Lecture 6 - Clinical Uses of anesthetics Flashcards Preview

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Flashcards in Lecture 6 - Clinical Uses of anesthetics Deck (18):
1

what are some desired components of General anesthesia?

• Desired components -- amnesia, (Preemptive) analgesia, anxiolysis/sedation, suppressed stress and hormonal responses, immobility/muscle relaxation, autonomic areflexia

2

what are the phases of anesthesia --

(pre induction), induction, maintence, emergence

3

What are the three most commonly used IV anesthetics?

Propofol
Ketamine
Etomidate

4

Propofol --
Mechanism
Pros vs Cons

Mechanism -- potentiation of GABA mediated inhibition

Pros -- Rapid onset/short acting; anti-emetic, bronchodilation
Cons -- pain on injection; no analgesia, hypotension

5

Ketamine
Mechanism
Pros vs Cons

Mechanism: NMDA receptor antagonists, and some opioid receptor function

Pros -- dissociative states, bronchodilation, POTENT ANALGESIC,

COns -- Hypertension, Increased ICP, use with caution CAD/CVA patients, tachycardia. PSYCHOTROPIC SIDE EFFECTS

6

Etomidate
Mechanism
Pros vs cons

potentiates GABA mediated inhibition

Pros -- Cardiovascularly stable (no effect on the heart of CV). Great for CV unstable patients

Cons -- adrenal suppression, pain on injection, myoclonus

7

Opiods -- pros vs cons

Pros -- Analgesia
§ Minimal cardiac depression; reduces inhalational agents; versatile (IV, IM, SL, regional anesthesia)

○ Cons -- Respiratory depression
bradycardia, skeletal muscle rigidity, nausea and vomiting

8

Of the opioids which have the shortest time of onset?

Remifentanil > alfentanil < Fentayl< Morphine/Meperidine/< Methadone -- minutes

9

How is immobility achieved during surgery?

what are the two classes

Depolarizing and Non Depolarizing Muscle relaxants

10

Depolarizing immobility agent
Mechanism
pros
cons

Succinylcholine --
Mechanism -- nicotinic ACH R Agonist; persistent depoarlization of the end plate

Pros -- fast onset, short duration

Cons -- Hyperkalemia, Trigger of Malignant Hyperthermia, Increased ICP/IOP
will be prolonged in persons who have acetylcholinesterase mutations

11

Non Depolarizing immobility agents
Mechanism
Pros
cons

Rocuronium, Vecuronium, Pancuronium, Cisatracurium

Mechanism -- competitive antagonists of the Nicotinic ACH R

Pros -- fast Onset, Longer Duration

12

Immobility agents --
which has the fastest onset ?

duration shortest to longest ?

Fastest onset -- Sux (1-1.5 minutes)

Duration
Sux < Roc < Vec = Cis < Pancuronium

13

Pre- induction -- what medication clsas is commonly used for anti-anxiety/amnesia prior to general anesthesia?

Versed (midazolam) -- and other benzos

14

what are the common inhalational induction agents?


which is the most commonly used? why?

Liquid: Isoflurane, Sevoflurane, Desflurane, (Halothane)

Gaseous form: Nitrous oxide

Isoflurane -- most commonly used -- cheap and long lasting

15

why must N2O be combined with other medications?

when is N2O contra-indicated ?

Combined with other meds bc its can't reach MAC of 1 on its own

Contraindicated in surgeries with open air pockets such as laproscopic surgeries, bowel obstruction surgeries, pneumothroax, middle ear surgeries.

16

which inhaled agent is good for kids before proceeding with another inducing agent ? why?

§ Sevoflurane: not reactive for airways; best for kids

Then switch to Isoflurane after airway secured

17

patients with heart disease
-- which Inhaled anesthetic is known to cause tachycardia?
-- which IV inducing agent is known to cause tachy?
---which IV inducing agent is best for cardiovascularly unstable patients
---which opiate is best for patients with CV instability?

Inhaled tachy -- desflurane

IV tachy -- ketamine

CV unstable patients -- Etomidate and Fentanyl

18

which immobility agent is best for persons with poor kidney function?

Cis astricurium