Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
67 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Balanced anesthesia
|
2+ agents summating to produce total desired effects with minimal undesirable actions
|
|
|
|
Thiopental
|
Barbiturate
Rapid onset anesthesia Terminated by redistribution Relatively rapid clearance Antiseizure activity |
|
|
|
Thiamylal
|
Barbiturate
Rapid onset anesthesia Terminated by redistribution Relatively rapid clearance Antiseizure activity |
|
|
|
Methohexital
|
Barbiturate
Rapid onset anesthesia Terminated by redistribution Relatively rapid clearance Antiseizure activity |
|
|
|
Propofol
|
Rapid recovery (high clearance)
Onset and duration similar to barbiturates Maintenence and induction Poor analgesia |
|
|
|
Etomidate
|
Cardiostable (Ok in hypotensive patient)
Induction Poor analgesia Significant nausea and vomiting Suppression of adrenocortical stress response |
|
|
|
Ketamine
|
Blocks glutamate-R (not GABAergic)
Analgesic Useful in children - short painful procedure Dissociative state (Amnesia despite patient being awake) Emergence delirium Analog of PCP |
|
|
|
Halothane
|
High blood/gas partition coefficient
Slow induction of anesthesia Liver toxicity (Drug induced hepatitis) Malignant hyperthermia Increased cerebral blood flow and intracranial pressure |
|
|
|
Isoflurane
|
Much lower blood/gas partition coefficient than halothane
Induction achieved in 10 minutes Dilates coronary arteries (potential for "coronary steal" Avoid use in patients with CAD |
|
|
|
Enflurane
|
Relativity high blood/gas partition coefficient
Slow induction of anesthesia Increased seizure activity Malignant hyperthermia |
|
|
|
Sevoflurane
|
Low blood/gas partition coefficient
Rapid onset/rapid recovery Use for induction Interaxn with soda lime (CO2 absorbent) makes nephrotoxic substance "Compound A" FDA recommends given with fresh gas flow |
|
|
|
Desflurane
|
Lowest blood/gas partition coefficient
Low fat solubility Useful for outpatient surgeries Concentration-dependent decrease in blood pressure but cardiac output not affected Transient bradycardia Coughing, salivation, bronchospasm in awake patients (no induction) CO production with dry soda lime (CO2 absorbent) |
|
|
|
Nitrous oxide
|
Insoluble in blood and tissues = rapid induction and emergence
Significant analgesia Adjunct to other anesthetics Cannot be used above [80%] b/c hypoxia |
|
|
|
Methoxyflurane
|
Withdrawn b/c of detrimental effects on kidneys
Extensive renal metabolism |
|
|
|
Proposed mechanism of general anesthetics
|
Increase GABA-R activity and potassium channels
Decrease Ach-R and Glutamate-R |
|
|
|
Name 6 IV anesthetics
|
Thipental
Thiamylal Methohexital Propofol Etomidate Ketamine |
|
|
|
Name 7 inhalation anesthetics
|
Halothane
Methoxyflurane Enflurane Isoflurane Sevoflurane Desflurane Nitrous oxide |
|
|
|
3 Barbiturates IV Anesthetics
|
Thiopental
Thiamylal Methohexital |
|
|
|
Most common barbiturate IV anesthetic
|
Thiopental
|
|
|
|
Barbiturate properties
|
Rapid onset (induction)
Terminated by redistribution Context-sensitive half life: terminal half-life longer with continued infusion Hepatic clearance |
Not for maintenence
|
|
|
Barbiturate contraindication
|
Porphyria patients
|
|
|
|
Barbiturate toxicity
|
Decreased cerebral metabolism, cerebral blood flow, blood pressure, respiration
Paradoxical excitation (muscle tremors) Hiccups |
|
|
|
Propofol toxicity
|
Decreased cerebral metabolism, cerebral blood flow, blood presure, respiration.
