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68 Cards in this Set

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Review the differences between "induction" "maintenance" and "emergence"
page 209
Since inhalational anesthetics are gases, how is the partial pressure of these gases useful as a measurement?
partial pressure is proportional to concentration
How are inhalant general anesthetics transferred from one compartment to another?
passive diffusion down their partial pressure gradients
Name the compartment inhalant general anesthetics pass through on their way to the CNS.
inspired gas --> alveoli --> blood --> target CNS and other tissues
What is the inhalent general anesthetic concentration in the CNS dependent upon?
the final alveolar tension
what 3 things govern the rate of induction of a general anesthetic?
1. Rate of equilibration (which is dependent on the tension of the anesthetic of the inspired gas + pulmonary ventilation rate)… 2. Rate of blood equilibration (which is dependent on the blood solubility of the drug, where the lower the blood solubility coefficient = faster rate, because the more blood soluble the slower the induction and the slower the equilibration)... 3. Rate of Tissue Equilibration (which is dependent on tissue blood flow rates... brain>heart>lung... etc.)
Which of the 3 things that govern induction rates of general anesthetic is most critical?
blood solubility
If general anesthetics are generally fat soluble, why do drugs take so long to equilibate in fatty tissue?
poor blood flow to fatty tissues
What governs rate of emergence?
the same factors that govern induction
T/F metabolism and renal clearance play a significant role in the elimination of inhalational anesthetics.
FALSE… they play a minimal role
What determines the potency of a inhalation anesthetic?
it's lipid solubility
T/F the more lipid soluble an inhalation anesthetic the less tension it require to produce anesthesia.
Do lipid soluble inhalation anesthetics tend to have low or high blood solubility?
they have high blood solubility, while they are more potent they tend to be slow inducers
What does MAC stand for? (2 things)
1. MAC = minimum alveolar concentration anesthetic needed to produce immobility in 50% of patients… 2. it's an index of potency…
What is a good measure of brain tension for inhalation anesthetics?
alveolar tension = brain tension
T/F MAC can only be applied to inhalation anesthetics if they were nor a solid or liquid first.
false all inhalation anesthetic are ranked by MAC
T/F MAC is stable across a variety of conditions, e.g., gender, height, acid-base status.
T/F MAC is additive for different inhalant anesthetics.
Which is the most potent inhalational anesthetic? Which is the intermediate MAC? Which ihalent has the least potent?
most potent = Halothane…Intermediate = Isoflurane... least potent = NO
What is considered a potent MAC a large value or small value?
Which inhalational anesthetic cause a decrease in intracranial pressure (while the other cause an increase.)?
Decrease = Isoflurane… increase = NO and Halothane
Which inhalational anesthetic would require pretreatment to avoid airway irritation?
Isoflurane, which is the the only inhalational anesthetic that causes airway irrititation
Which inhalational anesthetic would you avoid if the patient has issues of low blood pressure?
isoflurane and halothane, which both cause significant hypotension… use NO instead
Between NO, halothane and isoflurane, which has the lowest blood solubilitiy? What is the consequence of this?
NO… which makes it a rapid inducer… the other have a medium rate of induction
T/F NO, halothane and isoflurane all have analgesic effects.
which inhalation anesthtic will cause hypoxia at partial pressures of 70-80%?
NO (diffusion hypoxia)
In NO use, what happens during rapid emergence that causes a large drop in PaO2? And what is this effect called?
NO saturates the alveoli… this is called the diffusion hypoxia effect
Why is NO used as an adjuct with other inhalation anesthetics?
becaues of its low potency and risk for hypoxia
Rank the inhalational anesthetics in order of greater to least muscle relaxation effects.
Isoflurane > halothane> NO (yes>minimal>none)
Rank the inhalational anesthetics in order of greater to least respiratory system effects.
Isoflurane (potent respiratory depressant) > Halothane (causes moderate reduction in rate) > NO (minimal effect)
Which is the only inhalational anesthetic that comes in a gas form?
