Anesthesia

Question 1

Why Diethyl Ether was replace by halothane?

Answer 1

bc it is highly flammable

Question 2

General Anesthesia component:

Answer 2

Lost sensation
Lost consciousness
Amnesia
Relaxation of skeletal muscles
suppression of reflexes.

Question 3

Inhalation end-name?

Answer 3

’‘-ane’’

Question 4

IV anesthetic agents end-name?

Answer 4

’‘-al’’ exept for Barbiturates, benzo ‘‘-am’’ and Propofol

Question 5

Steps of drugs use in anesthesia

Answer 5

Premedication
Induction agent
Volatile agent and anesthetic gases
Analgesics
Muscle relaxants
Reversal agents

Question 6

Type of anesthetics often use for induction?

Answer 6

Intravenous anesthetics

Question 7

Structure of IV agent?

Answer 7

IV agent have ring structures

Question 8

Structure of Volatile anesthetics?

Answer 8

volatile do not have ring structure, but are small molecules with substitutions on the carbon chain.

Question 9

Partial pressure =

Answer 9

Partial pressure of a gas is the driving force that get the drug from the alveolus into the blood, and then from the bllod into the brain.

Concentration of the drug (%) x the atmospheric pressure (760mmHg)

Question 10

mix of gases need to include:

Answer 10

Oxygen

Question 11

Most of the removal of general anesthetics is by

Answer 11

exhalation

NOT BY METABOLISM

Question 12

All general anesthetics are lipid- or water-soluble?

Answer 12

Lipid soluble!

Question 13

The Minimal alveolar concentration (MAC) is

Answer 13

the Concentration that will produce a surgical level of anesthesia in 50% of humans.

Question 14

MAC is alter by:

Answer 14

Disease

presence of others drugs

Question 15

Increasing MAC mean increasing ____.

Answer 15

Levels of CO2.

Question 16

Increasing MAC can lead to

Answer 16

Respiratory depression (respiratory minute volume)
Cardiovascular depression (BP)

Question 17

Nitrous Oxide caracteristic

Answer 17

Is a GAS
Majority are exhaled (NOT METABOLIZE)
Good for pain relief
Low solubility (move quickly in the brain)
Do not decrease BP or respiration rate

Question 18

Halothane caracteristic

Answer 18

Is soluble and dissolve in blood. (less of it immediately available to enter the brain)
Not compatible with epinephrine.
Metabolized 15%
Rare toxic effect

Question 19

Isoflurane caracteristic

Answer 19

No production of toxic metabolites
Good muscles relaxant
Possible to use epinephrine

Question 20

Avantages of IV anesthetics

Answer 20

Less respi and cardiovasc depression
RAPID ONSET with short duration
Wider margin of safety
Recovery of patient less difficult

Question 21

Most commun inhalation anesthetics:

Answer 21

Nitrous Oxide
Halothane
Isoflurane
Sevoflurane

Question 22

Classic barbiturate used for induction:

Answer 22

Thiopental

Question 23

Most common IV anesthetics:

Answer 23

Thiopental (barbiturates), Midazolam (benzo), Etomidate, Propofol and Ketamine

Question 24

Thiopental caracteristic:

Answer 24

Rapid onset and wear off quickly too

half-live longer bc stay in adipose tissue

Question 25

Propofol caracteristics:

Answer 25

Rapid onset | Shorter half-life

Question 26

Context-sensitive half-life is

Answer 26

how the drug can accumulate in other body tissues (taking more time to get ride off)

Question 27

High half-life for:

Answer 27

Benzodiazepam (less for midazolam) and Barbiturates

Question 28

Conscious sedation can be reach with

Answer 28

Opioids + midazolam

Question 29

Fentanyl and Remifentanyl(more powerful) use as

Answer 29

induction agents for short procedures

Question 30

Neurolept analgesia is

Answer 30

Fentanyl + antipsychotic

Question 31

Ketamine

Answer 31

STIMULATE cardiovasc system | Psychiatric side effects: Dissociative Dysphoria

Question 32

Major site of action of general anesthesics:

Answer 32

Inhibition: GABA A, Glycine Exitation: Glutamate NMDA, 5HT, Nicotinic

Question 33

Ketamine site of action:

Answer 33

Decrease glutamate at the NMDA receptor (blocking excitation)

Question 34

IV anesthetics act primarly on:

Answer 34

Ligand-Gated ion channels

Question 35

2 categories of neuromuscular blocking agents:

Answer 35

Competitive blocking agents (compete with acetylcholine) | Depolarizing blocking agents (activate the receptor of acetylcholine and DESENSITIZES)

Question 36

Competitive blocking agents usual end-name:

Answer 36

''-ium''

Question 37

Succinylcholine is a

Answer 37

Depolarizing blocking agents (derivative of acetylcholine)

Question 38

Curare is a

Answer 38

Competitive blocking agents

Question 39

Pseudocholinesterase is a

Answer 39

plasma enzyme that breakdown succinylcholine

Question 40

Individual with deficite in plasma pseudocholinesterase can lead to

Answer 40

stop breathing and not be able to recover quickly as without the deficite.

Question 41

Local anesthesic act by

Answer 41

Blocking Voltage-gated Sodium channel.

Question 42

Adrenaline with local anesthesic alter the pharmacokinetics by creating

Answer 42

an vasoconstriction --> less blood flow to the region --> slow rate of carrying the local anesthesic away from the site of action AND lest plasma cholinesterase to break down --> INCREASE half-life

Question 43

Local anesthetics structure:

Answer 43

Lipid-soluble section, with ester link and an amine portion.

Question 44

Local anesthetics are metabolized by

Answer 44

plasma cholinesterase

Question 45

The delivery of the drug to the patient and subsequently to the brain is directly related to:

Answer 45

its partial pressure.

Question 46

Factor influencing the rate of induction of anesthesia: (how fast the person will be anesthetized and ready for the surgery)

Answer 46

1. Higher the concentration, faster the induction 2. Higher/better the alveolar ventilation rate, faster the induction. 3. Lower solubility of the agent in the blood, faster the induction. 4. Very high cardiac output = less will go to the brain, less the rate of induction.

Question 47

For most of the situations, we need (xMAC) for a safe amount?

Answer 47

1.3x MAC

Question 48

Methoxyflurane % metabolized?

Answer 48

50-70%

Question 49

Why is local anesthesia injected in the spinal fluid had a longer effect?

Answer 49

bc the spinal fluid is lower in cholinesterase. (take more time to get rid of the anesthetic agent)

Question 50

Eutectic muxture of local anesthesics (EMLA):

Answer 50

mixure of local anesthetics in base form that can be absorbed through the skin. (no need to inject, usefull for kids)