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94 Cards in this Set
- Front
- Back
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what drug produces dissociative anesthesia?
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ketamine
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In general, how do IV drug agents work?
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these facilitate GABA @ GABAa (like barbituates)
block glycine site of NMDA (memory loss) or bind to Opioid receptors |
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In general how do inhaled anesthetics work/
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these hyperpolarize neurons
enhance inhibition, inhibit excitation decrease NT release facilitate GABAergic transmission @ GABAa |
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What is the potency of inhaled anesthetics proportional to?
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their lipid solubility
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How do general anesthetics affect blood pressure?
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these decrease blood pressure
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How do general anesthetics affect respiration?
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decrease respiratory drive
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How do general anesthetics affect the CNS
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increases blood flow and intracrainal pressure
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How do general anesthetics affect body temp?
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these induce hypothermia
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How do general anesthetics affect nausesa and vomiting?
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these occur postoperatively with most anesthetics.
can treat with ondansetron |
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What general anesthetic is least likely to cause nausea and vomiting?
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Propofol
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How do general anesthetics affect the body upon Emergence?
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Hypertension, tachycarida
which may produce an MI Excitement/Shivering may also occur. these can be reduced with opioids |
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What is the partial pressure of a gas proportional to?
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this is proportional to the concentration of the gas
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Who does the depth of anesthesia of an inhaled agent directly vary with?
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the partial pressure of the drug in the brain
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What does the blood gas partition coefficient represent?
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this represents the concentration of the gas in the blood vs. alveloli @ eq.
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What does a low blood gas coefficient indicate with effect time?
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a low ratio (1:0.47) indicates that the blood will become saturated faster, and the effect of the anesthetic will be more rapid
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What influences the rate of induction of gas anesthetics?
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the concentration of gas
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How does the vent rate affect the partial pressure of a gas?
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a greater vent rate increases the partial pressure and this the blood partial pressure as well
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How does emphysema affect induction and recovery from anesthesia?
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this will slow both
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How does increased pulmonary blood flow affect induction?
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this slows induction, as more blood moves through the lungs, and it takes longer to satruate
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How does decreased pulmonary blood flow (like shock), affect induction?
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this speeds up induction- the blood moves slowly through the lungs so it becomes saturated quickly while sitting there
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What is the MAC definition?
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this is minimum alveolar concentration: the % gas concentration that results in immobility in 50% of pts when exposed to noxious stimuli during surgery.
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Is there alot of variability in MAC between people?
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no there is not
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How do MAC's of two drugs work together?
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these are ADDITIVE
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How does MAC change when using adjunct drugs?
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it will decreases, typically use a 0.8 MAC with adjuncts
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what is the margin of safety for inhaled anesthetics?
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this is LOW, usually 2-4 fold
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After you stop giving nitrous oxide, how do you have to adjust the oxygen delivery? and why?
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must give 100% oxygen, because the nitrous oxide will come out of the blood and displace air from the lungs
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What is the MAC for Halothane (fluothane)
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0.75
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What is the blood/gas ratio for Halothane (fluothane)?
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2.54
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What is the rate of induction of Halothane (fluothane)?
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slow induction, with rapid awakening
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How does Halothane (fluothane) affect the heart and lungs?
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causes respiratory depression
decreases BP, depresses myocaridum arrythmetics |
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What rare but dangerous side effect can occur with Halothane (fluothane)?
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hepatic necrosis- occurs 2-5 days after surgery.
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Halothane and succinylcholine produce what?
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malignant hyperthermia
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how do you treat malignant hyperthemia?
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dantrolene
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What is the MAC for enflurane (ethrane)
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MAC is 1.63
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What is the blood gas ratio for enflurane (ethrane)?
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1.90
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What is the induction of enflurane (ethrane) like?
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this is rapid induction, faster than halothane (due to its lower blood gas ratio)
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How does enflurane (ethrane) affect muscles?
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this causes muscle relaxation and analgesia
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How does enflurane (ethrane) affect the lungs?
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this depresses respiration
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What are the post operative effects of enflurane (ethrane)?
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nausea, vomiting, shivering
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What side reaction can cause damage with enflurane (ethrane)?
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this may produce fluoride ions which damage the kidneys
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What is the MAC of isoflurane (forane)
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the mac is 1.17
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What is the blood gas ratio of isoflurane (forane)?
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1.46
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What is the most commonlyused inhaled anesthetic because of its low toxicity?
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isoflurane (forane)
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How expensive is isoflurane (forane)?
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very much so
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How fast does isoflurane (forane) work?
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this works very fast
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What indicates the depth of anesthesia for isoflurane (forane)?
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decreased BP, decreased respiration, and an increased heart rate
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Does isoflurane (forane) have significant cardiac effects?
