Genral&Local anastheisa Flashcards by Omar Gazar

بسم الله الرحمن الرحيم وبه نستعين
____________________
Mention aim of general anastheisa

RAASI
Reversible loss of consciusness
Amensia
Analgesia
Skeletal muscle relaxation
Inhibtion of Visceral reflexes

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Blanced anasthsia is done by ?

Preanstehtic medication:- HOBA
H1,2blockers Opioides BZs Atropine
for amenisa anxiety and visceral reflexes and anathsies
____________________
IV anasthic for induction
Inhalation ansthetic for maintaence
_____________
Skeletal Muscle relaxant Succinylchlone or NMBs

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GA works by?

Inhibtion of midbrain reticular formation
by?
Facilitaion of GABA :
BZs+ Barbit. + halogenated agents Propfol + etomidate
OR
Inhibtion of glutamate NMDA receptor by?
Ketamine+Nitrous oxide

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MAC?

Minumun alvolar concentartion
اقل تركيز للغاز المخدر في الحويصلات الهوائية عشان العيان ميترحكش لما يتعرض لمؤثر الم زي فتح جراحي
measuring potency +ED50

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MAC is decreased by and inc by?

MAC dec by?
Anathetics BZs + Opioids
A2 blockers clondine
Elderly
Inc potency decreasing ED50
___________________
MAC decreased by?
Drugs increasing Cataechols
Alchol abuse
Increasing ED50 decreasing Potency

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High blood gas solubility
or parition cofficient means

slow induction
slow recovery
and vice versa

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Halogenated agent
used mainly for Maintaince bu may bu used for indcution

Halotahane
Non irritant smooth pleasnt odor

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why halothan + N2o ?

for powerful analgesia
as halothane weak anglesic storong anasthetic
and the N2o is the opposite

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Halogenated agent with mdeium rate of Induction and recovery

Halothane

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mention adverse effects of halothane

4H+BSCU
Hypotension
HR decreased
Hepatotoxic
Hyperthermia Malignant
_________________-
Uterine relaxation increasing bleeding
Increased ICP due to cerberal VD
Bronchodilator
skeletal muscle relax

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Newer Halogenated agents are discovered why?

To Overcome the Hepatoxic effect of halothane
but still
Resp and CVS depression with Maligant Hyperthermia
________________________-
Isoflurane
Desfulrane
SevoFlurane

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Halogenated agent casuses Ischemia ?

ISOflurane

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Halognated agent whichc is respiarotry irritant with purgant odor casing larynospam + Cough?
and may cause (ISCHEMIA)
OR with high PC

ISO flurane
Contraindicated in
Induction
Asthma

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Describe PC of ISOFLURANE

It is of high paritotion cofficient so? slow induction slow recovery not for short procedure

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Halognated agent whichc is respiarotry irritant with purgant odor casing larynospam + Cough?
WITH low PC

Desflurane
fastest onset and recovery so used in Short procedures

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Halogenated that is used for induction of Anastheisa
Halogenated that has no respiratory irritaion
Halogenated that has nephrotoxic effect?

Sevoflurane
___________
Interacting with soda lime forming substance A that is nephrotoxic

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Anathetic with Rapid onset and recovery PC=0.47
With Low potency High MAC
Used with other analgesics to minimize thier side effects and increasing analgesic effect
Used in analgesia
in dental clinic -Obsteric analgesia

Nitrous Oxide
N2O

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N2O is the safest inhalation agent give reason
__________________
N2O is perferd to Halothane
why?

Less CVS and resp depression
Less Hepatotoxica
Less uterine relaxation
No malignant hyperthermia
Less Effect in ICP
& Skeletal muscle relaxation

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List adverse effects of N2O

EHA3b
1-Expand gases in closed spaces increasing pressure in closed spaces
So contraindicated in Bowel obsteruction and Pnemothorax
2-Hypoxia on Recovery
on prolonged use
3-Abuse euphoria
4-Anemia Megaloblastic + Abortion

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Mention
Wiedly used IV anasthetic for induction
_________________
Or alone in anastheisa for short procedure

Thiopental

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Thiopental redistributed to ?

Skeletal muscles then fatty tissue so ? when readminstered may lead to toxicity due to accumulated amount in fatty tissue

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Mention adverse effects of thiopental

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Barbituate! ?
Narrow TI with no antidote:
CVS and resp Depression
Acute prophyria
Vasospam+Gangrene

IV anastheic that can cause Vasospam+Gangrene?

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Thiopental

IV anasthetic that is used for induction with rapid onset rapid recovery may be used also in IV infusion maintainance
And Has Antiemetic advantage !

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Propofol

IV anathetic used in Conscious and deep sedation in ICU ?"

Propofol

Disadvantages of Propofol mention ?

CVS and resp depression + Pain at site of injection

Dissociative anasteheisa by ?

