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51 Cards in this Set
- Front
- Back
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What are the 5 key components to uptake of anesthetic & onset of activity?
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1. solubility
2. anesthetic concentration 3. pulmonary vent. (volume) 4. Pulmonary blood flow 5. Arteriovenous drug conc. gradient (b/w art & mixed venous blood) 6? (FA & FI) |
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Which inhaled anesthetic is eliminated via hepatic metabolism?
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Halothane
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If you have an asthmatic patients, what inhaled anesthetics would be a good choice? What would be bad?
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Good (bronchodilators): sevoflurane & halothane
Bad: desflurane |
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Describe the distribution of STP.
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easily crosses BBB
induction of anesthesia in 20-40 seconds WILL stop breathin! |
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Although metabolized via hepatic oxidation, what is the primary mechanism for awakening from STP?
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Redistribution (to central blood pool and muscle)
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What is the MOA of STP?
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sedative-hypnotic effect via receptor complex w/ GABA receptor --> inc gCl-
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What are the cardiovascular effects of STP. What types of pt's need to be monitored in light of this?
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1. dec MAP (vasodilation), SVR; inc HR
2. HTN pt may have dramatic drop in map (give volume) |
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What are the respiratory effects of STP?
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dec response to hypercapnia --> apnea follows induction dose
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What is the protective effect on the CNS by STP?
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protects brain from focal (not global) ischemia
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How is etomidate absorbed, distributed, and metabolized?
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A: IV
D: lipid soluble --> 30-45 sec anesthesia M: hydrolysis via hepatic microsomal enzymes |
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What is the MOA of etomidate?
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binds GABA receptor (depresses the RAS)
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Which IV anesthetic has minimal effects on the cardiovascular system (good for volume-deplete pt)?
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etomidate
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How do you estimate CPP (cerebral perfusion pressure)?
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CCP = MAP - CVP/ICP
normal is 80-90 mmHg |
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What IV anesthetic can cause adrenocortical suppresion, myoclonus, and extrapyramidal symptoms?
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etomidate
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What IV anesthetic is a derivative of PCP that interrupts or disrupts thalamocortical and limbic systems?
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ketamine
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This IV anesthetic can cause "dissociative anesthesia."
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ketamine
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What is the absorption, distribution, and metabolism of ketamine?
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A: IV & IM
D: HIGHLY lipid soluble M: demethylation via P--450 |
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Which IV anesthetic has an active metabolite (1/5 as potent)?
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ketamine---> metabolite is norketamine
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What IV anesthetic DOES NOT interact w/ a GABA receptor?
What is its MOA? |
1. ketamine
2. NMDA, opioid, muscarinic |
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What are the cardiovascular effects of ketamine?
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inc sympathetic tone
INC. in :HR, SVR, PVR, CO, myocardial oxygen req |
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What IV anesthetic DOES NOT significantly depress resp function?
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ketamine
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What is the resp. effect of ketamine?
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bronchodilation
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What is the absorption, distribution, and metabolism of propofol?
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A: IV
D: highly lipid soluble; redistribution from blood to fat! M: hepatic conjugation |
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What is the MOA of propofol?
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ineracts w/ GABA receptor
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What is the major cardiovascular effect of propofol?
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dec in MAP
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What IV anesthetic would be a good choice for an asthmatic pt?
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ketamine: a bronchodilator
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Describe the 4 stages of anesthesia.
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1. analgesia
2. excitement (irreg. resp) 3. surgical anesthesia (reg. resp) 4. medullary dep (apnea) |
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What is the general MOA of inhaled anesthetics?
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activate GABA-A receptors
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What is the resp. goal of inhaled anesthetics?
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regular respiratons w/o response to noxious stimuli
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What are the 5 key components to uptake/onset of activity of anesthetics?
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solubility
concentration pulm. ventilation pulm. blood flow Arteriovenous drug conc gradient |
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What is the blood:gas partition coefficient and what is its clinical importance?
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1.defines relative affinity of anesthetic for blood compared w/ inspired gas
2. higher B:G = more soluble = longer buildup = longer time to anesthesia |
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Rate the solubility of the following anesthetics from insouble in blood, to soluble.....
DES, SEV, ISO, SEVO, EN, HALO |
ins:
DES NO SEVO ISO EN HALO sol... |
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insoluble agent = inc alveolar conc. = faster induction
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got it?
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Awakening from anesthesia is most affected by what two .... things?
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blood:gas
pulmonary vent/blood flow |
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How does pulmonary blood flow impact onest of activity?
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higher blood flow = slower onest
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How does the arteriovenous conc. gradient impact time to awakening?
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larger A-V conc --> drug stays in tissues --> dec lung elimination --> inc time to awakening
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This inhalation anesthetic is metabolized by the liver.
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Halothane
b/c Halothane = Hepatic |
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This term refers to the alveolar conc that prevents movement in 50% of pt.s in response to surgical stimulation.
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What is the MAC (minimum alveolar concentration)
allows for comparison of potency b/w agents |
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In terms of MAC, what are the least/most potent inhaled anesthetics?
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most: halothane
Least: NO |
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All inhaled anesthetics, except this drug, decrease MAP.
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NO
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All inhaled anesthetics, except NO, do what to BP & SVR?
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decrease BP & SVR
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How do inhaled anesthetics (except NO) increase RAP?
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negative ionotropic effect
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What are the respiratory effects of inhaled anesthetics?
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Dec TV
Inc. RR dec. minute volume depress response to inc CO2 some bronchodilate (HAL & SEVO) dec. mucociliary function |
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Which inhaled anesthetic may induce laryngospasm and worsen pulm function?
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desflurane
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What are the cerebral effects of inhaled anesthetics?
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dec. cerebral metabolic rate
inc. CBF --> inc ICP |
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What are the kidney, liver, and uterine effects of inhaled anesthetics?
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dec. GFR
dec. hepatic blood flow relax uterine smooth muscle |
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Which inhalation anesthetic can cause hepatitis.
What type of pt is most at risk? |
1. halothane
2. obese pt. |
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Which inhaled anesthetic can worsen pneumothorax?
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NO
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What inhaled anesthetic require a heated vaporizer?
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desflurane (boils at room temp)
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What inhaled anesthetic can induce nephrotoxicity secondary to formation of compound A?
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sevoflurane
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What are two good inhalation anesthetic choices for an asthmatic pt?
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sevoflurane
halothane |
