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Anatomy > Anesthetics part 2 > Flashcards

Anesthetics part 2 Flashcards

1
Q

only legal Dissociative Anesthetic

A

Only ketamine is used legally

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2
Q

how is ketamine used

A

• Used alone or with tranquilizers and opiods to induce anesthesia
– Cats—for minor procedures or to facilitate restraint
• Subanesthetic dose for analgesia

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3
Q

ketamine MOA

A

Mode of Action
• Disrupts nerve transmission in some brain sections
• Selective stimulation in parts of the brain
• Trancelike state – Critter appears awake – Immobile and unaware of surroundings *”Waxy rigidity”

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4
Q

waxy rigidity

A

muscles tense and goes back. can twist and will go right back

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5
Q

ketamine peak of action

A

Peakaction – 1-2 minutes after IV injection – 10 minutes after IM injection

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6
Q

ketamine duration of effect

A

– 20-30 minutes

– Increased dose prolongs duration but doesn’t increase anesthetic effect

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7
Q

ketamine metabolized?

A

All dissociatives are either metabolized in the liver or excreted unchanged in the urine
– Avoid use in critters with liver or kidney disease

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8
Q

Cataleptoid (what the heck is this???) state

A

waxy rigidity

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9
Q

what reflexes are intact with ketamine

A

Palpebral, corneal, pedal, PLR, laryngeal,

swallowing

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10
Q

Ocular effects of ketamine

A

– Eyes remain open (therefore must keep eyes moist)

– Central dilated pupil – MUST use ophthalmic ointment

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11
Q

Dissociative Effects muscle tone

A

– Normal to muscle rigidity – Counteract with concurrent tranquilizer

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12
Q

Dissociative Effects analgesia

A

– Somatic analgesia – Visceral analgesia

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13
Q

ketamine still

A

Sensitivity to sensory stimuli

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14
Q

ketamine sides

A

vivid halucinations, amnesia

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15
Q

Dissociative Effects on the Cardiovascular System

A

Increase in heart rate • Increased cardiac output • Increased mean blood pressure • Effects due to stimulation of the SNS

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16
Q

so while ketamine seems safer for patients with heart disease it

A

increases cardiac workload and increases myO2cardial make sick hearts work harder!

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17
Q

Dissociative Effects on the Respiratory System

A

Respiratory rate and tidal volume remain stable
• Respiratory depression usually insignificant
• Apneustic (what’s this?) respiration at higher doses hold their breath

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18
Q

Adverse Effects of Dissociatives on the Cardiovascular System

A

• Decreased inotropy • Cardiac arrhythmias in response to
epinephrine release
• Relatively safer than others…
• Significantly increased salivation and respiratory tract secretions with potential for aspiration.

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19
Q

Other Adverse Effects of Dissociatives

A
  • Increased intracranial and intraocular pressure

* NO reversal agent

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20
Q

Dexmedetomidine (Precedex) what is it? and how it affects heart and respiratory system

A

(Precedex) Increasingly-used α2-agonist sedative – Minimal respiratory depression – Good analgesia – “Dulls” cardiovascular responses to anesthesia – “Sympatholytic”

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21
Q

Etomidate what is it and what its used for

A

(Amidate) Noncontrolled, sedative-hypnotic imidazole drug with no analgesic properties
• Used for IV induction (although it hurts!)
• Minimal effects on the cardiovascular and respiratory systems! One of the few injectable anesthetics (>Propofol) to decrease ICP.expensive!!!

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22
Q

Etomidate onset, POA, duration

A

Short half-life makes for finer anesthetic control: – Onset of action: 30–60 seconds – Peak effect: 1 minute – Duration: 3–5 minutes; terminated by redistribution

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23
Q

etomidate distribution protein binding metabolism and half life

A

Distribution: Vd: 2-4.5 L/kg
– Protein binding: 76% – Metabolism: Hepatic and plasma esterases – Half-life redistribution: 29 minutes – Half-life elimination: 2.9 to 5.3 hours
Like a much safer, fast-acting barbituate!

