Neuro Test 1: Hupka_General Anesthesia

Front 1

Explain what is meant by MAC.

Indicate its significance, and the physical characteristic it best correlates with

Back 1

**Minimal Alveolar Concentration**
- minimal gas concentration that will block movement in response to incision in 50% of patients

**MAC best correlates inversley with lipid solubility**
(greater lipid solubility = lower MAC)

Front 2

which of the inhalation anesthetics has significant analgesic properties?

**EXAM**

Back 2

Nitrous Oxide

Front 3

What is the significance of the Blood/Gas partition coefficient (λ)?

What does this mean for induction and recovery?

**EXAM**

Back 3

Measure of the solubility** of a gas in blood.

Drugs with a higher solubility have slower induction

Drugs with lower solubility have faster induction

Front 4

Gaseous anesthetics with high solubility have faster/slower induction and recovery

Gaseous anesthetics with low solubility have faster/slower induction and recovery.

Back 4

Gaseous anesthetics with high solubility (high λ) have slower induction and recovery

Gaseous anesthetics with low solubility (low λ) have faster induction and recovery.

Front 5

4. Describe the proposed mechanism(s) of action of inhalation anesthetics

Back 5

Increase GABA activity
-increase chloride conductance to produce hyperpolarization



(Ketamine and NO act by binding to glutamate NMDA receptors or central ACh receptors)

Front 6

You want to give a patient a pre-anesthetic agent. You need it to be an anticholinergic drug to inhibit secretions, vomiting and bradycardia. Why would you use glycopyrollate over atropine?

**EXAM**

Back 6

Glycopyrollate does not cross BBB!

Front 7

What is the stage and plane of anesthesia when you can begin surgery?

Back 7

Stage III , Plane 3

(no eye movement, normal pupils, pupillary light reflex, decreased muscle tone, no response to skin incision)

Front 8

What is respiration, pupil size, and muscle tone like in a patient in STAGE IV anesthesia (overdose)?

Back 8

Respiration = apnea

Pupils = dilated

Muscle tone = flaccid

Front 9

Which drug has analgesic properties?

A) Etomidate

B) Ketamine

C) Propofol

D) Midazolam

Back 9

Ketamine

Front 10

Which drug has significant anti-emetic effects?

A) Etomidate

B) Ketamine

C) Propofol

D) Midazolam

Back 10

propofol

Front 11

Which drug has its clinical use limited by inhibiting the synthesis of cortisol?

A) Etomidate

B) Ketamine

C) Propofol

D) Midazolam

Back 11

Etomidate

Front 12

Which drug produces significant bronchodilation?

A) Etomidate

B) Ketamine

C) Propofol

D) Midazolam

Back 12

Ketamine

Front 13

Which drug is most likely to produce PONV?

A) Etomidate

B) Ketamine

C) Propofol

D) Midazolam

Back 13

Etomidate

Front 14

Which drug is most likely to produce myoclonic movement on induction or emergence

A) Etomidate

B) Ketamine

C) Propofol

D) Midazolam

Back 14

Etomidate

Front 15

Which drug is likely to cause amnesia?


A) Etomidate

B) Ketamine

C) Propofol

D) Midazolam

Back 15

Midazolam

Front 16

Which drug produces a "dissociative anesthesia'?

Back 16

**Ketamine**

Analgesia, immobility, amnesia

- No loss of consciousness but like in a trance with eyes open and cataleptic

- Patient may appear to be awake but does not respond to sensory stimuli

- Used for minor surgical and diagnostic procedures especially in children

Front 17

Which is most likely to stimulate the CV system?

A) Etomidate

B) Ketamine

C) Propofol

D) Midazolam

Back 17

B) Ketamine

Front 18

If you give a pt. too much Midazolam what can you give as a specific receptor antagonist? (antidote)

Back 18

Flumazenil

(Midazolam is a BDZ)

Front 19

What is the best way to get a "balanced anesthesia"?

Back 19

use a combination of anesthetic drugs!!

- take advantage of their best properties

- minimize the undesirable side effects

Front 20

Which has the shortest induction time?

A) isoflurane

B) desflurane

C) sevoflurane

Back 20

desflurane

Front 21

Which has the longest induction time?

A) isoflurane

B) desflurane

C) sevoflurane

Back 21

isoflurane

Front 22

Why is the rate of induction slower for desflurane (λ=.42) than N2O (λ=.47)?

Back 22

N20 is given at a much higher concentration! (#1 induction ranking)

Front 23

Which has the the greatest cardiovascular depression?

A) isoflurane

B) desflurane

C) sevoflurane

Back 23

isoflurane = desflurane = sevoflurane

Front 24

Which has the fastest recovery time?

