General and Local Anesthetics

Question 1

thiopental: what it is, use, positive/negative aspects, side effects, contraindications

Answer 1

• parenterally administered barbiturate general anesthetic
• induction only
• has a long half-life so it can produce “hang-over” effects after anesthesia has worn off
• side effect: causes decreased ICP, venodilation, respiratory depression
• contraindicated in patients with impaired ability to compensate for venodilation (e.g., hypovolemia, cardiomyopathy)

Question 2

can cause “hang-over” effects after anesthesia has worn off

Answer 2

thiopental

Question 3

propofol: what it is, use, positive/negative aspects, side effects, contraindications

Answer 3

-parenterally administered general anesthetic
-induction and maintenance
-antiemetic
-shorter half-life than thiopental so it is used for outpatient surgery
-side effects: decreased ICP,
more severe decrease in BP than thiopental, more respiratory depression than thiopental
-contraindicated in patients with impaired ability to compensate for venodilation (e.g., hypovolemia, cardiomyopathy)

Question 4

antiemetic

Answer 4

propofol

Question 5

shorter half-life than thiopental so it is used for outpatient surgery

Answer 5

propofol

Question 6

contraindicated in patients with impaired ability to compensate for venodilation (e.g., hypovolemia, cardiomyopathy)

Answer 6

thiopental, propofol

Question 7

etomidate: what it is, use, positive/negative aspects, side effects

Answer 7

• parenterally administered general anesthetic
• induction for patients at risk for hypotension
• little or no decrease in BP, less respiratory depression than thiopental and propofol
• side effects: significantly more nausea and vomiting than thiopental, increased post-surgical morbidity due to suppression of adrenocortical stress response

Question 8

suppression of adrenocortical stress response

Answer 8

etomidate

Question 9

used for induction for patients at risk for hypotension

Answer 9

etomidate

Question 10

dissociative anesthesia

Answer 10

ketamine

Question 11

parenterally administered general anesthetic that does not act on GABA receptors

Answer 11

ketamine (NMDA receptor antagonist)

Question 12

emergence delirium

Answer 12

ketamine

Question 13

ketamine: what it is, use, positive/negative aspects, side effects

Answer 13

• parenterally-administered general anesthetic reserved for patients with asthma/bronchospasm
• NMDA receptor antagonist
• causes “dissociative anesthesia”
• causes no respiratory depression and is a bronchodilator
• side effects: nystagmus, spontaneous limb movements, increased ICP, hypertension, emergence delirium

Question 14

anesthetic reserved for patients with asthma/bronchospasm

Answer 14

ketamine

Question 15

short-acting benzodiazepine parenterally-administered general anesthetic

Answer 15

midazolam

Question 16

conscious sedation

Answer 16

midazolam

Question 17

anxiolytic

Answer 17

midazolam

Question 18

midazolam: what it is, duration of action, use, positive/negative aspects, side effects, contraindications

Answer 18

• parenterally-administerd short-acting benzodiazepine general anesthetic
• induction only
• used for conscious sedation
• anxiolytic = good for pre-op
• side effects: respiratory depression/respiratory arrest, decreased BP
• contraindicated in patients with neuromuscular disease, Parkinson’s, bipolar disorder

Question 19

how does blood:gas coefficient influence the rate of induction and recovery from anesthesia?

Answer 19

the lower the blood:gas partition coefficient, the faster the rate of induction and the shorter the recovery from anesthesia

Question 20

isoflurane: what it is, blood:gas coefficient, use, side effects

Answer 20

• inhalational anesthetic
• moderate blood:gas coefficient
• induction and maintenance
• side effects: airway irritant, decreases BP, increased ICP

Question 21

desflurane: what it is, blood:gas coefficient, use, side effects

Answer 21

• inhalational anesthetic
• very low blood:gas coefficient (=rapid induction and recovery)
• maintenance (not used to induce because it can cause bronchospasm)
• side effects: airway irritant, decreases BP, increased ICP

Question 22

sevoflurane: what it is, blood:gas coefficient, use, side effects

Answer 22

• very low blood:gas coefficient (=rapid induction and recovery)
• induction and maintenance
• side effects: NOT a respiratory irritant, decreases BP, increased ICP, less respiratory depression than isoflurane; can be metabolized to fluoride ion in the liver –> renal damage

Question 23

inhalational anesthetic that is NOT a respiratory irritant

Answer 23

sevoflurane

Question 24

moderate blood:gas coefficient

Answer 24

isoflurane

Question 25

anesthetics used for induction and maintenance

Answer 25

SIP: propofol, sevoflurane, isoflurane

Question 26

nitrous oxide

Answer 26

- rapid uptake from the alveolae results in "concentration" of gases that are administered at the same time - can dilute oxygen when its use is discontinued, therefore need to place patients on 100% O2 during emergence

Question 27

cocaine: what it is, use

Answer 27

- ester local anesthetic - potent vasoconstrictor-->shrinks mucosal membranes and limits bleeding - used as topical anesthetic for upper respiratory tract

Question 28

procaine: duration of action, what it is, use

Answer 28

- short-acting synthetic ester local anesthetic | - infiltration anesthesia

Question 29

tetracaine: duration of action, what it is, use

Answer 29

- long-acting ester local anesthetic | - used in spinal anesthesia and in topical and ophthalmic preparations

Question 30

benzocaine: what it is, use

Answer 30

- ester local anesthetic | - applied topically to burns and ulcerated surfaces

Question 31

lidocaine: what it is, duration of action, comparison with procaine, uses

Answer 31

- amide local anesthetic - intermediate duration of action - faster, more intense, longer lasting anesthesia than procaine - wide range of clinical uses

Question 32

bupivacaine: duration of action, what it is, positive aspect, side effects

Answer 32

- long acting amide local anesthetic - motor-sparing - more cardiotoxic than lidocaine

Question 33

ropivacaine: duration of action, what it is, positive aspects, uses

Answer 33

- long acting amide local anesthetic - less cardiotoxic than bupivacaine - even more motor-sparing than bupivacaine - epidural and regional anesthesia

Question 34

drugs that are long acting amide local anesthetics

Answer 34

bupivacaine, ropivacaine

Question 35

least cardiotoxic amide local anesthetic

Answer 35

ropivacaine

Question 36

most cardiotoxic amide local anesthetic

Answer 36

bupivacaine

Question 37

short-acting synthetic ester local anesthetic

Answer 37

procaine

Question 38

long-acting ester local anesthetic used in spinal anesthesia and in topical and ophthalmic preparations

Answer 38

tetracaine

Question 39

most motor-sparing amide local anesthetic

Answer 39

ropivacaine