Pain on injection |
|
|
|
Give what with propofol to reduce pain on injection
|
Propofol + Lidocaine
Reason why not used in pediatrics |
|
|
|
Etomidate toxicity
|
Depressed cerebral metabolism, cerebral blood flow, respiration
Pain on injection Nausea and vomiting Suppression of adrenocortical stress response |
|
|
|
Etomidate drug interaction
|
Fentanyl prolongs T1/2 of Etomidate
|
|
|
|
Ketamine toxicity
|
Increased cerebral blood flow
Cataleptic state Emergence delirium PCP analog |
|
|
|
Three drugs with pain at injection site
|
Propofol
Methohexital Etomidate |
|
|
|
Speed of onset for IV anesthetics
|
Rapid
|
|
|
|
Two drugs for hypotensive patients
|
Etomidate
Ketamine |
|
|
|
IV Anesthetic eliminated by hepatic enzyme
|
Thiopental
Thiamylyl Methohexital |
|
|
|
Main side effect of Propofol
|
Decreased blood pressure and depressed respiration
|
|
|
|
Main side effect of Etomidate
|
Nausea and vomiting
Suppresses stress response |
|
|
|
IV anesthetic ability to produce analgesia, amnesia, muscle relaxation
|
Poor analgesia
Poor muscle relaxation Poor amnesia |
|
|
|
Speed and safety of emergence (Ketamine)
|
Ketamine associated with emergence delirium
|
|
|
|
Rate of metabolism or redistribution of Thiopental
|
Slow clearance after continuous infusion
|
|
|
|
Rate of metabolism or redistribution of Propofol
|
Propofol has more rapid recovery
|
|
|
|
Effect of IV anesthetics on respiration
|
Depression of respiration drive b/c of lower response to CO2 or to hypoxia
|
|
|
|
Effect of IV anesthetics on cardiovascular drive
|
Depressed
|
|
|
|
Effect of opioids and ketamine on muscle
|
Muscular rigidity
|
|
|
|
CNS effects of ketamine
|
Hallucinations
Emergence delirium |
|
|
|
Etomidate inhibits ____
|
Steroidogenesis
|
|
|
|
Reduction of pain threshold occurs with ____
|
Thiopental
|
|
|
|
Most soluble inhalation anesthetic
Highest blood/gas partition coefficient |
Methoxyflurane
|
|
|
|
Least soluble inhalation anesthetic
Lowest blood/gas partition coefficient |
Desflurane
Nitrous oxide |
|
|
|
Effect of ventiation on time to reach anesthetic equilibrium
|
Increased ventilation = increased rate to reach anesthetic equilibrium (reach faster)
|
|
|
|
Effect of cardiac output on time to reach anesthetic equilibrium
|
Decreased cardiac output = increased rate to reach anesthetic equilibrium (reach faster)
|
|
|
|
Miniminum Alveolar Concentration
|
MAC = concentration of gas in alveolar compartment that results in lack of response to noxious stimulus in 50% of subjects
|
|
|
|
Rate of emergence of Methoxyflurane
|
Slow emergence
Up to 30 minutes |
|
|
|
Rate of emergence of Nitrous Oxide
|
Rapid emergence
|
|
|
|
MAC of Haloflurane
|
0.75% = POTENT!
|
|
|
|
Treatment of malignant hyperthermia
|
Dantrolene
|
|
|
|
Malignant hyperthermia
|
Predispose patients to muscle rigidity and sudden rises in body temperature after exposure to halothane
|
|
|
|
Nitrous oxide effect on GI
|
Causes bowel distension (Bends)
|
|
|
|
Nitrous oxide effects in lung
|
Causes pneumothorax (Bends)
|
|
|
|
Nitrous oxide effects on ear
|
Causes pain with obstructed inner ear (Bends)
|
|
|
|
What must be administered at end of nitrous oxide anesthesia?
|
100% O2 to avoid diluting O2 in lung ("diffusional hypoxia")
|
|
|
|
Nitrous oxide CI
|
In patients with pulmonary HT due to increased vascular resistance
|
|
|
|
MAC of nitrous oxide
|
105%!!! Impotent!
|
|
|
|
Ketamine + Theophylline
|
Predispose to seizures
|
|
|
|
Ketamine drug interaction
|
Potentiates nondepolarizing muscle relaxants
|
|
|
|
Target of neuromuscular blockers
|
AchR at skeletal muscle
|
|
|
|
Major use of neuromuscular blocker
|
Paralyze/relax skeletal muscle
Prevent movement in patients under general anesthesia for s/p |
|
|
|
Neuromuscular blocker does/does not have analgesic properties?
|
Does not have analgesic properties
|
|
|
|
4 Qualities of Anesthesia
|
1. Amnesia
2. Loss of consciousness 3. Analgesia 4. Muscle relaxation |
|
|
|
Balanced anesthesia
|
Anesthesia produced by safe doses of 2+ agents, each of which contributes to the total desired effect (summate)
|
|
|
|
Curare alkaloids
|
Non depolarizing neuromuscular blockers
|
|