NO.. The others are in volitile liquid form
why is isoflurane a good choice for neurosurgery?
isoflurane decreases cerebral blood flow and lowers intercranial pressure
Which is the most potent inhalation anesthetic?
which inhalation anesthtic will cause liver nicrosis in adults, but is still used in pediatrics?
which inhalation anesthtic will cause coughing and layrngospams and requires premedication or use of thiopental as an induction agent?
What is the advantage of IV general anesthetics?
fast onset and ultra short acting… but moreover they are highly POTENT!!!!
Why is the combination of IV general anesthetics and inhalation anesthetics useful?
IV general anesthetics lowers the doses of inhalational anesthetics
What properties do all IV general anesthetics share?
all are IV injected and all are lipophilic (which makes sense in terms of potency)
Why is the CNS preferentially targeted by IV general anesthetics?
the CNS is highly perfused and lipophilic friendly
What two things is the rate of induction for IV general anesthetics dependent upon?
1. Lipid solubility of the IV general anesthetics… 2. The administered dose (i.e., one large bolus)
where do IV general anesthetics redistribute after first going to the CNS?
1. First, the less well perfused muscle and viscer… 2. Then the hydrophobic, but poorly perfused adipose tissues
After redistribution, how are IV general anesthetics cleared from the body?
liver metabolism and renal excretion
Which is more responsible for emergence for IV general anesthetics, liver metabolism, renal excretion, or redistribution? (not continuous or intermittent use!!!)
1. If the IV general anesthetics is used continuously or intermittently for a prolonged period, Which is more responsible for emergence for IV general anesthetics, liver metabolism, renal excretion, or redistribution?… 2. What then determines IV general anesthetics elimination half-life?
1. Since the drug has equilibrated in all tissues, termination of drug action is now dependent on elimination from the body… 2. Infusion DURATION.
What is the best example emergence being dependent upon infusion duration?
a single bolus dose of thiopental has rapid emergence, while prolonged infusion takes a day to emerge
How are IV general anesthetics measured?
potency (lipophilicity) and dose
Which IV general anesthetics is a barbiturate?
which IV general anesthetics is a phenol?
Which IV general anesthetics is susceptible to bacterial contamination?
Which IV general anesthetics dissociates the thalamus from the limbic cortex?
Which IV general anesthetics have lipid solubility and high potency?
all of them
Which IV general anesthetics is a synthesized as a Na-salt from propylene glycol, alcohol and water?
which IV general anesthetics is similar to PCP?
Which IV general anesthetics increases CO, HR, and BP?
which IV general anesthetics can increase the risk of seizure in epileptic patients?
which IV general anesthetics decreases intracranial pressure?
Which of the IV general anesthetics offers analgesic properties?
Which IV general anesthetics produce early airway irritation?
which IV general anesthetics can allergic rxns in patients with a phenol allergy and has a high incidence of injection pain?
which IV general anesthetics can cause hypotention?
thiopental can cause hyptension in hypovolemic patients… propofol can cause moderate hypotension
Which IV general anesthetics can cause dose dependent respiratory depression?
both propofol and thiopental
which IV general anesthetics does not shows prolonged emergence due to prolonged infusion? What does this mean for its use as a maintenance anesthetic?
propofol… quick emergence --> it's a good maintenance IV general anesthetics
Which IV general anesthetics has a slow-long emergence?
which IV general anesthetics can be titrated to achieve various levels of consciousness?
Which IV general anesthetics can produce severe pain and necrosis if accidental extravascular injection occurs?
Which drug is has an active metabolite, is an analog of PCP, can develop tolerance, and is a potent broncho dilator?
How do general anesthetics work?
change activity of voltage gated and ligand gated channels (Ca), also GABA receptor have increased sensitivity… except NO is thought to depress the nervous system by inhibiting NMDA receptors
which inhalent is sweet smelling?
Halothane... used for kids