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59 Cards in this Set

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List the 4 Stages of Anesthesia
1. Stage 1 = Analgesia = from administration - loss of consciousness

2. Stage 2 = Delirium = loss of consciousness - regular respiration

3. Stage 3 = Surgical = regular respiration - respiratory arrest

4. Stage 4 = Medullary Paralysis Stage = respiratory arrest - death
List the properties of the ideal general anesthetic
-
What are the 2 general types of anesthesia?
1. Inhalable

2. Fixed (IV)
What are the advantages & disadvantages of Inhalable Anesthetics?
Ad's
1. Very controllable
2. readily reversible

Disad's
-induction not as fast or smooth as with fixed agents
What is the mechanism of action of the Inhalable Anesthetics?
1. depress spontaneous & evoked neuronal activity

2. may involve actions at various ion channels
-voltage-gated K+ channels
-GABA-A receptor Cl- channels
*results in Hyperpolarization
What does the concentration of an individual gas in a mixture of gases depend on?
Partial pressure (tension)
What does the rate at which a given concentration of anesthetic in the brain depend on?
1. Blood: gas partition coefficient (Ostwald Coefficient) = lower coefficient -> less soluble -> more rapid rise in partial pressure in blood -> faster equilibration w/ brain

2. Brain: blood partition coefficient

3. Anesthetic concentration in the inspired air

4. Pulmonary ventilation

5. Pulmonary Blood flow

6. Arteriovenous concentration gradient

7. Elimination - blood:gas partition coefficient is very important = less soluble -> faster elimination
Define the "Minimum Alveolar Concentration"
the concentration of anesthetic (%) in the inspired air at equilibrium when there is no response to a skin incision in 50% of the patients
What does a higher "Minimum Alveolar Concentration" correspond to?
Less potency = takes more anesthetic to cause no response to skin incision in 50% of pts
Name a gaseous inhalable anesthetic?
Nitrous Oxide
What are the properties of Nitrous Oxide? (4)
1. Gaseous inhalable anesthetic
2. insufficient potency for surgical anesthesia
3. has analgesic activity (absence of pain w/out losing consciousness)
4. can be used as a carrier for volatile anesthetics
What are the 4 Volatile Inhalable Anesthetics?
1. Halothane
2. Desflurane
3. Enflurane
4. Isoflurane
What is the most widely used Inhalable Volatile Anesthetic?
Isoflurane
What properties do the Inhalable Anesthetics vary in?
1. Potency
2. Rate of induction & emergence
3. degree of muscle relaxation produced
What are the adverse effects of the Inhalable Anesthetics?
1. Depression of the CV function
-decreased BP
-depressed myocardium
-decreased CO
-Arrythmias &/or tachycardia
-Sensitization to Catecholamines

2. Decreased blood flow to liver & kidneys

3. Organ toxicity
-Liver = Halothane
-Kidney = Enflurane

4. Malignant Hyperthermia = occurs in genetically susceptible individuals w/ inhalable anesthetics combined with paralytics
What inhalable Anesthetic can cause Liver toxicity?
Halothane
What inhalable anesthetic can cause kidney toxicity?
Enflurane
Nitrous Oxide
What inhalable anesthetic?
What inhalable anesthetic?
Halothane
What inhalable anesthetic?
Enflurane
What inhalable anesthetic? Only one that does NOT DEPRESS the Heart
Isoflurane
What inhalable anesthetic?
Desflurane
What are the advantages & disadvantages of IV/Fixed Anesthetics?
Advantages over Gaseous
-Quick, easy, & smooth induction

Disadvantages
-slow elimination
Barbiturate that is used as a Fixed Anesthetic
Thiopental
List the properties of Thiopental as a Fixed Anesthetic
1. Barbiturate
2. Rapid & pleasant induction
3. No analgesia, but Hyperalgesia
4. profound decrease in respiration at anesthetic doses
5. difficult to control the level of anesthesia
6. redistributes to other tissues, can accumulate in adipose tissue
7. Often used with Nitrous Oxide
Fixed Anesthetic that is similar the Barbiturates, except a more rapid recovery (less postoperative nausea).