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24
Q

benzodiazepine MOA

A

Tranquilizers-all controlled substances *As with most other anesthetics & sedatives & hypnotics it targets Υ-amino- butyric acid receptors (GABA) since GABA is the major inhibitory CNS neurotransmitter. can synergize with ketamine. gets rid of waxy rigidity

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25
Q

valium half life

A

diazepam, benzodiazepine 1-4 days (long duration)

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26
Q

Versed half life

A

midazolam, 2-6 hours (short duration)

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27
Q

ativan half life

A

loazepam, benzodiazepine 10-20 hours (medium duration)

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28
Q

Effects of Benzodiazepines

A

 CNS  Calming and antianxiety  Not an effective sedative or analgesic  Anticonvulsant (raises seizure threshold)

Cardiovascular and respiratory systems  Minimal effect with a high margin of safety *Midazolam has a greater hypotensive effect than the others.
Skeletal muscle relaxation
  Potentiate general anesthetics

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29
Q

Diazepam(Valium) how to use

A

Not water soluble (should only be administered concurrently with opiods, thiopental, & propofol)
–Don’t mix with water- soluble drugs!
– Don’t store in plastic – Light sensitive

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30
Q

Lorazepam(Ativan) how to use

A
  • Water soluble/poorly lipid soluble.
  • Decreasing use in open-heart
  • D.O.C. for symptomatic treatment of recreational stimulant overdose.
  • High addictive potential and antegrade amnesia effects make it popular in the non-licensed pharmaceutical industry.
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31
Q

Midazolam(Versed) how to use

A

– Water soluble (unlike valium)
– Can be administered IM or SC
– VERY commonly used in combination with Propofol for cardiac surgical anesthetic induction.

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32
Q

side effects of benzodiazepines

A

Also cause antegrade amnesia (how could this be a problem?)

• Long-term use results in the development of tolerance and dependence. can be used so people dont remember surgery

33
Q

Benzodiazepine Reversal

A

Flumazenil (Anexate) effectively reverses the effects of benzodiazepines by competitive inhibition at the GABA receptor sites. but is rarely used in the cardiovascular setting (why?)

34
Q

Inhaled Anesthetics

Volatile anesthetics

A

All are liquids at room temperatures and pressures.

35
Q

Nitrous oxide is

A

a gas at room temperatures and pressures (but this blue tank ain’t room pressure!

36
Q

soflurane and sevoflurane are the most common

A

sed agents in this class
• Liquid at room temperature • Stored in a vaporizer on
an anesthetic machine
• Vaporized in oxygen blend that flows through the vaporizer

37
Q

sevoflurane

A

• High vapor pressure: needs a precision vaporizer
• Blood:gaspartitioncoefficient: rapid induction and recovery • Good for induction with a mask
or chamber • High controllability of depth
of anesthesia • MAC = 2.34% to 2.58%

38
Q

suprane/desflurane

A

future! • Closely related to isoflurane
• Expensive
• Lowestblood:gaspartitioncoefficient: very rapid induction and recovery
• Used with a special precision vaporizer • MAC = 7.2% and 9.8%
– Least potent inhalant agent • Eliminated by the lungs.
one breath aesthesia

39
Q

isoflurane

A

Most commonly used inhalant agent in North America
Isoflurane (Cont’d)
• Properties – High vapor pressure: need a precision
vaporizer
– Low blood:gas partition coefficient: rapid induction and recovery Good for induction with mask or chamber – MAC = 1.3% to 1.63%: helps determine
initial vaporizer setting
– Low rubber solubility
– Stable at room temperature; no preservatives needed

40
Q

halothane

A

The archetypical halogenated volatile anesthetic.
Halothane
• Relatively rapid induction & recovery. • Not explosive like some of its predecessors
(Notice the door…) Somewhatarrhythmogenic • Somewhat metabolized (a BAD thing!)
producing hepatotoxic byproducts
• Somewhat contributing to malignant hyperthermia (particularly when used in conjunction with succinylcholine)No longer used in the U.S.A…
‘Cause it is the reference standard