Ketamine

Mention Advanatages of Ketamine

Bornchodilator so ? prefered in athmatics Increasing HR and ABP As CVS stimulant Analgesic: used for minooor procedure

Mention adverse effect of ketamine

-Increasing ICP so CI in head injuires -Hallucinations and disorientaion on Recovery so proceeded by Diazpam

Benzodiazepine lkie ,,,,,,and,,,,and,,,,, used in anastheisa especially ,,,,,, due to its ,,,, and ,,,,,and,,,,,, ________________ indications : 1- 2- 3- ____________________ Advantage?

Midazolam Lorazepam Diazpema _____________ Midozolam Short onset and duration and less irritant ___________________ Conscious sedation preanasthetic Balanced anastheisa ___________________ Flumzenil as antidote

gopioids and propfol may be combined in .... anastheisA

What is the mechanism of Local anastheisa

ان الجزء المحب للدهون للمخدر الموضعي يعدي غشاء الخلية العصبية ويقفل من جوا بوابات الصوديوم ويمنع جهدالحركة انه بتولد وبالتالي يمنع انتقال النبضات العصبية في مسارات الألم

اذكر العوامل المؤثرة علي حساسية العصب للمخدر الموضعي

1-LA is more effective in rapid firing nerves 2-More effective on small nerves of Pain &temperature

chemical structure of LA ?

(Aromatic + ( Ester-Amide ) + Amine )

Compare between Esters &Amide LA MDLE Metabolism duration liable to expanison of duration ________________ Esters like Procaine - benzocaine -Cocaine Amides lkie Lidocaine bupivacaine

Esters hydolysed by pseudocholin esterases but Amide by Liver metabolism _________________ Esters shorter duration due to palsma esterases but amide longer duration due to liver ________________ Esters liable to allergy (analgue with PABA) But Amide liable to Systemic Toxicity _____________________ Esters duration increased in genetic defect on enzyme but Amide duration increased in liver diseases

Examples to LA

Procaine from esters short acting may extends to one hour Lidocaine intemediate 2 hours Bupivacane Long 3 hours

Mnetion Factos affecting Activity of Lcoal anasthetics

p2L -Plasma protein binding Bubivacne > lidocaine so longer acting -Lipid Solubility Bubivance 7 times more potent than lidocaine -PKa of drug as the less basic the more non ionized extracellular the more rapid tha action is as Bupivacne >lidocaine

LAs are weak,,,,,,, Pka from ,,,,,to ,,,,,,, Only,,,,,,, form can cross the nerve membrane to the site of action ECF PH= ? IC = ?

bASES (7,7-9 Non ionized ______________ 7,35 6-7,4

What happens in increased ECF acidity for LAs? What happens in infection in relation to LAs? What Happes in Repeated lidocaine ?

increasing ECF acidity ________________________ Incrasing IOINZED Decreasing Non ionized so few inoized intracellular so less action

how to improve local anasthetsia?

By adding NaHCO3 to alkalnization of the media of ECF Increasing NON ionized form of the LA so increased Ionized Intracellulaet potenitating the blockade

GR for using vasoconstrictors with LAs?

LAs except cocaine cause VD of blood vessels increasing absorption of LAs in blood causing systemic toxicity _________________ Vasoconstirtors prevents absorption of LAs preventing Systemic toxicity as Epinphernie CI in finger toes nose gangrene Felypressin perefered to EP in cardiac patients

LA in surface anasthesia ?

applied to skin and muscous membrane

LA in infiltartion anasthesia ?

Submucosal subcutanuous dentist

LAs nerve block ?

in denistiry and surgery Inject clost to trunk blocking all branches

used in surgery of abdomen , pelvis and legs when general anasthesia in contraindicated

spinal and epidural anastheisa

Injection in subarachanoid space below L2 Acting on spinal cord and spinal roots with immediate onset?\ Mention side effects

Spinal anasthesia side effcets:HSI Headache (CSF Leakage and traction) Hypotension due to sympathatic block Spinal root injury Infection

Injection outside dura blckong spinal roots onset 10 minutes delay

Epidural anasthesia\in painless labot

Injection outside dura blckong spinal roots onset 10 minutes delay

Epidural anasthesia\in painless labor

Mention adverse effect of Local anasthertics

1-CNS : Numbness -restlessness tremors - consulsions coma death 2-Neurotoxicity: spinal cord or trunks as paraplegia or parathesia in spinal and eipdural anathesia 3-CVS decrasing HR and ABP Bbpivacin is extermely cardiotoxic in high doses 4-VCs increasing BP may peripitate arryhtmia 5-allergy: Esters analogue to PABA

Lidocaine is CI with ?

Propranolol as propranolol reuces the hepatic blood flow decrasing clearance of lidocaine casuing toxicity

Lidocain/EP CI with Propranolo ?

As propranolo blockinb2 so alpha is not opposed casuing sever VC and severe hypertension

MAOI &TCAs are CI with Lidocaine/EP ? WHY

MAOI and TCAs increasing CA + EP = hypertensice crisis

الله نزل أحسن الحديث كتابا متشابها مثاني تقشعر منه جلود الذين يخشون ربهم ثم تلين جلودهم وقلوبهم إلي ذكر الله ذلك هدي الله يهدي به من يشاء

Genral&Local anastheisa Flashcards

(53 cards)