Causes significant decrease in Blood Pressure
Propofol
Benzodiazepine used as a Fixed Anesthetic
Midazolam
Fixed anesthetic whose induction is too slow to induce anesthesia; good for maintenance of anesthesia with other agents
Midazolam
This is the most common drug used for Endoscopy
Midazolam = causes Anterograde Amnesia
Fixed Anesthesia that causes Dissociative Anesthesia (Loss of sensation for pain and temperature without the loss of tactile sense)
Ketamine
What is the mechanism of action of Ketamine?
Blocks Glutamate receptor ion channels

**Glutamate receptors are excitatory
What are the properties of Ketamine? (8)
1. Dissociative Anesthetic
2. related to Phencyclidine
3. short duration of action
4. Excellent analgesia & amnesia
5. poor muscle relaxation
6. Cardiac stimulation
7. "Emergence Phenomenon" = hallucinations & disorientation
8. use is limited mainly to small children

"Kat"-amine is Dissociative, does PCP, no pain & forgets, always works out so no muscle relaxation but high Heart rate (cardiac stimulation), has hallucination & disorientation, is short (duration) like a kid (use)
Fixed anesthetics that can achieve anesthesia with sufficient dose; useful in patients with compromised Cardiovascular function
Opioids = Fentanyl & Alfentanil
Fixed anesthetic used for the induction & balanced anesthesia, especially in patients at risk for Hypotension
Etomidate

Judge "Eto is My Date" & when we are together we do not cause CV or Respiratory depression or Hypotension
Fixed Anesthetic with the following properties:
-Minimal Cardiovascular or Respiratory Depressant effects
-No analgesic activity
-high incidence of nausea, vomiting, pain on injection, & myoclonus (rapid, shock-like jerking movement)
Etomidate
List 5 reasons as to why Preanesthetic medication is given
1. Increase rate of induction
2. decrease anxiety
3. decrease pre- & postoperative pain
4. decrease side effects of general anesthetics
5. reduce amount of general anesthesia required
List the types of Preanesthetic Medications given
-
What are the advantages of Neuromuscluar Blocking Agents?
1. Minimize anesthetic use
2. Good for Orthopedic procedures
3. Short acting paralytics good for intubations, Electroconvulsive Therapy, etc
4. Should never be used as a substitute for inadequate anesthesia
List the Competitive Motor Nicotinic Antagonists (Neuromuscular Blocking Agents)
1. Tubocurarine
2. Atracurium
3. Mivacurium
4. Roncuronium
What is the mechanism of action of the Neuromuscular Nicotinic Antagonists?
Compete with ACh for receptors
Tubocurarine
1. what is its potency altered by?
2. What does it cause a large increased release of?
1. pH

2. Histamine
What is the name of the Neuromuscular Blocking agent that is a Depolarizing Nicotinic Agonist?
Succinylcholine
What is the duration of action of Succinylcholine?
< 8 min
-
-
What are the adverse effects of Neuromuscular Blocking Agents?
Many paralytics cause Histamine release -> hypotension & bronchospasm

**most pronounced with d-Tubocurarine
What drug interactions do the Neuromuscular Blocking Agents possess?
1. Opioids
2. Local anesthetics = increase potency of both competitive & depolarizing agents
3. Anticonvulsants
4. Cardiovascular drugs
5. Antibiotics = esp. Aminoglycosides
6. Inhalable anesthetics
What is the mechanism of Local Anesthetics?
1. Block nerve conduction by blocking voltage-gated channels
2. Small diameter neurons are affected first
-pain neurons are blocked first
-then cold, warmth, touch, & deep pressure
List the Ester Local Anesthetics
Cocaine
Benzocaine
Procaine
Tetracaine

**"-CAINE"
**have only 1 "I", as opposed to the Amides which have 2 "I"'s
Ester Local Anesthetic that penetrates membranes, is a vasoconstrictor, & is medium acting
Cocaine
Ester Local Anesthetic that is used on surfaces only (topical use)
Benzocaine
Ester Local Anesthetic that is used in Infiltration & Spinal Block anesthesia; is short acting (half-life = < 1 min)
Procaine
Long-acting Ester Local Anesthetic
Tetracaine
What are the Amide Local Anesthetics used for?
1. Infiltration = injection of local anesthetic into the tissue to be anesthetized

2. Peripheral Nerve block = injection of local anesthetic in the vicinity of a peripheral nerve to anesthetize that nerve's area of innervation

3. Epidural block = local anesthetic is injected into the epidural space where it acts primarily on the spinal nerve roots
List the Amide Local Anesthetics
1. Lidocaine

2. Bupivicaine

3. Mepivacaine

**end in CAINE but also have 2 I's
This is the most widely used, medium acting Amide Local Anesthetic
Lidocaine
Long acting Amide local anesthetic
Bupivicaine
List the adverse effects of the Local Anesthetics
1. CNS = stimulation leading to convulsions (esp. Esters)

2. CV = depression of myocardial conduction & peripheral vascular tone = Hypotension

3. Allergic reaction = Esters, due to p-aminobenzoic acid metabolites
Why are the Ester Local Anesthetics more prone to Allergic reaction?
p-aminobenzoic acid metabolites
Local Anesthetic Pharmacokinetics:
1. metabolism/excretion
2. what can increase the duration of action?
3. when is sensitivity increased?
1. Metabolism = liver; excretion = urine

2. by adding Vasoconstrictor

3. during pregnancy