B7-097 CNS Anesthetics

Question 1

which stage of anesthesia is from regular respiration to respiratory arrest

Answer 1

stage 3

Question 2

stages of anesthesia are based on the effects of

Answer 2

Ether

Question 3

the less soluble, the […] induction and emergence

Answer 3

faster

Question 4

concentration of anesthetic in the inspired air at equilibrium when there is no response to skin incision in 50% of patients

Answer 4

minimum alveolar concentration (MAC)

Question 5

lower MAC = […] potent

Answer 5

more

Question 6

actual relative potency depends on the anesthetic’s partial pressure in the

Answer 6

brain

Question 7

has analgesic activity but is insufficient potency for surgical anesthesia

Answer 7

nitric oxide

Question 8

-ane

what class?

Answer 8

volatile (inhaled) anesthetics

desflurane, isoflurane, sevoflurane

Question 9

most widely used inhaled anesthetic

Answer 9

isoflurane

Question 10

MOA of the inhaled anesthetic agents

Answer 10

depress spontaneous and evoked neuronal activity

Question 11

why must patients be monitored under anesthesia?

Answer 11

causes medullary depression of respiratory and CV function

complete CNS depressants (can lead to coma/death)

Question 12

adverse reaction to inhaled anesthetics that occurs in individuals with ryanodine receptor mutations

Answer 12

malignant hyperthermia

Question 13

malignant hyperthermia can be treated with

Answer 13

dantrolene

Question 14

which inhalable anesthetic depresses the myocardium?

Answer 14

nitrous oxide

also desflurane, minimally

Question 15

which inhalable anesthetics cause vasodilation and tachycardia? [2]

Answer 15

isoflurane
desflurane

Question 16

which inhalable anesthetic causes vasodilation without tachycardia?

Answer 16

sevoflurane

Question 17

rate of induction of nitrous oxide

Answer 17

rapid

Question 18

rate of induction of isoflurane

Answer 18

medium

Question 19

rate of induction of sevoflurane

Answer 19

rapid

Question 20

rate of induction of desflurane

Answer 20

rapid

Question 21

list the inhaled anesthetics from least potent to most potent (MAC) [4]

Answer 21

nitrous oxide
desflurane
sevoflurane
isoflurane

Question 22

barbituates used as IV anesthetics [2]

Answer 22

thiopental
methohexital

long DOA due to accumulation in adipose

Question 23

no analgesia, in fact causes hyperalgesia

Answer 23

IV barbiturates

thiopental, methohexital

Question 24

cause a profound decrease in respiration at anesthetic doses

Answer 24

IV barbituates

Question 25

IV anesthetic that redistributes to other tissues can accumulate in adipose leading to long duration of action

Answer 25

thiopental

Question 26

propofol acts at [...] receptors

Answer 26

GABA-a

Question 27

similar effects as barbituates, but there is a more rapid recovery due to 10x faster hepatic metabolism

Answer 27

propofol

Question 28

often used for maintenance of anesthesia, as well as induction

Answer 28

propofol

Question 29

most popular fixed anesthetic often used for OP prodcedures

Answer 29

propofol

Question 30

used for induction, especially in patients at risk of hypotension

Answer 30

etomidate | no analgesia

Question 31

does etomidate have analgesic activity?

Answer 31

no | used for induction in patients with hypotension

Question 32

dissociative anesthesia causes catatonia, analgesia, and amnesia **without loss of consciousness**

Answer 32

ketamine

Question 33

ketamine blocks the [...] receptor

Answer 33

NMDA

Question 34

IV anesthetic that provides excellent analgesia and amnesia

Answer 34

ketamine

Question 35

associated with "emergence phenomenon" of hallucinations and disorientation

Answer 35

ketamine (can be decreased by benzos, kids tolerate this better)

Question 36

anesthetic use mainly limited to small children

Answer 36

ketamine

Question 37

IV anesthetic that causes cardiac stimulation via increased SNS outflow

Answer 37

ketamine

Question 38

IV benzodiazepines used for anesthetic [2]

Answer 38

midazolam remimazolam | short-acting 2-4 hours

Question 39

which IV benzodiazepine is faster and shorter acting, allowing it to be used for induction?

Answer 39

remimazolam

Question 40

can be used for maintenance of anesthesia with other agents or for conscious sedation

Answer 40

IV benzodiazepines

Question 41

IV benzodiazepines have good [...] effect

Answer 41

amnestic

Question 42

antagonist [...] can accelerate recovery when using IV benzodiazepines

Answer 42

flumazenil

Question 43

can achieve anesthesia with sufficient dose provides excellent post-op analgesia

Answer 43

fentanyl | useful in patients with compromised CV function

Question 44

nomenclature of ___cur___ indicates they belong to what class?

