Anesthesia Summer Study

TV; amount of air breathed into or out of the lungs in quiet, relaxed breathing

RV; amount of air that remains in the lungs after maximum exhalation

ERV; amount of air that rcan be exhaled after a normal exhalation

IRV; amount of air that can be inhaled above normal inhalation

TLC; total amount of air that can be contained in the lungs after maximum inhalation

IC; amount that can e inhaled after normal exhalation

VC; amount of air that can be expelled from the lungs by maximum exhalation after maximum inhalation

FRC; amount of air remaining in the lungs after normal exhalation

FEV; volume of gas exhalaed with maximum force within a given interval of time, the time interval is shown as a subscript such as FEV, (1 second), FEV 3(3 seconds

FVC; volume of gas exhaled as rapidly and completely as possible after a complete inhalation

Localized pathological process scheduled for surgery or procedure. No systemic disturbances

mild to moderate systemic disturbances with or without relation to scheduled surgery or procedure

severe systemic disturbances from whatever causes

life threateing systemic disorders which may not be correctable by planned surgery or procedure

moribund patient

organ donor

Dose: 0.3 mg/kg (0.2-0.5)
pain on injection
class: hypnotic
antagonist of GABA receptors

Dose: 2 mg/kg IV (1-2), 1.5 mg/kg IM
minimum respiratory depression
class: NMDA receptor antagonist
contraindications: alcohol, sedatives, stimulants
effects: impairs senses, such as sight, balance, sense of time, decrease HR

Dose: 2 mg/kg (1-2.5)
Notes: pain on injection
class: hypnotic

AKA sodium thiopental
dose: 4mg/kg (3-6)
class: barbituate
notes: high pH
decrease in HR, decrease in Resp. Rate

Dose: 0.1 mg/kg (0.1-0.5)
Notes: used in renal failure, facilitate intubation

Dose: 0.1mg/kg (0.08-0.12)
notes: produces tachycardia, displaces acetylcholine, increases HR, decrease RR

Dose: 0.6 mg/kg (0.6-1.2)

Dose: 1 mg/kg (1-1.5)
Notes: paralyze, facilitate intubation, non-competative, mimics acetylcholine, decreases HR, hyperkalemia

Dose 0.1 mg/kg (0.08- 0.12)

Dose: 1-2 mcg/kg, 2-5 mcg/kg
Notes: during induction, immediate effect

Dose: 0.5 MG (0.25-1)
Notes: post op analgesia, derivative of morphine

Demerol
Dose: 12.5 mg
Notes: treats shivering, serious interactions with MAOI's

Dose: 0.1 mg/kg (0.05-0.15)
Notes: postop analgesia
contraindications: acute resp. depression, renal failure, chemical toxicity, increased intracranial pressure, biliary colic

Dose: 20-40-80mcg
Notes: progressive dosing, counter opiod dose

Dose: 1 mg (0.5-2)
notes: induces sedation
contraindications: pregnancy, neonates, elderly, alcohol and drugs

Dose: 5 mg (5-25) initial dose
class: sympathomimetic aminr
notes: bronchodilator
contraindications: antidepressants, impaired adrenal fnct, acidosis, diabetes, cardio disease, MAOI's

Dose: 8mcg (8-16) initial dose (Adrenaline)
Notes: neurotransmitter, increase HR, bronchodilator, constricts blood vessels, increase BP
Added to local anesthetics to retard the absorption and prolong the effect (vasocontrictor)

Dose: 10mg (5-50) initial dose
Notes: treats tachycardia and supraventricular tachycardia, prevents the actions of epinephrine and norepinephrine

Dose: 5mg (5-10) initial dose
Notes: treats high BP, treats pregnancy induced hypertension

Dose: 50 mcg (50-100) initial dose
Notes: vasodilator, threats heart conditions

Dose: 50 mcg(25-50) initial dose
notes: vasodilator in arterioles and venules, treats heart failure

Dose: 16mcg (8-16) initial dose
notes: catecholamine, increase BP, decrease HR

Dose: 100 mcg(50-200) initial dose
Notes: decongestant, dilates pupil, increases BP, vasopressor, counteracts the hypotensive effect of epidural and subarachnoid anesthetics

Dose: 1.0 mg, 0.01 mg/kg
Notes: vagolytic dose, NMB reversal increases firing of SA node and conduction through AV node, lowers parasympathetic activity

