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pharm 2 > Anesthesia > Flashcards

Anesthesia Flashcards

1
Q

Types of Sedation

A

Conscious sedation - alleviates pain and anxiety without altering consciousness. Patient is able to maintain a patent airway and can respond to verbal commands.

Deep Sedation - light general anesthesia with decreased consciousness in which the person is not easily aroused. May be indistinguishable from general.

General Anesthesia - Depress the CNS causing complete loss of protective reflexes, ability to maintain a patent airway and respond to verbal commands.

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2
Q

5 Effects of General Anesthesia

A

Unconsciousness
Amnesia
Analgesia
Inhibition of autonomic reflexes
Skeletal Muscle relaxation.

No anesthetics currently available achieve all 5 alone.

Ideally should induce rapid, smooth, and reversible loss of consciousness.

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3
Q

Guedel’s Stages of anesthesia

A

Analgesia - Normal respiration, ocular movement, pupil size, reflexes, muscle tone, HR, BP. Used in labor, incisions, and minor operations

Delirium - Rapid respiration and HR, roving eye movements, dilated pupils, most reflexes, high BP, high skeletal muscle tone. Not used

Surgical Anesthesia - Respiration slows, eyes become fixed, pupil sizes from normal to dilated, loss of reflexes, decreased muscle tone, BP, HR. Stages 1 and 2 for most surgeries, 3 for some, 4 never attempted.

Medullary Paralysis - severe CNS depression resulting in death.

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4
Q

Anesthesia objectives

A

Minimize deleterious effects
Sustain homeostasis
Improve postoperative outcomes

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5
Q

General Hemodynamic Effects

A

Decreased MAP
Blunted baroreceptor reflex
Decrease in sympathetic tone.

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6
Q

General Respiratory Effects

A

Reduce or eliminate ventilatory drive and airway patency. Endotracheal intubation is necessary.

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7
Q

Reasons for Hypothermia

A

Low ambient temp, exposed body cavities, cold IV fluids, reduced thermoregulatory control, and reduced metabolic rate.

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8
Q

Causes of Nausea and Vomiting

A

Action of anesthetic on chemoreceptor trigger zone modulated by 5HT, histamine, ACH, DA, and NK1

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9
Q

Other Postoperative side effects

A

HTN
Tachycardia
Ischemia
Airway Obstruction

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10
Q

Balanced Anesthesia

A

Use of multiple classes to achieve the desired effect and depth given both preop and postop

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11
Q

Inhibitory Neuron Target of Anesthetics

A

GABAa receptor
Potassium channels

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12
Q

Excitatory Ion Channel Targets

A

NMDA receptors
Serotonin Receptors
ACH receptors

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13
Q

Parenteral Anesthetics

A

Methohexital
Etomidate
Ketamine
Propofol

Small Hydrophobic and lipid soluble

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14
Q

Parenteral Anesthetics that potentiate the GABA receptor

A

Etomidate and Propofol

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15
Q

Parenteral Anesthetics that inhibit the NMDA receptor

A

Ketamine

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16
Q

Redistribution: Three Compartment Model

A

Blood -> brain -> skeletal muscle.
Leads to termination of effects

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17
Q

Context sensitive half time

A

Elimination half time after discontinuation of a continuous infusion.

Ketamine, propofol, and etomidate show little increase in half life with prolonged infusion.

Redistribution, accumulation in fat, and drugs metabolic rate affect duration of action

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18
Q

Propofol

A

MOA: Potentiation of GABA, sodium channel blockade

Applications: Rapid onset and short duration. anesthetic induction, used in procedures for rapid return to preop mental status

Reduce dose in elderly due to reduced clearance, increase dose in young children due to rapid clearance

**Propofol infusion syndrome associated with prolonged high doses in young or head injured patients

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19
Q

Etomidate

A

MOA: Stimulates GABA

Applications: Rapid onset and short duration. anesthetic induction, used in procedures for rapid return to preop mental status

Preferred for patients at risk of hypotension or MI. Produces hypnosis and has no analgesic effects. INCREASED EEG ACTIVITY. DO NOT USE IN EPILEPSY

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20
Q

Ketamine

A

MOA: NMDA antagonist

Applications: Rapid onset and short duration. anesthetic induction, used in procedures for rapid return to preop mental status

Suited for patients with hypotension, asthma, and pediatric procedures. Increases HR, BP, CO, CBF, and ICP. Mental side effects like delirium and hallucinations

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21
Q

Methohexital and Thiopental

A

MOA: Stim GABA

Application: Anesthetic induciton

Respiratory and EEG depressant

Rapid clearance

Possible inflammatory or necrotic reaction with injection

22
Q

Inhalation Anesthetics

A

Fluranes and NO

Most dangerous drugs in clinical use due to narrow therapeutic window

Fluranes are liquids are room temp, NO is gas

Increase in solubility slows induction of anesthesia. NO less soluble than fluranes

23
Q

Inhalation Uptake

A

FA approaches FI fastest for the least soluble agents.

Low blood solubility leads to rapid concentration increase

Greater blood solubility causes more molecules to dissolve in the blood before the partial pressure changes, causing the arterial pressure to increase less rapidly

24
Q

Effect of ventilation on FA/FI

A

To accelerate induction increase the inspired anesthetic pressure.

Increase tidal volume and respiratory rate

Greater increase in FA/FI ratio with an increase in ventilation for halothane when compared to NO

25
Q

Minimum Alveolar concentration

A

Concentration of inhaled anesthetic needed to eliminate movement in 50% of patients stimulated by incision.

Inverse is a measure of potency

MAC is small for potent and large for weak.

NO cannot produce anesthesia alone

26
Q

Elimination

A

Most soluble take longer to clear.

