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Flashcards in General Anesthetics Deck (18)
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0
Q

What is MAC?

A

‘Minimum alveolar concentration’
Concentration of inhaled agent at which 50% of pts will NOT move in response to surgical incision
Directly related to agents olive oil solubility

1
Q

What are 2 ways to increase alveolar concentration of inhalant?

A
  1. Increase ‘dialed in’ concentration (I.e. partial pressure of agent)
  2. Increase ventilation
2
Q

What are the 3 volatile anesthetics? Rank in order of potency.

A

Isoflurane- most potent, gold standard
Sevoflurane- less soluble/potent
Desflurane- least soluble/potent

3
Q

What are some side effects of isoflurane and the others in its class?

A

Airway irritation; dose dependent CNS depression, increase in cerebral blood flow and intracranial pressure; dose dependent decrease in systemic BP; decrease in respiratory function; relaxes skeletal muscle; malignant hyperthermia

5
Q

What barbiturate is used to induce general anesthesia? Mechanism?

A

Methohexital-

GABAa agonist, NMDA antagonist; produces hypnosis and sedation but anti- analgesic

6
Q

Propofol- mechanism and therapeutic use

A

GABAa agonist, NMDA antagonist; rapid onset/offset

Anti-emetic at low doses, induction/maintenance general anesthesia; sedation in ICU

7
Q

What are the side effects of Propofol?

A

Propofol infusion syndrome-
Usually assoc with concurrent catecholamine and glucocorticoid infusion (impaired fatty acid oxidation?); metabolic acidosis, rhabdomyolysis, renal failure, bradycardia, death

8
Q

Etomidate- mechanism and therapeutic use?

A

GABAa agonist (D-isomer)
Hypnosis, no analgesic activity
-used in pts with minimal cardiac reserve

9
Q

What are the side effects of Etomidate?

A

Pain on administration; involuntary myoclonus (due to subcortical disinhibition, not a seizure); PONV; inhibits cortisol synthesis

10
Q

What is Ketamine’s mechanism and use?

A
NMDA antagonist- dose dependent unconsciousness, amnesia, analgesia
Adjuvant during (w/Propofol) and after surgery
Pain therapy; depression
11
Q

What are the side effects of Ketamine?

A
  • sympathetic stimulation: useful in hypovolemic, cardiac myopathy; contraindicated in CAD
  • increases cerebral blood flow and intracranial pressure (contraindicated if mass lesion)
  • bronchodilator
12
Q

What is the mechanism and side effects of nitrous oxide?

A
  • NMDA receptor antagonist
  • post-op nausea/vomit, inactivated vit B, insoluble in blood and accumulates in spaces
  • NO muscle relaxation
13
Q

What is the mechanism and therapeutic use of Dexmedetomidine?

A
  • a2 adrenergic agonist in spinal cord (produces sedation, sympatholysis, and analgesia)
  • FDA approved for ventilation of ICU pts <24 hrs
  • used for awake intubations, awake craniotomies; adjunct to general anesthesia in patients susceptible to narcotic-induced post-op respiratory depression; withdrawal/detoxification
14
Q

What is the only depolarizing NMB agent used today? Use?

A

Succinylcholine

-facilitates endotracheal intubation (short duration of action: 9-12 min)

15
Q

What are the side effects of Succinylcholine?

A

Malignant hyperthermia; cardiac dysrhythmias, hyperkalemia, increased intraocular pressure, increased intracranial pressure

16
Q

What are 3 drugs used to reverse non-depolarizing NMB drugs? Which is most common?

A

AChesterase inhibitors: Edophonium (shortest), Pyridostigmine, Neostigmine (most common)

17
Q

What are the 3 non-depolarizing amino steriod NMBs? The 2 Isoquinolinium agents?

A

amino steriod- Pancuronium, Vecuronium, Rocuronium

isoquinolinium- Atracurium, cisatracurium

18
Q

Which non-depolarizing NMB subclass is used for pts with liver or renal dysfunction?

A

Isoquinolinium (atracurium and cisatracurium)