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General anesthetics Flashcards

(44 cards)

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1
Q

clinically effective concentration range

A

1-100mM. no single “receptor”

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2
Q

property determining general anesthetic potency

A

high lipid solubility

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3
Q

Lipid theory of general anesthesia

A

volatile general anesthetics exert their effects by partitioning into the lipid component of the nerve cell membrane

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4
Q

Protein theory of general anesthesia

A

volatile anesthetics act via interactions with hydrophobic pockets in membrane proteins

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5
Q

General anesthetic action in nervous system

A

potentiation of GABAa receptor activity, inhibition of excitatory synapses –> increased duration of inhibitory postsynaptic potentials –> greater inhibition in CNS, depression of neuronal excitability

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6
Q

Describe action potential conduction in the peripheral nervous system of anesthetized patients

A

Normal conduction. conduction block only appears at doses well above the clinical range

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7
Q

Sequence of general anesthesia progression

A

loss of fine motor function and coordination –> altered consciousness and analgesia –> loss of temp regulation –> unconsciousness –> effects on eye motion, pupil size, and light reflex –> loss of muscle tone –> respiratory failure –> cardiovascular failure –> coma and death

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8
Q

Stage I anesthesia

A

analgesia

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9
Q

Stage II anesthesia

A

excitement, delirium

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10
Q

Stage III anesthesia

A

surgical anesthesia

plane 1: regular metronomic respirations
plane 2: onset of muscle relaxation, fixed pupils
plane 3: good muscular relaxation, depressed excursion of intercostal muscles during respiration
plane 4: diaphragmatic breathing only, dilated pupils

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11
Q

Stage IV anesthesia

A

medullary paralysis

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12
Q

Stage able to be reached by N2O gas

A

Stage II

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13
Q

Time course of surgical anesthesia

A

Induction (time until stage III is reached)
Maintenance (surgery)
Recovery (termination to complete recovery from anesthesia)

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14
Q

steady state anesthesia

A

anesthetic gas partial pressure in lung = anesthetic gas partial pressure in blood = anesthetic gas partial pressure in body tissues

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15
Q

Four phases of uptake of volatile anesthetic

A

lung factors, uptake from alveoli to blood, uptake from blood to tissues, tissue distribution

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16
Q

lung factors for uptake

A

rate of partial pressure increase in proportional to rate of ventilation

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17
Q

Determinants of uptake rate from alveoli to blood

A

solubility of gas in blood, pulmonary blood flow

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18
Q

effect of higher gas solubility in blood

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A

need more gas dissolved in blood to produce anesthesia. less solubility –> more rapid anesthesia

19
Q

Higher lung blood flow

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A

slower achievement of anesthesia

20
Q

higher tissue blood flow

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A

faster anesthetic delivery

21
Q

Estimation of anesthetic potency

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A

1/MAC

MAC = minimum alveolar anesthetic concentration = alveolar concentration that prevents gross skeletal muscle response to painful stimulus

22
Q

Major elimination route for general anesthetics

23
Q

determinants of lung excretion

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A

cardiac output and respiratory rate

24
Q

distribution to vessel-rich group

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A

brain, heart, kidney, liver, endocrine glands. anesthetic effects in minutes

25
distribution to muscle group
muscle and skin. uptake in 2-4h due to lower perfusion than vessel-rich group
26
distribution to fat group
very slow uptake due to low perfusion and high lipid solubility. Eventually dominates rate of uptake into total body tissue
27
fat group effects on recovery
longer duration of anesthesia --> higher fat load of anesthetic --> long recovery from anesthesia
28
volatile anesthetics
xenon, nitrous oxide, diethyl ether, cyclopropane, chloroform, halothane, enflurane, isoflurane, desflurane, sevoflurane
29
IV anesthetics
thiopental, propofol, etomidate
30
IV adjuncts
ketamine, d-tubocurarine, morphine, fentanyl, diazepam, ondansetron, glycopyrrolate
31
treatment of malignant hyperthermia
dantrolene
32
nitrous oxide
advantages: excellent analgesia, rapid on/off, less increased cerebral blood flow (head injuries) disadvantages: low potency --> not general anesthetic contraindications: respiratory obstruction, pregnancy
33
Diethyl ether
advantages: complete anesthetic disadvantages: flammable and explosive, slow induction/recovery
34
Chloroform
no longer used due to hepatoxocity and arrhymogenicity
35
Halothane
Advantages: mid-high potency, fast on/off, non-explosive, non-irritant Disadvantages: not good analgesic, can produce respiratory and cardiac failure, can cause liver damage, can trigger malignant hyperthermia (excessive Ca release from ryanodine receptors)
36
Enflurane
Advantages: excellent analgesic, moderately fast on/off, good muscle relaxant Disadvantages: can trigger seizures during induction/recovery
37
Isoflurane
Advantages: more potent than enflurane, little hepato/renal toxicity, does not trigger seizures, fast on/off, minimal direct cardiac depression, good muscle relaxant. Most widely use inhalational anesthetic Disadvantages: can trigger coughing (use IV to overcome)
38
Desflurane
Advantages: fast recovery from extended anesthesia, similar pharmacokinetics to N2O with higher potency Disadvantages: pungent odor --> airway irritation and cough. Requires special vaporizer Contraindications: patients with predisposition to malignant hyperthermia
39
Sevoflurane
Advantages: high potency, fast on/off, rapid adjustment of anesthetic depth, no coughing or airway irritation (can be used for induction of anesthesia) Disadvantages: chemically unstable. releases F ions --> renal toxicity
40
Thiopental
Advantages: Very short-acting barbiturate (potentiates GABAa), very rapid onset (15-20s) and offset (reawaken in 3-5 min)
41
Propofol
Potentiates GABAa Advantages: loss of consciousness in seconds, recovery faster than thiopental, less nausea post-op, no involuntary movements seen with etomidate
42
Etomidate
Nonbarbiturate hyponotic. Potentiates GABAa Advantages: minimal depression of CV and respiratory function, larger safety margin than thiopental, fast on/off Disadvantages: involuntary movements during induction, high incidence of nausea, vomiting, pain on injection
43
Ketamine
PCP derivative glu-NMDA antagonist Advantages: potent bronchodilator --> indicated for asthmatics Disadvantages: catatonia, amnesia, disorientation and hallucination (reduced with IV diazepam), slow effect IV
44
Use of neuromuscular blocking adjuvants
vecuronium and D-tubocurarine --> competitive antagonism of Ach at NMJ --> relaxation of skeletal muscle Common in abdominal surgeries. relaxed abdominal wall --> lower dose of volatile anesthetic required --> reduced danger of anesthetic overdose

Neuro IV (21 decks)

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