Intravenous and Inhalational Anesthesia Flashcards by Bryan Edwards

What is the triad of anesthesia

Analgesia
Amnesia
Skeletal Muscle Reaction

How well did you know this?

Not at all

Perfectly

Significance of no anasthesia specific antagonists

Rely on metabolism of the drugs

How well did you know this?

Not at all

Perfectly

What are the four stages of anesthesia

1 - Analgesia
2 - Disinhibition (Delirium and Excitement)
3 - Surgical Anesthesia
4 - Medullary Depression (Resp + CV depression)

How well did you know this?

Not at all

Perfectly

Minimum Alveolar Concentation is…

Minimum alv. conc. that stops movement in 50% of patients in response to painful stimulus.
Used to define potency of inhalational anesthetics

How well did you know this?

Not at all

Perfectly

Relationship of N20 and mac

itself – 104%

combinew ith others to lower the MAC of other anesthetics

How well did you know this?

Not at all

Perfectly

Some non-drug factors that lower MAC

Increasing Age
Hypothermia
CNS depression/Drugs
Acute OH intox
Pregnancy
Alpha Adrenergic (clonidine)

How well did you know this?

Not at all

Perfectly

Things that increase MAC requirements

Hyperthermia
Chronic Ethanol Abse
Increase CNS neurotransmitters (MAO inhib.)

How well did you know this?

Not at all

Perfectly

Blood-Gas Partition Coefficient is a measure of…

the relative solubility of a drug in blood vs air. Determines the uptake from the alveoli

How well did you know this?

Not at all

Perfectly

______ Blood Solubility will cause slow induction? Rapid Induction?

Low Solubility – Rapid Induction

High Solubility – Slow Induction

How well did you know this?

Not at all

Perfectly

Important Nitrous Oxide details

Insoluble,
Analgesia + Sedation
Second Gas Effect

How well did you know this?

Not at all

Perfectly

Adverse effects of Nitrous Oxide

Oxidizes Cobalt in B12
Expansion in Closed Spaced
Diffusion hypoxia on emergence

How well did you know this?

Not at all

Perfectly

Important Diethyl Ether facts

Flammable, easy to administer
Respirator Irritant
Complete Anesthetic (Relax, unconscious, analgesia)

How well did you know this?

Not at all

Perfectly

Advantages of Halothane

Sweet odor, smooth inhalation
Fair analgesia, muscle relaxation
Excellent hypnosis

How well did you know this?

Not at all

Perfectly

Disadvantages of Halothane

CV, respiratory depression
Catecholamine Sensitization (ventricular arrythmia)
Hepatotoxicity (genetic predisp., massive necrosis)

How well did you know this?

Not at all

Perfectly

Important Enflurane details

Rapid Induction and Recovery
Good Analgesia/relaxation/hypnosis
No catecholamine effect
Bad odor, CNS stim (seizures), CV depression

How well did you know this?

Not at all

Perfectly

Important Isoflurane details

Rapid Induction/Emergence
Good analgesia/sedation
Pungent odor, drops BP, coronary steal

How well did you know this?

Not at all

Perfectly

Important Sevoflurane details

Rapid Induction
Non irritating
Non-flammable
CANNOT USE WITH LOW FLOW ANES.

Important Desflurane details

Rapid achievement of anesthesia, recovery/awakening
Uterine relaxant
Drops in CO, BP

CV effects of Anes.

Drop MAP (HE drops CO, others drop SVR)
Alter HR (Halo decreases via vagal, other increase)

Resp. effects of anethetics

decrease TV, increase rate
impaired mucociliary apparatus
Bronchodilation (esp. Halothane)

CNS effects of anes.

Lower CNS metabolic rate
May increase intracerebral pressure
Enflurane can trigger seizures

Renal effects of anes.

Decrease GFR, RPF, inc. filtration frac.

Enflurane, Sevoflurane, Methoxyflurane can be nephrotoxic

Most potent anesthetic given

Methoxyflurane

Important detail on cycloflurane

Explosive

Important details on Malignant Hyperthermia

- Ca+ in SR released --> HTN, Tachy, hyperthem, acidosis, hyperkalemia - Trigger by Halogenated agent or succinylcholine - Treat w/ IV Dantrolene Sodium

Important Sedative Hypnotics for this exam

``` Barbiturates Ketamine Propofol Etomidate Benzos ```

Clinical Uses of Barbiturates

Induction of anesthesia Treatment of Increased ICP Decreased Cerebral Blood Volume Decrease Cerebral Metabolism

5 most common Barbs in anesthesia

``` Sodium Pentathal (Thiopental) Methohexital Thiamylal Secobarbital Pentoparbital ```

Important Sodium Pentothal details

``` Sedation+Hypnosis+Anesthesia IV adinistration Rapid onset, short duration NO muscle relaxation, antanalgesic Resp depression, cough, bronchospasm ```

Important Ketamine details

PCP derivative, NMDA antag. Rapid Onset, Short Duration Profound anterograde amnesia for 1 hr, analgesia Copious salivation Increases Intracranial Pressure, Don't give w/ head injury

Relationship of Ketamine to autonomics

Sympathomimetic (blocks reuptake) | Smooth muscle relaxant

Details about Ketamine Emergence Delirum

Auditory Hallucinations Vivid Dreams Reduced by benzos

Important propofol details

IV, rapid onset, short duration hypnosis Sedation, hypnosis, anesthesia, antiemetic No analgesia. Pain on injection, hypotension, drop in SVR

Important details on Etomidate

NON - Barb, analgesic Pain on injection, myoclonus Adrenal suppression w/ chronic N/V

Mechanism of Benzos in anesthesia

increased C- GABA activity Diminished Reticular Activating System Antagonized by Flumenazil

Common Benzos in anesthesia

Diazepam (Vallium) Lorazepam Midazolam (versed)

Important details on Diazepam (Vallium)

Rapidly absorbed from GI Minimal CV depression Protein binding paralleling lipid solubilty

Clinical uses of Diazepam

``` Preoperative Induction of anesthesia (w/ large dose) IV sedation anticonvulsant/muscle relaxant delirum tremens ```

Important details of Midazolam (versed)

More rapid, potent than valium 50% first pass effect Elimination half time = 1-4 hrs Excellent anterograde amnesia

Midazolam downside

CV depression (esp. w/ narcotics)

Lorazepam details

More potent amnestic than diazepam Slow onset, long duration, slow dissociation Minimal effects on muscle, CV, pulm Pharmacologically inactive metabolites