General Anesthesia 1

Question 1

A pharmacologically-induced state of unconsciousness, amnesia, relaxation of skeletal muscles, and reduction in
autonomic responses. This refers to _

Answer 1

General anesthesia

Question 2

A lack of recall refers to _

Answer 2

Amnesia

Question 3

Impaired perception and response to stimuli refers to _

Answer 3

Unconsciousness

Question 4

The absence of pain sensation without loss of

consciousness refers to _

Answer 4

Analgesia

Question 5

The two major uses of volatile anesthetics are _

Answer 5

Maintenance
Induction (sometimes)

Question 6

What types of drugs are able to produce amnesia, muscle relaxation and suppress hemodynamic responses to surgical stimuli?

Answer 6

Volatile anesthetics

Question 7

True or false; Volatile anesthetics require a low inspired percentage (1-10%) and have low solubility in blood.

Answer 7

True

Question 8

The percentage occupied by a single gas in a mixture of gases is referred to as _. Where can this be measured?

Answer 8

Partial pressure

In the lung

Question 9

When delived, the partial pressure of an anesthetic gas equilbrates in 3 different areas at equilibrium. They are _

Answer 9

Alveoli (PA)
Arterial blood (Pa)
Brain (Pb)

Question 10

Regarding anesthetics, what does MAC stand for? What is 1 MAC?

Answer 10

Minimum alveolar concentration
Concentration of anesthetic that prevents response to noxious stimulus in 50% of patients. (Think ED50) Used to compare one anesthetic to another

Question 11

What is a useful index of anethetic potency? I.e. how can you compare one anesthetic to another?

Answer 11

MAC (1.3 MAC knocks out most patients)

Question 12

Isoflurane, Nitrous oxide, desflurane, sevoflurane. Rank the preceeding in decreasing MAC.

Answer 12

Iso - 1.15
Sevo - 2.05
Des - 7.25
NO - 105 - 110

Question 13

The ratio of blood to gas partition coefficient defines _. This term determines what 2 properties of any anesthetic?

Answer 13

Anesthetic solubility

Onset and Elimination

Question 14

An anesthetic that has a slow onset and offset would be expected to have _ solubility. An anesthetic that has fast onset and offset would be expected to have _ solubility

Answer 14

High solubility

Low solubility

Question 15

The partial pressure of an anesthetic in what area produces general anesthesia?

Answer 15

The brain

Question 16

Which represents a more soluble anesthetic.

• A blood:gas partition coefficient =1
• A blood:gas partition coefficient =2

Answer 16

A blood:gas partition coefficient = 2, more of it is in the blood

Question 17

Isoflurane, Nitrous oxide, desflurane, sevoflurane. Rank the preceeding in order on increasing blood:gas partition coefficient. What does this mean practically?

Answer 17

Des - 0.42
NO - 0.46
Sevo - 0.68
Iso - 1.4

The higher the number, the longer to induce and the longer to wake up (most soluble)

Question 18

Identify the anesthetic. Irritating to airways, 0.2% metabolism (moderate) and minimal myocardial depression, not as prompt recovery as others

Answer 18

Isoflurane

Question 19

Identify the anesthetic. Irritating to airways, 0.02% metabolism (low), prompt recovery and minimal myocardial depression.

Answer 19

Desflurane

Question 20

Identify the anesthetic. Non-irritating to the airway, 2-5% metabolism (relatively high), minimal myocardial depression and prompt recovery

Answer 20

Sevoflurane

Question 21

Identify the anesthetic. Adjunct to volatile anesthetics, reduces MAC requirements, very insoluble.

Answer 21

Nitrous oxide

Question 22

What are the receptors thought to be facilitated by general anesthetics? What receptors are thought to in inhibited?

Answer 22

Facilitated - GABA and glycine

Inhibited - Excitatory glutamatergic transmission

Question 23

Anesthetics are most likely to affect _ and _ receptor signaling systems. Adjuncts are most likely to affect _ (3) signaling systems and would therefore have MAC sparing effects

Answer 23

Glu and GABA signaling

His, Ach and NE

Question 24

What is the effect of volatile anesthetics on:

• Respiratory rate
• HR
• Cardiac output
• Systemic vascular resistance

Answer 24

• Decrease
• Decrease
• Decrease
• Decrease (vasodilators)

Question 25

In some individuals, a drug increases skeletal muscle metabolism, which overwhelms the body’s capacity to supply O2, remove CO2, and regulate. body temperature. This refers to _. What are 2 types of drugs that can cause this? What drug is used to treat it?

Answer 25

Malignant hyperthermia
Volatile anesthetics, succinylcholine
Dantrolene

Question 26

General anesthetics are administered by mixing with _(3)

Answer 26

Air
Nitrous oxide
Oxygen

Question 27

Anesthetics are analgesic or amnestic, or both?

Answer 27

Amnestic, not analgesic

Question 28

What is the major neurotransmitter of the reticular activating system (2)? Where is it found?

Answer 28

NE and glutamate

Brainstem

Question 29

What is the major neurotransmitter by which the thalamus communicates with the cortex? The Cortex connects with the thalamus via what NT?

Answer 29

GABA

Glutamate

Question 30

An EEG is a recording or activity in what area of the brain? It can be used as a proxy for_

Answer 30

Cortical activity

Depth of anesthesia

Question 31

The hypothalamus and basal forebrain communicate with the cortex via what neurotransmitters (3)?

Answer 31

NE, Ach and Histamine

Question 32

Hyperacidosis, rigiditiy, hyperkalemia, myoglobin release and kidney failure can all develop if _ is not treated

Answer 32

Malignant hyperthermia

Question 33

What is the mechanism by which dantrolene works? What is the mechanism?

Answer 33

Blocks calcium release from the sarcoplasmic reticulum, which relaxes skeletal muscle and decreases high metabolism