Answer 44

competitive nicotinic antagonists

Question 45

competitive nicotinic antagonists [4]

Answer 45

d-tubocurarine atracurium rocuronium parcuronium

Question 46

depolarizing nicotinic agonist

Answer 46

succinylcholine

Question 47

depolarizing nicotinic agonist with very short duration of action **less than 8 min**

Answer 47

succinylcholine

Question 48

competitive neuromuscular blocking agents are nicotinic [...]

Answer 48

antagonists

Question 49

depolarizing neuromuscular blocking agents are nicotinic [...]

Answer 49

agonists

Question 50

[competitive/depolarizing] neuromuscular blocking agents cause partial persistent depolarization

Answer 50

depolarizing

Question 51

[competitive/depolarizing] neuromuscular blocking agents cause fasiculations

Answer 51

depolarizing

Question 52

[competitive/depolarizing] neostigmine causes reversal of the block

Answer 52

competitive

Question 53

many paralytics cause [...] release, leading to hypotension and bronchospasm

Answer 53

histamine (esp. d-tubocurarine)

Question 54

paralytic that can cause muscle pain due to fasciculations

Answer 54

succinylcholine

Question 55

reversal agents for neuromuscular blocking agents [2]

Answer 55

neostigmine (cholinesterase inhibitor) sugammadex (SRBA)

Question 56

encapsulates rocuronium and renders it unavailable for binding at NMJ

Answer 56

sugammadex

Question 57

increase the potency and duration of competitive antagonist neuromuscular blocking agents [2]

Answer 57

antibiotics inhalable anesthetics

Question 58

produce readily reversible anesthesia

Answer 58

inhaled anesthetics

Question 59

do fixed or inhaled anesthetics produce rapid, smooth induction?

Answer 59

fixed | however, slow elimination

Question 60

produces a relatively slow induction and emergence and is hepatotoxic no longer used in USA

Answer 60

halothane

Question 61

etomidate is a [...] anesthetic

Answer 61

fixed

Question 62

not sufficiently potent to produce surgical anesthesia or muscle relaxation, **hematoxic**

Answer 62

nitrous oxide

Question 63

inhaled anesthetic that produces rapid induction and emergence, good muscle relaxation, and has potential **renal toxicity**

Answer 63

sevoflurane

Question 64

medium rate of induction and emergence, has no known organ toxicities, and produces moderate skeletal muscle relaxation

Answer 64

isoflurane

Question 65

definition of MAC

Answer 65

percentage of anesthetic in the inspired air when there is no response to a skin incision in 50% of patients

Question 66

MAC is [...] proportional to potency

Answer 66

inversely

Question 67

hallucinations and other emergence phenomena are associated with

Answer 67

ketamine (disturbing to adults, but don't bother small children)

Question 68

thiopental accumulates in [...] tissue

Answer 68

adipose | causes long duration of action

Question 69

non-competitive antagonist at NMDA receptor

Answer 69

ketamine

Question 70

inhaled anesthetic that can cause myocardial depression

Answer 70

nitrous oxide | also desflurane, minimally

Question 71

primarily used for induction and balanced anesthesia in patients at risk for hypotension

Answer 71

etomidate | no analgesia

Question 72

barbiturate that is less lipophilic and does not penetrate the BBB rapidly enough to be used for induction

Answer 72

phenobarbital

Question 73

widely used because its hepatic metabolism is roughly 10x faster than IV barbiturates, leading to a more rapid recovery and lower likelihood of accumulation in adipose

Answer 73

propofol

Question 74

which barbiturate is most likely to be used as an induction agent

Answer 74

thiopental

Question 75

often used as a carrier gas

Answer 75

nitrous oxide

Question 76

the lower the MAC, the [...] the agent

Answer 76

more potent

Question 77

has the greatest influence on induction and emergence

Answer 77

oswald coefficient (blood:gas partition coefficient)

Question 78

the less soluble the agent in blood, the [...] the rate of induction

Answer 78

more rapid (blood:gas partition coefficient) | oswald coefficient

Question 79

the potency and duration of [...] is increased when used in combination with inhaled anesthetics

Answer 79

nicotinic antagonists

Question 80

causes fasciculations because it is a nicotinic agonist

Answer 80

succinylcholine

Question 81

short duration of action (less than 8 min) makes it suitable for short procedures like ECT

Answer 81

succinylcholine

Question 82

reversal agent for nicotinic antagonists

Answer 82

neostigmine

Question 83

reversal agent for rocuronium

Answer 83

sugammadex

Question 84

hypotension and brochospasm are most likely due to [...] release

Answer 84

histamine (atracurium and morphine cause histamine release)

Question 85

are mixed anesthetics used to maintain anesthesia?

Answer 85

no, make it difficult to control