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28 Cards in this Set
- Front
- Back
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Name 4 effects general anesthetics have
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Analgesia
Amnesia Unconsciousness Muscle Relaxation |
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List 4 modern anesthetics
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Nitrous Oxide
Isoflurane Sevoflurane Desflurane |
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List 4 non anesthetic effects of generals
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Depressed B.P
Increased HR (baroreflex) Depress Breathing Depressed Metabolism |
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Which general anesthetic raises BP?
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Nitrous Oxide, you can add it to a stronger anesthetic to compensate for their effects.
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What two generals increase airway reflexes?
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Desflurane and isoflurane
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What is MAC and what is it analogous to?
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MAC is the property of an anesthetic where 50% of people will not respond to a skin incision. It is additive between drugs.
It is analogous to a pharmacodynamic property |
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What is Fa/Fi? Name 3 properties that determine it.
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Its a property of how much of a drug makes it into the alveolus versus what is inspired.
Its related to the A/V gradient, cardiac output, and drug soluability |
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Describe a drug that has a high Fa/Fi in terms of solubility and circulation.
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You want to get as much drug into the alveolus as possible, not diluted into the blood where it cant effect the brain.
This means a high Fa/Fi drug has low solubility and induces reduced circulation. |
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What primarily effects general anesthetic uptake and redistribution once it is in the blood?
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Vascularization, the more vascularized the tissue, the faster it enters the tissue.
This gives rise to the sharp turns seen in an Fa/Fi curve |
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How are most anesthetics eliminated? How are they metabolized?
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They are eliminated by respiration. Some of the drug is metabolized by the liver (this can be toxic in extremely long cases, so long they never happen)
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List 5 induction agents
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Thiopental
Midazolam Etomidate Propofol Ketamine |
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Describe the kinetics of induction agents relative to their effect.
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The initial bolus generates a rapid effect for the drug. As the drug redistributes, it goes to sub therapeutic levels. By this time, you would have administered a gaseous general
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Describe the unique properties of thiopental.
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Not a benzodiazapine, 15-30 second efficacy, highly fat soluable.
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How do most barbituates function?
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Stimulation of the release of GABAa and decreased glutamate function.
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What is a major contraindication of thiopental?
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Global ischemia. It can have a positive shunt effect in focal ischemia though
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What is a negative effect of thiopental?
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Venodilation, in major blood loss cases this it really kinda deadly.
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What are the side effects of thiopental?
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Allergic reaction, tissue irritation, respiratory depression
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What are the effects of propofol?
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Amnesia, antiemesis, decreased ICP, decreased respiration, pain on injection
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What is a major side effect of propofol?
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Hypotension, it vasodilates, depresses CV function and inhibits the baroreflex.
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What are the effects of etomidate?
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Hypnosis WITHOUT ANALGESIA
Decreased ICP, CBF Myoclonus (sometimes seizures) |
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What is the upside of etomidate?
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Minimal effects on HR, BP, and CO.
It has an adrenocortical effect as well do it can be used in an addinsonian crisis. This makes it good for induction in trauma and CV patients |
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What are the contraindications for etomidate?
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Steroid therapy
Addinson's disease Severe volume contraction Seizure Disorders |
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What are the effects of Ketamine?
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Dose related unconsciousness, Increased ICP, CBF, CO, HR, BP (despite direct myocardial depression)
Emergence delerium (prevenatable by midazolam) |
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What are the contraindications of Ketamine?
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Elevated ICP
Ischemic heart disease Aneurysms Psychiatric Disorders |
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How do general anesthetics maintain CO despite vasodilation?
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They increase HR to compensate
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Anesthetics all depress respiratory drive so why are they used as a last line in asthma?
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They are bronchodilators as well.
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In some cases of anesthesia it is important to relieve pre-anesthesia anxiety. How?
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Give a benzodiazapene such as etomidate.
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What anesthetic is useful in mask induction?
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Sevoflurane
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