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NBB1 > General Anesthesia > Flashcards

General Anesthesia Flashcards

1
Q

What are the 5 major effects of general anesthetics?

A 
Unconsciousness
Amnesia
Analgesia
Attenuation of autonomic reflexes
Skeletal muscle relaxation
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2
Q

What is an ideal general anesthetic?

A

Rapid, smooth loss of consciousness
Rapidly reversible on discontinuation
Wide margin of safety

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3
Q

What is the goal of balanced anesthesia?

A

Minimize side effects, maximize efficacy

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4
Q

What is balanced anesthesia?

A

Use small doses of multiple agents, inhaled and IV

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5
Q

What is conscious sedation?

A

Use minimal amnestic and opioid

Patient can converse, respond to stimuli/commands, able to protect airway and maintain ventilation

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6
Q

When is anesthesia considered general?

A

Once the patient has lost the ability to protect the airway

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7
Q

What are the 3 phases of general anesthesia?

A

Induction
Maintenance
Emergence

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8
Q

What is the difference in phase state for gaseous vs. volatile inhaled anesthetics?

A

Gaseous: gas at room temp
volatile: liquid at room temp

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9
Q

What are the ideal PK for inhaled anesthetics?

A

Ideal agent is fast on/fast off

Adequate potency

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10
Q

What is the driving force for the uptake of inhaled anesthetics?

A

Alveolar fraction/partial pressure

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11
Q

What are the anesthesiologist controlled paramaters of an inhaled anesthetic?

A
  1. Increase Fi (inspired fraction or partial pressure)

2. Increased alveolar ventilation

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12
Q

What are the agent dependent parameters of inhaled anesthetic?

A

Solubility of inhaled anesthetic

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13
Q

How does solubility affect onset?

A

More insoluble agent have a faster onset

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14
Q

What the most important factor of emergence?

A

Alveolar ventilation

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15
Q

What is the measure of potency of inhaled general anesthetics? What does it tell you?

A

Minimal alveolar ccn - ccn at which 50% of non-relaxed patients respond

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16
Q

How do inhaled anesthetics affect CV system?

A

Decrease BP

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17
Q

How do inhaled anesthetics affect respiratory system?

A

Decrease minute volume

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18
Q

How do inhaled anesthetics affect hepatic system?

A

Decrease in portal vein flow

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19
Q

How do inhaled anesthetics affect uterine smooth muscle?

A

Decrease in uterine tone, may increase uterine bleeding

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20
Q

What is a potential toxicity of nitrous oxide?

A

Decrease in methionine synthase –> megaloblastic anemia

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21
Q

What is malignant hyperthermia?

A

Hypermetablic syndrome: genetically susceptible patients after exposure to trigger (halogenated inhalationals/succinylcholine)

22
Q

What causes malignant hyperthermia?

A

Decrease in the reuptake of Ca2+ from sarcoplasmic reticulum

23
Q

What can malignant hyperthermia lead to?

A

Hyperthermia
Hypercapnia
Hypoxia
Hyperkalemia

24
Q

What is the antidote to malignant hyperthermia?

A

Dantrolene - inhibits release of Ca2+ from sarcoplasmic reticulum

25
Q

How can we prevent malignant hyperthermia?

A

Ask about family history of reaction to GA

26
Q

What is the preferred method of induction?

A

IV anesthetics

27
Q

What are the 3 major general IV anesthetics?

A

Propofol, etomidate, ketamine

28
Q

What is a major chemical property of the IV anesthetics? Why is this property beneficial?

A

lipophilic - preferential partitioning into highly perfused lipophilic tissues = brain/SC

29
Q

How can we describe the onset and elimination of IV anesthetics?

A

Rapid, for both

30
Q

What is the context sensitive half time?

A

Describes elimination half time after continuous infusion

31
Q

What does the context sensitive half time tell us?

A

Drug’s suitability for maintenance sedation

32
Q

What is the mechanism of propofol?

A

GABA agonist

33
Q

What are the effects/benefits of propofol?

A

Non analgesic
Amnestic
Anti-emetic (small doses)

34
Q

What are the uses of propofol?

A

induction/maintenance of GA

sedation

35
Q

How does propofol affect the CV system?

A

Decrease in BP

36
Q

How does propofol affect the respiratory system?

A

Decrease in Vt, RR and minute volume, decrease in upper airway reflexes

37
Q

What is the time limit for using propofol after dispensing? Why?

A

8 hours - bacterial contamination

38
Q

What is etomidate used for?

A

Induction and short sedation

39
Q

What is the mechanism of etomidate?

A

GABA agonist

40
Q

What are the clinical effects/benefits of etomidate?

A

Non analgesic

41
Q

What organ effects result from etomidate? (3)

A

minimal hemodynamic
Endocrine: may inhibit 11 B hydroxylase (chol to cortisol)
Respiratory depressant

42
Q

What are the effects from ketamine?

A

dissociative anesthesia with nystagmus - freak out or great

analgesic

43
Q

What is the mechanism of ketamine?

A

NMDA receptor antagonist

44
Q

What are the organ effects of ketamine?

A

Increases in BP, CO and HR

Minimal respiratory depression

45
Q

Why use benzodiazepine with ketamine?

A

Hallucinations and unpleasant emergence may occur

46
Q

How can ketamine aid in opioid addiction?

A

Sub analgesic doses may help to limit or reverse opioid tolerance

47
Q

What is dexmedetomidine used for?

A

Sedation or adjust to GA

48
Q

What is the mechanism of dexmedetomidine?

A

Alpha-2 agonist

49
Q

What are the clinical effects of dexmedetomidine?

A

Sedative, analgesic

50
Q

What are the organ effects of dexmedetomidine?

A

Decrease BP, HR

Presserves respiratory drive

NBB1 (16 decks)

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