Dose: 0.01 mg/kg
notes: NMB reversal, reduces salivary, thracheobronchial, and pharyngeal secretions, decreases the acidity of gastric secretions, reduces body sweating ability

Dose: 0.625 mg initial dose
notes: prevents postop vomitting and nausea

Dose: 4mg initial dose
notes: treats nausea and vomitting, reduces activity of vagus nerve, treats postop shivering

Dose: 2 mg (12.5-50)
notes: acts as antiemics, mild anxiolytic, antihistamine

Dose: determined by surgeon
notes: glycosaminoglycan, anticoagulant

Dose: 30 mg (15-60) IV or IM
Notes: NSAID, antipyretic, analgesic, inhibits prostaglandins, blocks the enzyme cyclooxygenase (COX), non-selective COX inhibitor

Dose: 1 mg/kg IV
Notes: local anesthetic, blocks sodium channels and signal propagation

Dose: 0.04 mg/kg
notes: parasympathomimetic, reverses muscle relaxants, such as vecuronium

catecholamine, precursor to norepinephrine and then epinephrine

sympathomimetic, treats heart failure, stimulates sympathetic nervous system, increase BP, increase HR

increases calcium ion uptae enhances relaxation of the left ventricle

ADH, affects tissue permeability in the kidneys, increases arterial BP, releases naturally when the body is dehydrated, moderate vasoconstriction

treat high BP and angina, calcium channel blocker

Class: natural
Use: IV, epidural, spinal
supplied: 10mg/ml
Dose: itraop- 0.1-1 mg/kg IV
postop- 0.03-0.15 mg/kg IV
Caution: depression of ventilation, PONV, biliary spasm, itching

IV/IM, onset in 15-30 minutes, 2-10 mg peak effect 45-90 minutes, duration 3-4 hours, metabolized in the liver and excreted by the kideys

Class: synthetic opiod
use: analgesia
supplied: 50 ug/ml
dose: low- 1-2 ug/kg
moderate- 2-20 ug/kg
cation: 75-125 x more potent than morphine

IV, transdermal, PO
Peak effect: 3-5 minutes
duration: 30-60 minutes
75% undergoes 1st pass pulmonary uptake
highly lipid soluble and protein bound, hemodynamic stability, drug interactions

class: synthetic opiod
use: analgesia, post-op shivering
supplied: 2.5%, 5%, 7.5%, 10%
Dose: periop analgesia 75-100 mg IV
post-op shivering 25 mg IV
Caution: neurotoxic, renal disease

Class: semi-synthetic
use: analgesia
supplied: 2 mg ampule
dose: 0.5-2 mg
caution: 5x as potent as morphine

Class: opioid antagonist
use: overdose, respiratory depression
supplied: 0.4 mg vial
Dose: dose 1-4 mcg/kg
caution: N/V pain, tachycardia, increased SNS,

Minimum alveolar conc.
-the concentration of the vapor that is needed to prevent movement (motor response) in 50% of subjects in response to surgical (pain) stimulus.

Minimum Alveolar Concentration,
allows comparison of potency
MAC values are additive
1.3 MAC prevents movement in 95%
6% decrease in MAC per decade of age

Resp. Rate
-all volatile increase RR (dose dependent)
-also decrease tidal volume
-this equals net decrease Minute Ventilation
-rapid, shallow, breathing
-decrease ventilatory response to hypoxemia
-ventilatory response to hypercarbia
-decrease FRC

CO2 absorbers
-compound A
--higher levels in Baralyme vs. soda lime
--use high flows (>2L/min0
Carbon Monoxide
--volatiles and bases in CO2 absorber
--dry dessicated absorber
--baralyme v. soda lime

Very stable, highly potent, A/W irritant, mi metabolism-0.2%, CV changes-minimal at 1 MAC, MAC=1.1%

Pungent, A/W irritant, avoid with reactive airways, decreased potency, easily titratable, carbon monoxide formation, prompt recovery, MAC=6.0%

Least A/W irritant, inhalation induction, metabolized 2-5%, prompt recovery, low flows for 2 MAC hours, MAC=2%

Sweet smelling, highly insoluale, decrease MAC, increase POV, MAC > 100%, CAUTION: enclosed spaces, diffusion hypoxia