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no it does not. But may produce a cardiac steal (stealing blood from ischemic regions by non ischemic ones)
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What drug prevents isoflurane (forane)'s effect on lowering BP?
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nitrous oxide
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how does isoflurane (forane) affect the brain/
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this dilates cerebral vasculature, increasing blood flow and pressure
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What is the MAC for sevoflurane (ultane)
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1.80
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What is the blood/gas ratio for sevoflurane (ultane)?
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0.69
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What has the least airway irritation of the inhaled anesthesias
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sevoflurane (ultane)
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How do you minimize the rise in intracrainial pressure with sevoflurane (ultane)?
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try hyperventilating the pt
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What is the safest inhaled anesthetic for pts with cardiovascular disease?
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sevoflurane (ultane)
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What is the MAC of desfurane (suprane)
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MAC is 6.60
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what is the blood gas ratio for desfurane (suprane)?
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0.42
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What is the emergence and induction of desfurane (suprane)?
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this is very rapid emergence, used for outpt surgery
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Why is desfurane (suprane) not used for induction?
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because it smells bad and is irritating
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How does desfurane (suprane) affect the heat and lungs?
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Lowers BP
Profoundly depresses vent rate** increases HR |
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What can cause the immune response and hepatitis from halothane?
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chlorine and bromine may be removed from the drug
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What is nitrous oxide used for?
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this is rapid onset and low solubility- used for dental procedures
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Why is nitrous oxide used as an adjuvant?
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this is used with other inhaled anesthetics to increase the rate of induction
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can nitrous oxide be used to produce anesthesia?
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no the concentrations required are too high
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What happens when you stop nitrous oxide?
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diffusion hypoxia can occur, requires 100% oxygen admin upon anesthesia termination
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How does nitrous oxide affect BP?
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this attenuates hypotension when combined with other anesthetics
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How can trapped gas be dangerous with nitrous oxide?
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this will displace nitrogen gas, which will expand as it comes out of solution- kind of like the bends
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What can chronic low level exposure to nitrous oxide lead to?
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peripheral neropathy like in B12 deficiency
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What can happen with prolonged administration of nitrous oxide?
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decreased leukocyte production and RBC production. causing a megaloblastic anemia
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What is the MAJOR contraindication to use of nitrous oxide?
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eye surgery that used intraocular gasses within 3 months of procedure
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What is thiopental (pentothal) used for?
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this is used for induction of anesthesia
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How long does thiopental (pentothal) last, and how is it given?
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this lasts for about 10-20 min,
given IV |
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What is the absolute contraindication of thiopental (pentothal)?
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with people who have acute intermittent porphyria
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What is midazolam (versed) used for?
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this is ultrashort acting benzo- used for sedation, anxiety relief, and anterograde amnesia
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What is midazolam (versed) often combined with for minor surgical procedures
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fentanyl
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What is the IV drug of choice for anesthetic procedures?
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Propofol (Diprivan)
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How does Propofol (Diprivan) work?
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this facilitates GABAergic transmission
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What is Propofol (Diprivan) used for?
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induction and maintenance of anesthesia
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what is the induction and emergence of Propofol (Diprivan) like?
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rapid induction, but even more rapid emergence (compared to thiopental)
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How does Propofol (Diprivan) affect the lungs?
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this is a severe respiratory depressant
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how does Propofol (Diprivan) affect the brain?
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this decreases cerebral blood flow, metabolism, and intracrainial pressure- good for neurosurgery
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Is Propofol (Diprivan) safe for pregnancy?
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yes it is
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What are the three adverse reactions of the generally safe Propofol (Diprivan)?
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respiratory depression
injection site reaction anaphylactic reactions |
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How does Etomidate (amidate) work?
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this facilitates GABAergic transmission
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What kind of pts is Etomidate (amidate) best used in?
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ones who are at risk for hypotension. because it doesnt affect BP or HR
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What side effects is Etomidate (amidate) very likely to cause?
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nausea and vomiting
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How does Ketamine (Ketalar) work?
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this acts by blocking NMDA receptors
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What effects does Ketamine (Ketalar) produce?
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a catatonic state, eyes open and respiration ok.
dissociative anesthesia- profound analgesia, anmesia, superficial level of sleep |
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How does Ketamine (Ketalar) affect the lungs?
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very little respiratory depression
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How does Ketamine (Ketalar) affect BP?
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increased HR and increased BP as it is a sympathomimetic
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What are the emergence effects of Ketamine (Ketalar) ?
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bizarre dreams, hallucinations, psychosis
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Does Ketamine (Ketalar) cause nausea or vomiting?
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no it does not
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How is fentanyl given?
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as IV injection, or lollipops for kids
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What can be given to antagonize fentanyl?
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naloxone
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What are the side effects of Enflurane at high MAC?
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these cause CNS stimulation and seizures, contraindicated in seizure pts
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