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What are the 6 general anesthetics?
They are Nitrous oxide, desflurane, sevoflurane, enflurane, isoflurane, and halothane.
What are the intravenous anesthetics?
Barbiturates (=S and =O), non-barbiturates (ketamine, bzds, etc), and opioids
what are typical anesthetic adjuncts?
Antihistamines, anticholinergics, and benzodiazepines
What are the states of anesthesia in the continuum of depression and to what degree does anesthesia have to be increased to achieve the next level?
Sedation -> Hypnosis -> Anesthesia -> Coma; 4x
What types of agents are used for pre-anesthetic medications?
Sedatives/hypnotics, opioids, anticholinergics, gastroprotective agents, and NSAIDs.
During which stage of anesthesia is breathing exaggerated?
During stage II
What are intravenous anesthetics used for and what are some general characteristics?
IV anesthetics are used for induction and they are rapid, however difficult to control.
Which organs equilibrate rapidly?
Brain and lung
Which agents have low lambda values?
Nitrous oxide, desflurane, and sevoflurane.
What is the relationship between lambda and the rate of induction?
The lower the lambda, the faster the agent acts.
How does cardiac output affect the approach to equilibrium?
An increase in C.O. decreases the rate to reaching equilibrium. A decrease in C.O. decrease the time to reach equilibrium, but increase toxicity.
How does the ventilation rate affect the approach to equilibrium?
The higher the ventilation rate, the faster equilibrium is reached.
Describe overpressurization
Overpressurization involves administering 2-3x the MAC initially and then bringing the concentration down in a step-wise manner.
According to the Neurophysiologic Basis, which transmission are affected?
The action potential is decreased slightly and the synaptic potential is greatly decreased.
Which ionic channels are affected by anesthetics?
Ligand-gated channels are sensitive.
Which agents affect GABA-ergic receptors and what is their effect?
IV agents prolong IPSPs and GABA action by enhancing inhibitory transmission allosterically.
What does a lack of stereospecificity suggest?
It suggests a non-specific interaction with receptors, EXCEPT AT GABA RECEPTOR.
What does lipophilicity refer to?
It referes to the drug distribution, NOT THE SITE OR MECHANISM OF ACTION.
What factors influence the minimum alveolar concentration (MaC)?
Other drugs, temperature and age.
Which agents depress the blood pressure?
All agents, except nitrous oxide; they also decrease contractility.
what is the long term danger with nitrous oxide and how is it avoided?
Diffusional hypoxia; 100% oxygen is given.
What cardiac complications may arise from general anesthetics, what are they caused by and how are they treated?
Cardiac arrythmias, caused by improper depth of anesthesia; pCO2, and hormonal influence (mechanisms- hypercarbia, NE/CA, Myocardial sensitization; treatment is to avoid or use phentolamine (nonspecific alpha blocker)
What affects to the anesthetics have on respiration?
All general anesthetics depress respiration.
What can enflurane induce?
electrical seizure activity
What other rare condition can be caused by general anesthetics, what are the predisposing factors and how is it treated?
Malignant hyperthermia; exisiting muscle disease, dehydration, infections, precipitious increase in body temperature, agents that cause Ca release (SuCh, halothane); treat with DANTROLENE (blocks Ca release from sarcoplasmic retriculum), cooling, oxygen, A/B status