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13 Cards in this Set
- Front
- Back
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What are the 4 Basic Elements of General Anesthesia?
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1. Unconsciousness (hypnosis)
2. Amnesia 3. Analgesia (no reflex responses) 4. Immobility (skeletal m. relaxation) |
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What are the Guedel Stages of Anesthesia?
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Stage I - Analgesia
(induction to loss of consciousness) Stage II - Excitation (loss of consciousness to rhythmic beating) Stage III - Surgical Anesthesia (subdivided into 4 planes) Stage IV - Medullary Paralysis (overdose!) |
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Under what conditions were Guedel's stage's described?
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Inhaled Diethyl Ether with NO premeds
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Tell me more about Stage II
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Excitation (loss of consc. to rhythmic beating)
PASS Through this stage ASAP Uninhibited Excitation - potentially dangerous responses to noxious stimuli --movement, biting, vomiting, defecation, laryngospasm, hypertension, tachycardia, hyperventilation |
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Tell me more about Stage III
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Surgical Anesthesia (onset of regular breathing - respiratory arrest)
Plane 1 - eyes, responsive, slight muscle relax, normal breathing Plane 2 - eyes immobile, shorter inspiratory than expiratory Plane 3 - relaxed ab and diaphragmatic breathing Plane 4 - Pupils Dilated, Irregular Breathing |
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Tell me more about Stage IV
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OD -- AVOID STAGE FOUR!
Apnea due to Diaphragmatic Paralysis progresses to CV depression and arrest. |
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What is the most significant site of action for anesthetic drugs?
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Dispute:
The Lipid Theory (the membrane) The Protein Theory (membrane receptors) Current evidence is leaning towards the Protein Theory. |
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What are the goals of Injectable Anesthesia?
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-Safe, Rapid, Reversible general anesthesia in a single bolus.
-maintain anesthesia with continued doses without notable accumulation or adverse effects |
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Rapid Acting Injectables
(B-PICS) |
Barbituates (Thio, Methohexital)
Phenols (Propofol) Imidazoles (Etomidate, Metomidate) Cyclohexanes (Ketamine, Tiletamine) Steroids (Alphaxalone, Alphadolone) |
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Slower Acting Injectables
(CN-PoUCh) |
Chloralase
Neuroleptanalgesics Potent Opiods (Fentanyl, Sufentanil, Alfentanil) Urethan Chloral Hydrate |
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What rocks about rapid acting injectables?
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Pass by Stage II (Excitation)
Unconsciousness comes generally in less than One Minute. |
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What major factor affects how rapidly these drugs take?
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Lipid Solubility
High solubility - easy to cross BBB - fast! Barbital :: Phenobarb :: Thio 1 (22mins) :: 3 (12mins) :: 280 (immediate) |
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Why do injectables last for such a short period of time?
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Rapid Redistribution from highly perfused tissues to LEAN and eventually fatty stores.
(especially for ultra-rapids like Thio) |