Catecholamines-dopamine, norepinephrine, epinephrine
Synthetic catecholarmines-isoproteronol, dobutamine
synthetic non-catecholamines: ephedrine, phenylephrine

Class: catecholamines
use: increase HR/BP, anaphylaxis, bronchospasm
supplied: 16 ug/ml syringe
Dose: Bolus, small doses(1-2 ug/min) med doses (4 ug/min) large doses(10-20 ug/min)

Class: synthetic non-catecholamine, direct and indirect action
use: increase HR/BP
Supplied: 5 mg/ml (25 or 50 mg i 1 ml)
Dose: 5-20 mg
Caution: tachyphylaxis, depletion of norepinephrine

Class: Synthetic non-catecholamine direct-acting
use: increase BP, nasal decongestant
supplied: 100 ug/ml (1mg vial)
Dose: Bolus 50-100 ug
infusion - 0.25-1 ug/kg/min
Caution: icreased afterload, reflex bradycardia

Class: cardioselective beta blocker
use: decrease HR
supplied: 100 mg (10 mg/mL in 10mL)
Dose: 0.2 -0.5 mg/kg
Caution: Decrease HR, contractility, BP, CHF, asthma

Class: beta-blocker
Long acting selective for beta 1 (heart)
use: decrease HR
supplied: 5 mg (1 mg/ml)
Dose: 1-2 mg
caution: decrease HR, contracility, BP, CHF, asthma

Class: mixed antagoist a1, B1, B2
Use: control HR and BP
Supplied: 5mg/ml (20 mL vial)
Dose: 0.1-0.25 mg/kg
Caution: alpha 1 and nonselective B1 and B2 antagonist

Sodium Nitroprusside (SNP)
Nitroglycerin (NTG)
Nicardipine
Hydralazine

Class: hypotensive agent
use: relax arterial and venous
supplied: 100ug/mL
Dose: Bolus-- 1-2 ug/kg
Infusion: 0.5-10 ug/kg/min
Caution: non-selective, cyanide toxicity, methemoglobinemia, light sensitive

Class: Hypotensive agent
Use: angina, HTN
Supplied: 100 ug/mL
Dose: Bolus--50-100ug
Infusion--0.5-10 ug/kg/min
Caution: principally venous dilator, decreases ventricular wall tension

Class: hypotensive agent
use: HTN
supplied: 20 mg in 1 mL
dose: 5-20 mg
onset: 20 minutes
duration: 6-8 hours
caution: principal arterial dilator, tachycardia, headache angina, flushing rush

Clinical Uses: Reversal of NMBD effects, antagonism of CNS effects of other drugs
Mechanism of action: enzyme inhibition, pre-synaptic effects, NMJ effects

Class: synthetic non-catecholamine, direct and indirect action
use: increase HR/BP
Supplied: 5 mg/ml (25 or 50 mg i 1 ml)
Dose: 5-20 mg
Caution: tachyphylaxis, depletion of norepinephrine

Class: Synthetic non-catecholamine direct-acting
use: increase BP, nasal decongestant
supplied: 100 ug/ml (1mg vial)
Dose: Bolus 50-100 ug
infusion - 0.25-1 ug/kg/min
Caution: icreased afterload, reflex bradycardia

Class: cardioselective beta blocker
use: decrease HR
supplied: 100 mg (10 mg/mL in 10mL)
Dose: 0.2 -0.5 mg/kg
Caution: Decrease HR, contractility, BP, CHF, asthma

Class: beta-blocker
Long acting selective for beta 1 (heart)
use: decrease HR
supplied: 5 mg (1 mg/ml)
Dose: 1-2 mg
caution: decrease HR, contracility, BP, CHF, asthma

Class: mixed antagoist a1, B1, B2
Use: control HR and BP
Supplied: 5mg/ml (20 mL vial)
Dose: 0.1-0.25 mg/kg
Caution: alpha 1 and nonselective B1 and B2 antagonist

Sodium Nitroprusside (SNP)
Nitroglycerin (NTG)
Nicardipine
Hydralazine

Class: hypotensive agent
use: relax arterial and venous
supplied: 100ug/mL
Dose: Bolus-- 1-2 ug/kg
Infusion: 0.5-10 ug/kg/min
Caution: non-selective, cyanide toxicity, methemoglobinemia, light sensitive

