Local and General Anesthetics (NEURO)

Question 1

3 stages of anesth. and drugs used

Answer 1

Induction
•	Propofol
•	Muscle relaxants: succinylcholine & rocuronium
•	Anxiolytic: Diazepam
Maintenance
•	Fentanyl: pain relief
Recovery
•	Muscle relaxant reversal: neostigmine

Question 2

4 depths of A

Answer 2

Stage 1: Analgesia
Stage 2: Excitement & delirium
Stage 3: Surgical anesthesia
Stage 4: Death

Question 3

Desirable effects

Answer 3

Unconsciousness
Amnesia
Analgesia
Inhibition of reflexes
Paralysis/muscle relaxation

Question 4

Any 3 SE

Answer 4

• Cerebral (depressed)
• CDV (halogenated drugs)
• Respiratory (inhaled cause dose dependent decrease in tidal volume)
• Renal & hepatic
• Uterine smooth muscle relaxation (halogenated, allows uterine procedures)
• Lipid rescue: Highly lipid soluble and so can use lipid bolus to correct an overdose

Question 5

What is lipid rescue

Answer 5

• Lipid rescue: Highly lipid soluble and so can use lipid bolus to correct an overdose

Question 6

Name the 3 gaseos agents
- Whic has rapid onset
- WHich has the slowest onset
- Which is OK in preganacy
Which causes meglablastic anemia

Answer 6

• Which has rapid onset
  NO
• Which has the slowest onset
  Isoflurane
• Which is OK in preganacy
  Sevoflurane

Which causes meglablastic anemia
NO

Question 7

Ketaime

• Mechanism
• SE

Answer 7

• NMDA receptor antagonist
• Inhibits NO synthase
Liver
Hallucinations so avid alcohol & barbiturates

Question 8

Propofol

• ME
• SE

Answer 8

GABA agonists
Antiemetic
Raid onset
OK pregnancy

• Aseptic technique since has fats in its preparation
• Egg allergies

Question 9

Name the 3 opiods used in Anesth.

• Effect
• Which one should not withdraw suddenly?
• SE for all

Answer 9

• Analgesic
• Sedation
• Opioid agonist
• Abuse potential
• Fentanyl: avoid abrupt withdrawal

Question 10

Name the benzodiazepin used and why it is only used in a hospital setting

Answer 10

• Benzodiazepine
• Only is hospital or ambulatory care setting since respirator depression

• Respiratory depression

Question 11

Ketorolac

• Ckass
• How long do you use it
• Major SE

Answer 11

•	Short term use (5 days)
Liver
Renal
Hepatic
GI
Bleeding (labor)

Question 12

Etomidate

• class
• SE

Answer 12

•	Hypnotic w/o analgesia
Liver
•	Laryngospasm
•	Skeletal muscle movement
•	Shock

Question 13

Local anesthics

• often used with?
• mechanism
• two types & difference iin metabolism

Answer 13

• Add vasoconstrictor (epi) to prevent drug leaving the site - don’t need to do this cocaine
• Have channels in open/active state by adding potassium (Ca closes channels)

Esters (one i): pseudocholinesterase
Amides (2 I’s): Metabolized in the liver by P450

• Na channels blocked
• Most effective on: barrow, heavily myelinated, rapidly firing peripheral nerves.

Question 14

Name the most popular esters

Answer 14

• Cocaine (topical)
• Benzocaine (topical)
• Procaine
• Tetracaine

Question 15

Name the 2 amides & SE /contradindications

Answer 15

Bupivacaine
• Toxicity: Convulsions & cardiac arrest & arrhythmias
• Avoid in obstetrical use

Lidocaine
• Lipid rescue therapy
• SE side effects corrected with diazepam

Question 16

Which drug can be rescued with lipids

Answer 16

lidocaine

Question 17

What is the three compartment model

Answer 17

Compartments
•	Blood
•	Brain & viscera
•	Muscle & fat
Theory
•	Perceived dose and half-life are complicated by distributing to these compartments and is not linear