41
Q

enflurane

A

1

42
Q

Uptake and Distribution of Halogenated Organic Compounds

A
  • Liquid anesthetic is vaporized and mixed with oxygen-blend gas
  • Mixture travels to lungs (alveoli) &/or oxygenator and diffuses into the bloodstream.
43
Q

Uptake and Distribution of
Halogenated Organic Compounds
(Cont’d) diffusion rate

A

Diffusion rate is dependent on concentration gradient (alveoli/capillary &/or opposite sides of oxygenator membrane/pseudomembrane) and lipid solubility

44
Q

Concentration gradient is greatest during initial induction whyy?

A

because no anesthetic during induction. same with coming off

45
Q

Distribution to tissues is dependent on blood supply  Lipid solubility determines entry into tissues
through cell walls. why?

A

1

46
Q

Depth of anesthesia is dependent

A

partial pressure

of anesthetic in the brain

47
Q

 Partial pressure in the brain is dependent on

A

partial pressure of the anesthetic in blood and

alveoli

48
Q

Maintenance of anesthesia is dependent on

A

sufficient quantities of anesthetic delivered to the lungs &/or oxygenator bundle fibers.

49
Q

Elimination of Halogenated Organic Compounds

A

Reducing amount of anesthetic administered reduces amount delivered to the alveoli/oxygenator
• Blood level is initially higher than alveolar/oxygenator level
• Concentration gradient now favors anesthetic diffusion from blood into the alveoli/oxygenator vent
• Blood levels drop quickly as patient breathes out anesthetic from the alveoli/oxygenator bundle
• Brain levels drop as less anesthetic is delivered by blood
• Patient wakes up

50
Q

Adverse Effects of Halogenated Organic Compounds on cns?

A

– Increased intracranial pressure in patients with

head trauma or brain tumors – Considered safe for epileptic animals

51
Q

Adverse Effects of Halogenated Organic Compounds on cardio system?

A

–Decreases blood pressure and may

decrease renal blood flow

52
Q

Adverse Effects of Halogenated Organic Compounds on respiratory system?

A

– Hypoventilation

– Carbon dioxide retention and respiratory acidosis

53
Q

One of perfusionists’ most effective tools for changing blood pressure/arterial pressure is their anesthetic vaporizer.
(Why?)

A

Increasing the level (percentage) of volatile anesthetic provides a reliable, dose-dependent vasodilatory response.
• This is caused by a com- bination of direct vaso- dilatory effect and sympatholytic effect.

54
Q

volatile Anesthetics

• Potential Disadvantages:

A

– Very significant hemodynamic variability

from patient to patient. – Possibility of “coronary steal syndrome”

55
Q

Coronary Steal

A

– Arteriolar dilation of normal vessels diverts blood away from stenotic areas
– Commonly associated with adenosine, dipyridamole, and SNP
– Forane causes steal and new ST-T segment depression
– May not be important since Forane reduces SVR, depresses the myocardium yet maintains CO

56
Q

Physical and Chemical Properties of Inhalant Anesthetics

A

• Important properties to consider – Vapor pressure – Partition coefficient – Minimum alveolar concentration (MAC) – Rubber solubility
– Cardiac output dependent

57
Q

Vapor Pressure

A

• “The tendency of an inhalation anesthetic to vaporize to its gaseous state”
• Determines how readily an inhalation anesthetic will evaporate in the anesthetic machine vaporizer
• Temperature and anesthetic agent dependent
gas has higher pressure than water.