Class: Hypotensive agent
Use: angina, HTN
Supplied: 100 ug/mL
Dose: Bolus--50-100ug
Infusion--0.5-10 ug/kg/min
Caution: principally venous dilator, decreases ventricular wall tension

Class: hypotensive agent
use: HTN
supplied: 20 mg in 1 mL
dose: 5-20 mg
onset: 20 minutes
duration: 6-8 hours
caution: principal arterial dilator, tachycardia, headache angina, flushing rush

Clinical Uses: Reversal of NMBD effects, antagonism of CNS effects of other drugs
Mechanism of action: enzyme inhibition, pre-synaptic effects, NMJ effects

lidocaine, mepivacaine, prilocaine, bupivacaine, ropivacaine, etidocaine

Epinephrine- occasionally phenylephrine
increased duration of action of local anesthetic
limits systemic absorption and maintains the drug conc. at the nerve
addition of epi decreases the possibility of systemic toxicity
addition of epi has little effect on onset
epinephrine-5mcg/ml

Class: amide
use: local anesthesia, cough, inhalation, PVC's
supplied: 0.5-5%
Dose: varies on method
Caution: hepatic disease

Enteral-via the alimentary tract
-oral (PO)/sublingual
-rectal
Parenteral- "aside from" the alimentary tract
-inhalation
-intravenous IV
-intramuscular-IM
-subcutaneous SC
-transdermal
-topical

Class: Benzodiazepine
Uses: anxiolysis, sedation, amnesia
supplied: 1 mg/mL
dose: sedation 1-2.5 mg
caution: hepatic disease, elderly, synergy narcotics

Class: Diisopropylphenol
Use:Inductio, Sedatio, MAC
Supplied: 10 mg/ml
Dose: Induction- 1.5-2.5 mg/kg
Infusion- 25-100 ug/kg/min
Caution: Bacterial growth, soy or egg allergy

Class: Carboxylated imidazole
use: induction/hypnosis
supplied: 2 mg/mL (35% propylene glycol)
Dose: 0.2-0.3 mg/kg
Caution: pain on injection, myoclonus, PONV

Class: Phencyclidine
Use: Induction, analgesia, amnesia
Supplied: 10, 50. 100 mg/mL
Dose: Analgesia 0.2-0.5 mg/kg
Induction-- 1-2 mg/kg
Caution: Emergence delerium, drug interactions

Class: Barbituate
Use: Induction, cerebral protection
supplied: 2.5%
dose: 3-5 mg/kg
caution: drug interaction, apnea

Facilitate tracheal intubation

Improve surgical working conditions

Mechanical ventilation of lungs

Laryngospasm

pancuronium, doxacurium, pipecuronium, atracurium, vecuronium, rocuronium

Interrupt transmission of nerve impulses at NMJ (postsynaptic receptor)
-SCh: Binds/activates receptor
-NDNMBs:Bind/block receptor
Lack of Specificity
-cardiac muscarinic receptors
-autonomic ganglia nicotinic receptors

Class: Depolarizing NMBD
Use: Intubation, paralysis, laryngospasm
supplied: 20 mg/ml
dose: intubation- 1-1.5 mg/kg
laryngospasm- 0.1 mg/kg IV
Caution: bradycardia, hyperkalemia, open globe injury

Class: Aminosteroid, non-depolarizing
use: paralysis, RSI
supplied: 10mg/mL
Dose: Intubation -- 0.6-1,2 mg/kg
Maintenance: 0.1 mg/kg
Infusion: 5-12 ug/kg/min
Caution: renal failure

Class: Aminosteroid, non-depolarizing
Use: paralysis
supplied: 10 mg powder vial reconstituted to 1 mg/mL
Dose: Intubation: 0.08-0.12 mg/kg
Infusion: 1-2 ug/kg/min
Maintenance: 0.01 mg/kg
Caution: renal failure, hepatic dysfunction, peds v. elderly

Class: Benzyl isoquinolinium, non-depolarizing
use: paralysis
supplied: 20 mg vial (2 mg/mL)
dose: Intubation: 0.1-0.15 mg/kg
Infusion: 1-2 ug/kg/min
Caution: Slow onset

Class: Aminosteroid, non-depolarizing
use: paralysis
supplied: 1 mg/ml
dose: intubation: 0.08-0.12 mg/kg
maintenance: 0.01 mg/kg
Caution: increase HR, MAP, and CO. Clearance decreases up to 50% with renal failure