General Anesthetics Flashcards
1
Q
Nitrous Oxide
A
- Inorganic gas: NMDA receptor antagonist
- Mask induction in children, adjuvant to volatile anesthetics, opioids
- Side effects: post-operative nausea and vomiting; inactivates vitamin B, accumulates in closed-air containing spaces
- No muscle relaxation
2
Q
Isoflurane
A
- Volatile anesthetic: most potent
- Gold standard for maintenance of anesthesia
- Side effects: pungent, 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, increase in HR, malignant hyperthermia
3
Q
Desflurane
A
- Volatile anesthetic: least soluble, least potent (rapid emergence from anesthesia)
- Maintenance of anesthesia
- Most pungent (airway irritation symptoms), 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, increase in HR, malignant hyperthermia
4
Q
Sevoflurane
A
- Volatile anesthetic: less soluble, loss potent (but not irritating)
- Mask induction in children and adults, maintenance of anesthesia
- Side effects: can form CO if not combined with CO2 correctly, 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
Methohexital
A
- Barbituate: GABAa receptor agonist, antagonist of NMDA-glutamate receptor, produces hypnosis and sedation but is anti-analgesic
- Induce general anesthesia
- Redistributes from brain to muscle to fat
6
Q
Propofol
A
- Alkylphenol: GABAa receptor agonist, antagonist of NMDA-glutamate receptor, some a2 receptor activity, rapid onset and offset
- Anti-emetic at low doses; induction and maintenance of general anesthesia; sedation in ICU, procedural sedation
- Side effects: propofol infusion syndrome- being given for several days leads to metabolic acidosis, rhabdomyolysis, heart and renal failure, lowering of BP, bradycardia, and death, painful injection site
- IV in an egg and soy emulsion
- NO malignant hyperthermia
7
Q
Etomidate
A
- Carboxylated imidazole: GABAa receptor agonist
- Hypnosis, no analgesic activity
- Side effects: pain on administration, involuntary myoclonic movements, postoperative nausea and vomiting, single dose inhibits cortisol synthesis
- Minimal respiratory depression
8
Q
Ketamine
A
- Phencyclidine: NMDA receptor antagonist, kappa opiate agonist, leads to dose-dependent unconsciousness, amnesia, analgesia
- Sedative/anesthetic for pediatric/developmentally delayed patients; induction in patients with reactive airway disease, hypovolemia (trauma patients), cardiac disease; with propofol for IV procedural sedation; adjuvant during and after surgery to reduce opiod use; part of multimodal pain therapy regimen; depression treatment
- Side effects: Stimulates sympathetic nervous system outflow; increases cerebral blood flow, ICP; emergence delerium; nystagmus, lacrimation, salivation, and dissociative anesthesia
9
Q
Dexmedetomidine
A
- A2 adrenergic agonist: binds a2a and a2b in locus coeruleus and spinal cord (sedation, sympatholysis, analgesia)
- Awake intubations, awake craniotomies, adjuct to general anesthesia in patients susceptible to narcotic-induced post-op repiratory depression, withdrawl/detox
- Side effects: limited respiratory depression, wide safety margin
10
Q
Succinylcholine
A
- Depolarizing NMB: divalent ACh molecule, attaches to all ACh receptors, overstimulating them, then paralysis
- Skeletal muscle relaxant
- Side effects: malignant hyperthermia, cardiac dysrhythmias, hyperkalemia, increased intraocular pressure, increased intracranial pressure
- Blockage cannot be reversed
11
Q
Pancuronium
A
- Amino-steroid non-depolarizing NMB, competitive blockage of ACh (no depolarization)
- Skeletal muscle relaxant, avoid in patients with renal insufficiency
- Side effects: increase in HR
- Reverse with AChEi
12
Q
Vecuronium
A
- Amino-steroid non-depolarizing NMB, competitive blockade of ACh (no depolarization)
- Skeletal muscle relaxant
- No cardiovascular effects
- Reverse with AChEi
13
Q
Rocuronium
A
- Amino steroid non-depolarizing NMB: competitive blockade of ACh (no depolarization)
- Skeletal muscle relaxant
- No cardiovascular effects
- Reverse with AChEi
14
Q
Sugammadex
A
- Selective relaxant binding agent: complexes with rocuronium rendering it inactive
- Immediate reversal of rocuronium
- Side effects: decrease in BP, nausea, vomiting, dry mouth
15
Q
Atracurium
A
- Isoquinoline non-depolarizing NMB: competitive blockade of ACh (no depolarization)
- Skeletal muscle relaxant, use in patients with liver or renal dysfunction
- Side effects: histamine release with hypoT and tachycardia
