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69 Cards in this Set
- Front
- Back
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What is the MAC of Sevoflurane?
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2%
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What is the MAC of Isoflurane?
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1.15%
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What is the MAC of Nitrous Oxide?
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105%
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What is the MAC of Desflurane?
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5.8%
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What is the B/G coefficient of Sevoflurane?
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0.6
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What is the B/G coefficient of Isoflurane?
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1.4
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What is the B/G coefficient of Nitrous?
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0.47
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What is the B/G coefficient of Desflurane?
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0.42
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What is the O/G coefficient of Sevoflurane?
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50
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What is the O/G coefficient of Isoflurane?
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99
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What is the O/G coefficient of Nitrous Oxide?
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1.4
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What is the O/G coefficient of Desflurane?
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18.7
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What inhaled anesthetic is the only inorganic molecule?
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Nitrous Oxide
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What type of molecule are the inhaled anesthetics?
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halogenated ethers (except nitro)
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What type of molecule permeates GABA receptors?
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CL ions
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What drug reverses the effects of benzodiazepines?
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Flumazanil
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What is the mechanism of action of the anesthetics?
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GABA mimetic (propofol, etomidate, benzos)
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What drug blocks glutamate?
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Ketamine
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What is the mechanism of action of ketamine?
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NMDA antagonist . Blocks glutamate.
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What is the mechanism of action of precedex?
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Pre-synaptic alpha 2 agonist
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Mechanism of action of GABA receptor?
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Linked to CL channels. Hyperpolarize cells and therefore inhibit them.
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What are the CNS effects of anesthetics?
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- Depression of CNS
- Decreased CMRO2 - Decreased intra-ocular pressure - Increased ICP |
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What are the 5 Mechanisms for decreased BP in gas anesthetics?
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1) CNS depression
2) Direct cardiac depression 3) Decreased SVR 4) Baro- receptor depression 5) Hormonal changes (decreased renin or vasopressin) |
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What gas anesthetic does not follow the same mechanisms for decreased BP ?
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Nitrous Oxide
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What are the upper limits of Epinephrine dosing under anesthesia?
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- No stronger than 1:100,000
- No more than 10ml/10min (.1mg) - No more than 30ml/hr (.3mg) |
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What gas anesthetics bronchodialate?
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All except nitrous oxide
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What effect does gas anesthetics have on the respiratory system?
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- Depression except nitrous.
- Depress tidal volume before resp rate - Hypoxic pulmonary vasoconstriction (dose dependent) |
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Which two gas anesthetics are respiratory irritants?
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Desflurane and Isoflurane. May cause coughing during induction and emergence.
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What effects do anesthetics have on the renal system?
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- Decrease renal blood flow
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What anesthetic is significantly metabolized?
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Sevoflurane
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What are sevoflurane metabolites?
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- Flouride ions
- Compound A |
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How much of sevoflurane is metabolized?
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5% - 8%
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What anesthetics have analgesic properties?
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- Precedex
- N2O - Ketamine |
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What IV anesthetic has bronchodialating properties?
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Ketamine
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What are 2 effects of Ketamine administration?
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- Bronchodialation
- Salivation |
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What anesthetic is contraindicated in pregnancy?
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Nitrous Oxide
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What enzyme does Nitrous oxide inhibit?
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Methionine synthitase
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What are 4 disadvantages to Nitrous Oxide administration?
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1) Expansion of closed air spaces
2) Requires high concentrations 3) Immune suppresion 4) Teratogenic |
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What are the advantages to Nitrous Oxide administration?
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- Moderate analgesia
- Rapid uptake and elimination - Little cardiac or resp depression - Nonpungent - Allows for co-administration of less potent anesthetics |
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What are the advantages to Isoflurane administration ?
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- Minimal biotransformation
- Maintains cardiac output - inexpensive |
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What are advantages of Desflurane administration?
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- Rapid uptake and elimination
- Stable molecules - Minimal biotransformation |
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What are the advantages of Sevoflurane administration?
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- Rapid uptake and elmination
- Nonpungent |
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What are the disadvantages of Isoflurane administration?
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- Pungent odor
- Airway irritant |
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What are the disadvantages of Desflurane administration?
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- Airway irritant
- Low boiling point - Sympathetic stim. (tachy) - Expensive |
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What are the disadvantages of Sevoflurane administration?
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- Biotransformation
- Reacts with soda lime (compound A) - increase Flourine concentration - Expensive |
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Which agents have the longest elimination half life ?
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Diazepam = 20-40 hr
Lorazepam = 10-20 hr |
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What agent has the shortest elimination half life?
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Propofol = 1-3 hr
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What two proteins do drugs primarily bind to?
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1) Albumin
2) AAG |
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What 4 types of patients would have altered protein binding?
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- Liver disease
- Kidney disease - Malnourished - Last trimester of pregnancy |
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What is the mechanism of action of Ketamine?
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Blocks glutamate from binding to NMDA receptors
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What drugs cause pain on injection?
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- Propofol
- Etomidate |
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What drug is contraindicated in asthmatics?
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Propofol with sulfites
(also pts allergic to sulfites) *Use diprivan |
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What drug can cause myoclonia during induction?
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Etomidate
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What anesthetic is the most cardiac depressing?
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Propofol
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What anesthetic is the least cardiac depressing?
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Etomidate
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What anesthetic stimulates cardiac response?
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Ketamine
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How does Ketamine differ from the other IV induction drugs?
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- Maintain reflexes
- Maintain respirations - Significant bronchodialator |
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What enzyme does Etomidate suppress?
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11 beta hydroxylase
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What enzyme does Etomidate induce?
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ALA synthetase (contraindicated in porphyria)
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What are the primary clinical effects of Ketamine?
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- Phenycyclidine derivative
- Dissociative anesthesia - Increased cerebral metabolic rate, cerebral blood flow, ICP - Nystagmus - Increased intraocular pressure - Analgesic - Increase BP / pulse - Bronchodialator - Maintain reflexes and respirations - Salivation - Increased muscle tone - Emergence Delirium |
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What is the induction dose of Ketamine?
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0.5 - 2 mg/kg IV 4 -6 mg/kg IM
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What drug has anti- emetic properties?
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Propofol
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What drug has emetic properties?
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Etomidate
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What enzyme is inhibited by N20?
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Methionine synthitase
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What drug is contraindicated in parkinsons patients?
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Droperidol
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What cardiac side effects does Droperidol have?
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Long QT
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What medication is contraindicated in patients with Porphyria?
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Etomidate
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Where does dexmedatomidine work?
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presynaptic alpha 2 agonist
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How is droperidol anti-emetic?
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blocks dopamine
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