does not respond to sensory stimuli
ketamine

Front 12

isoflurane, desflurane, sevoflurane
recovery, extent of metabolism, heart rate, respiratory irritation

emergence delirium?

Back 12

recovery
desflurane>sevoflurane>isoflurane

% metabolized?
sevoflurane> isoflurane >desflurane

heart rate: stable in sevoflurane, increased in iso and des

respiratory irritation: non in sevo, significant in iso and des

delirum: des and sevo

Front 13

what abused substance is related to keatmine?

Back 13

PCP

Front 14

what is induction anesthesia? what IV agents are used for this?

Back 14

rapid onset, fast recovery

propofol (#1), thiopental, etomidate, ketamine, midazolam

Front 15

mech of propofol's brief duration of CNS fx following IV bolus

Back 15

redistribution and rapid clearance from plasma by metabolism

Front 16

why can general anesthetics be used safely even though they have a low therapeutic index?

Back 16

lots of minute to minute control

Front 17

what is an incomplete anesthetic?

which gas is considered to be incomplete?

Back 17

incomplete: can't produce all stages of anesthesia without producing hypoxia

NO

Front 18

propofol, etomidate, ketamine:
systemic BP and HR

Back 18

propofol: decreases both
etomidate does nothing
ketamine increases both

in CVD: etomidate
in vascular disease: ketamine

Front 19

what are the most common pre-anesthetic agents?

Back 19

benzodiazepines: reduce anxiety, create amnesia
antihistamines: sedation
opioids: reduce tension and anxiety, provide analgesia
phenothiazines: sedation, antihistamine, antiemetic, decreased motor funciton
anticholinergics: inhibit secretions, bradycardia, vomiting, laryngospasms
GI drugs: antiemetics, decrease gastric acidity, decrease stomach contents

Front 20

what is malignant hyperthermia?
what triggers it?
what is used to manage it?
what does not trigger it?

Back 20

hyperthermia, muscle rigidity, metabolic acidosis
triggered by inhalation anesthetics and succinylcholine
treated with dantrolene
N2O is not a trigger

Front 21

what is irregularly descending anesthesia?

Back 21

all parts of the CNS are dose-dependent- order of descension:
RAS and cortex-> hippocampus-> basal ganglia-> cerebellum-> spinal cord-> medulla
important because medulla does heart and breathing and is last

Front 22

what do you use flumazenil for?

Back 22

midazolam OD

Front 23

analgesic with fast uptake, elimination, and nonpungent
BUT high concentration required

Back 23

pros and cons of N2O

Front 24

cheap and no tox and maintains CO because of VD BUT pungent odor, airway irritant, and triggers MH

Back 24

pros and cons of isoflurane

Front 25

no systemic tox, fast uptake and elimination, stable with little metabolsim BUT triggers MH and is airway irritant and expensive and triggers tachycardia and hypertension

Back 25

desflurane pros and cons

Front 26

fast uptake and eliminate; non pungent and good for inhalation induction with CO maitained BUT increases fluoride concentration, expensive, triggers MH, and high amount is metabolized

Back 26

sevoflurance

Front 27

induction vs. blood/gas

Back 27

lower ratio means faster rate of induction

Front 28

moa of dexmedetomidine and unique properties /advantages

Back 28

central acting alpha 2 agonist
profound sedation with anxiolytic and analgesic properties
slwoer onset and longer acting than propofol
minimal respiratory depression but causes bradycardia and hypotension vs. ketamine-stim CV

more like respiration in natural sleep
clear consciousness on waking