Insoluble prefer gas phase and rapidly diffuse to alveoli and are eliminated

Ventilation is the determining variable.

27
Q

Toxicity of Inhalation Anesthetics

A

Acute: nephrotoxicity, hematotoxicity, genetic hyperthermia, hepatotoxicity.

Chronic: Mutagenicity, teratogenicity, reproductive effects, cardiogenicity.

28
Q

Isoflurane

A

MOA: Increases GABA release and glutamate reuptake decreasing motor function.

Application: Maintenance of anesthesia

Highly volatile at RT. Decreases ventilation and RBF. Increases CBF. Hypotension and increased coronary blood flow, decreased myocardial O2 demand. Decreased baroreceptor reflex.

29
Q

Enflurane

A

MOA: Positive allosteric effector of GABA receptor.

Application: Maintenance

Also volatile with slow induction. Decreased arterial BP and decreased contractility. Possible increased ICP and seizure

30
Q

Sevoflurane

A

MOA: not fully understood, likely membrane hyperpolarization through GABA

Application: Anesthetic induction for outpatient surgery.

Ideal induction agent. Decreased AP and CO, so preferred for patients with ischemia. Sevoflurane + CO2 absorbent soda lime is nephrotoxic.

31
Q

Desflurane

A

MOA: Same as sevoflurane

Application: Same as sevoflurane, although not preferred over it.

Highly volatile, nonflammable in mixtures of air of O2. Airway irritant

32
Q

Nitrous Oxide

A

MOA: Unknown

Weak anesthetic with analgesic effects

Used as adjunct.

Expands volume of air containing cavities, so avoid in ear or bowl obstructions or introcular bubbles.

Administer 100% O2 rather than air when discontinuing to avoid hypoxia.

Controversial due to potential changes in DNA and protein synthesis

33
Q

Neuromuscular Blocking Agents MOA

A

Nondepolarizing: prevents the opening of sodium channel when bound to the receptor

Depolarizing occupies the receptor and blocks the channel.

34
Q

Neuromuscular Blocking Agents Uses

A

Surgical relaxation
Endotracheal intubation
Control of ventilation
Treatment of convulsions, although they don’t cross the BBB.

35
Q

Assessment of Neuromuscular Transmission

A

Nondepolarizing: Fade

Depolarizing phase I: Diminished

Depolarizing phase II: Fade

36
Q

Succinylcholine

A

MOA: Persistent depolarization at NMJ

Rapidly metabolized by plasma cholinesterase

Arrhythmias. hyperkalemia, intraocular and abdominal pressure, and postop muscle pain are possible side effects.

37
Q

-curium/curonium

A

MOA: Competitive antagonist at nACH receptors

Application: relaxation for surgical procedures

Action is usually antagonized by Sugammadex or and ACH inhibitor when the effects is no longer desired.

Toxic Effects: Prolonged apnea

38
Q

Sugammadex

A

MOA: Noncompetitive inhibition of rocuronium and vercuronium through encapsulation

Used to reverse neuromuscular blockade.

Side effects: Bradycardia, hypersensitivity, recurrence of neuro blockade, headache, vomiting, nausea.

39
Q

Benzodiazepines

A

Midazolam
Diazepam
Lorazepam

Enhance GABA

Used to anxiolysis, amnesia, sedation.

Midazolam is most commonly used followed by the other two

40
Q

A2 agonists

A

Dexmedetomidine

Short term sedation of critically ill adults or sedation prior to procedures in non-intubated patients

Side Effects: Hypotension and Bradycardia

41
Q

Opioids

A

Reduce anesthetic requirement and minimize hemodynamic changes due to painful stimuli

Primary analgesics during perioperative period.

Administered intrathecally and epidurally.

42
Q

NSAIDs

A

Used for minor surgical procedures to control postoperative pain

43
Q

Oxygen

A

Used to reverse or prevent hypoxia

Excessive use decreases ventilation
HR and CO decrease
Can irritate mucosal surfaces so humidified O2 should be used.

44
Q

Carbon Dioxide

A

Insufflation during endoscopic procedures
Flooding surgical field during cardiac procedures
Adjusting pH during bypass

Highly soluble
Respiratory acidosis
Increases CO, HR, and BP

45
Q

Local Anesthetics

A

MOA: Bind inside ion channel and block sodium ion entrance to prevent depolarization

Extradural injection = epidural

Caudal block = needle inserted into caudal canal via sacral hiatus

Peripheral nerves = perineural block

CSF = Spinal block

46
Q

Local Anesthetics Absorption

A

Dependent on dosage, site of injection, drug tissue binding, local tissue blood flow, and physiochemical properties of the drug.

More lipid soluble = more potent and longer duration of action + longer time to achieve effect.

Peak serum values vary based on site of injection. Intercostal is highest while femoral and sciatic are lowest

47
Q

Local Anesthetic Toxicity

A

CNS - sedation, lightheadedness, visual and auditory disturbances

Cardio - Negative effects on conduction and overall function

Neural: Potential neruotoxicity leading to neural injury.

Transient Neurologic symptoms: possible transient pain or dysthesia

48
Q

Short Duration Local Anesthetics

A

Lidocaine
Prilocaine
Mepivacaine

Duration 1-2h/ 2-4h with epi

Prilocaine and Mepivacaine pose a risk of methemoglobinemia

49
Q

Longer Duration Local Anesthetics

A

Bupivacaine
Ropivacaine
Levobupivacaine

Duration 3-6 h

Possible cardiovascular collapse

50
Q

Popular Dental Anesthetic

A

Articaine

51
Q

Very Short Acting Local Anesthetics

A

Chloroprocaine
Procaine

30-60 min/ 60-90 with epi

Procaine not used epidurally

52
Q

Spinal Anesthetic

A

Tetracaine

pharm 2 (11 decks)

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