58
Q

Volatile agents vapor pressure

A

– High vapor pressure
– Isoflurane, sevoflurane, desflurane, and halothane
– Delivered from a precision vaporizer to control the delivery concentration
– All precision vaporizers are made to deliver only one specific halogenated agent

59
Q

Non volatile agents vapor pressure

A

Nonvolatileagents – Low vapor pressure – Methoxyflurane – Delivered from a nonprecision vaporizer
***NO LONGER USED (but now you understand why they are referred to as “precision vaporizers”

60
Q

blood gas partition coefficient

A

The measure of the solubility of an inhalation anesthetic in blood as compared to alveolar/oxygenator gas Indication of the speed of induction and recovery for an inhalation anesthetic agent
• Low blood:gas partition coefficient – Agent is relatively less soluble in blood
than alveolar/oxygenator gas
– Faster expected induction and recovery

61
Q

Blood: gas partition coefficient determines the

A

clinical use of the anesthetic agent – Maintenance: How fast will the anesthetic depth change in response to changes in the vaporizer setting?
– Recovery: How long will the patient sleep after anesthesia? early extubation
– How soon do I have to turn down/off my vaporizer so volatile anesthetics won’t depress the heart as we try to wean? have to gauge how fast its coming out of solutuion

62
Q

Minimum Alveolar Concentration

A

“The concentration of anesthetic vapor in alveoli that is required to prevent a motor response in 50% of patients subjected to surgical pain stimuli”

*This is confusing because it isn’t really a minimum concentration, it’s really an average concentration. measure of potency

63
Q

he lower the MAC

A

the more potent the anesthetic agent and the lower the vaporizer setting (does this make sense?)

64
Q

MAC may be altered

A

by age, metabolic activity, body temperature, disease, pregnancy, obesity, and other agents present
• Every patient must be monitored as an individual

65
Q

A vaporizer setting of

A

roughly 1-2 X the MAC of an agent is required for surgical anesthesia and completely depends on the individual critter!

66
Q

Rubber Solubility

A

LikeBlood:GasPartitionCoefficient except with the rubber/plastic/silicon parts of your ventilation circuit.
• An anesthetic circuit can act like another compartment or reservoir for the distribution of gas.
• What does this mean for YOU!? slows down anesthetics. anesthetic rebound. have to give more

67
Q

Given what you know…

…how will changes in blood flow or sweep rate effect volatile anesthetic levels?

A

increasing gas flow will increase amount of anesthetic

68
Q

Effects of Isoflurane

A

Maintains cardiac output, heart rate, and rhythm – Fewest adverse cardiovascular effects

69
Q

adverse effects of isoflurane

A

Depresses the respiratory system • Maintains cerebral blood flow • Almost completely eliminated through the lungs • Induces adequate to good muscle relaxation • Provides little or no analgesia after anesthesia
• Can produce carbon monoxide when exposed to a desiccated carbon dioxide absorbent

70
Q

Effects and Adverse Effects of Sevoflurane

A

Minimal cardiovascular depression
• Depresses respiratory system
• Eliminated by the lungs, minimal hepatic metabolism
• Maintainscerebralbloodflow
• Induces adequate muscle relaxation
• Some thrashing, etc. and excitement during recovery

71
Q

Nitrous Oxide

A

Excellent analgesic, poor anesthetic (by itself )
• Doesn’t require a precision vaporizer
• Often mixed with other gas anesthetics to produce better analgesia (NEVER more than 80% N2O!)
• Very poorly soluble in blood and tissues presenting two problems for us:

72
Q

NO problems

A
  1. )

2. ) Diffusion Hypoxia …therefore little used in cardiac surgery

73
Q

Unlike other gas anesthetics, nitrous oxide is a

A

compressed liquid, therefore: it is always giving off vapor so gauge will show its full when its really not

74
Q

halothane MAC and blood/gas partition coefficient

A

.75% AND 2.4

75
Q

isoflurane MAC and blood/gas partition coefficient

A

1.2% AND 1.4

76
Q

sevoflurane MAC and blood/gas partition coefficient

A

2% AND.65

77
Q

nitrous oxide MAC and blood/gas partition coefficient

A

105% AND .47

78
Q

desflurane MAC and blood/gas partition coefficient

A

6% AND .42

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