A) isoflurane

B) desflurane

C) sevoflurane

Back 24

desflurane

Front 25

Which is metabolized the most?

A) isoflurane

B) desflurane

C) sevoflurane

Back 25

sevoflurane

Front 26

Which is metabolized the least?

A) isoflurane

B) desflurane

C) sevoflurane

Back 26

desflurane

Front 27

Which has no respiratory irritation?

A) isoflurane

B) desflurane

C) sevoflurane

Back 27

sevoflurane

Front 28

Which two create an increased heart rate?

A) isoflurane

B) desflurane

C) sevoflurane

Back 28

Isoflurane
Desflurane

(sevoflurane has a stable heart rate)

Front 29

Which two are more likely to cause "emergence delirium" in children?

A) isoflurane

B) desflurane

C) sevoflurane

Back 29

desflurane and sevoflurane

Front 30

Know which substance of abuse Ketamine is related to

Back 30

PCP

Front 31

What is meant by "induction anesthesia?

Name the IV agents primarily used for this procedure.

Back 31

Induction anesthesia is when a patient cannot feel or react to a skin incision.


Induction Agents:
-propofol is most common (IV)

-halothane most common in children (gas)

Front 32

12. Explain the mechanism behind propofol’s brief duration of CNS effects following IV bolus administration

Back 32

Short recovery time attributed to redistribution and rapid
clearance from plasma by metabolism (mainly glucuronidation)

Front 33

13. Explain why in spite of the fact that the general inhalation anesthetics have a low Therapeutic Index they still can be safely used to produce anesthesia.

Back 33

They are given at the MAC (minimal alveolar concentration) and then titrated up if necessary.

The MAC is the minimum concentration level that will knock out 50% of patients!

Agents can be combined to reduce the MAC of each. (additive effect)

Front 34

14. Explain what is meant by "incomplete anesthetic", indicate which anesthetic gas is considered an incomplete anesthetic.

Back 34

An Incomplete Anesthetic can't produce all stages of anesthesia without producing hypoxia

***Nitrous Oxide is an incomplete anesthetic***

Front 35

Which inhaled anesthetic is least likely to cause malignant hyperthermia?

**Exam**

Back 35

N2O

Front 36

Which drug decreases both systemic BP and Heart Rate?

a) Ketamine

b) Propofol

c) Etomidate

Back 36

Propofol

Front 37

Which drug increases both systemic BP and heart rate?

a) Ketamine

b) Propofol

c) Etomidate

Back 37

ketamine

Front 38

Which drug does not affect systemic BP or heart rate?

a) Ketamine

b) Propofol

c) Etomidate

Back 38

Etomidate

Front 39

**EXAM**

Back 39

Somewhere in that table is an exam question... have fun... I think it's under Anticholinergics...

Front 40

You are an anesthesiologist and you just put a patient under using an inhaled anesthetic... Suddenly they have:

-hyperthermia (110+ degrees)
-muscle rigidity
-metabolic acidosis

What's going on?

Back 40

Malignant Hyperthermia

Front 41

Specific drug to treat malignant hyperthermia?

****

Back 41

dantroline

Front 42

18. Explain what is meant by ‘irregularly descending anesthesia’ and the importance of this concept.

Back 42

Order of sensitivity (most to least) is RAS and cortex →
hippocampus → basal ganglia → cerebellum → spinal
cord → medulla (irregularly descending anesthesia)

GAs cause an irregularly descending depression of CNS,i.e. the higher functions are lost first and progressively lower areas of the brain are involved, but in the spinal cord lower segments are affected somewhat earlier than the higher segments.

The vital centres located in the medulla are paralysedthe last as the depth of anaesthesia increases. This is stage IV anesthesia.. You die...

Front 43

MOA of dexmedetomidine?

**

Back 43

Central acting α2 agonist

-Decreases propofol, opioid, inhalation anesthetic
dose requirements

Front 44

another objective..

Back 44

Front 45

Compared to Propofol and Ketamine, Dexmedetomidine does not stimulate the _______

Back 45

Heart

Front 46

What neuromuscular blocking agent can cause malignant hyperthermia?

Back 46

Succinylcholine

Front 47

How does Etomidate decrease Intracranial pressure?

Back 47

causes direct cerebral vasoconstriction
↓
↓CBF and ↓CMRO2

Front 48

All of the following IV Anesthetics work by enhancing the GABA receptor except:

A) Propofol

B) Ketamine

C) Midazolam

D) Etomidate

***EXAM***

Back 48

Ketamine

-primarily produces its effects by binding noncompetively
to the NMDA receptor site to inhibit the excitatory NT glutamate

Front 49

This IV anesthetic binds to the NMDA receptory to inhibit the excitatory NT glutamate

***EXAM**

Back 49

Ketamine