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42 Cards in this Set
- Front
- Back
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stages of anesthesia
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analgesia
disinhibition surgical anesthesia medullary depression |
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in what stage of anesthesia does amnesia definitively begin?
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stage 2 (disinhibition)
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in what stage of anesthesia is respiration irregular?
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stage 2 (disinhibition)
|
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in what stage of anesthesia are heart rate and respirations regular?
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stage 1 and stage 3
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MOA of most general anesthetics?
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facilitation of inhibitory GABA action at GABA-A receptor-chloride channels
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Which gen anesthetic has a unique MOA? What is it?
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Ketamine
antagonism of excitatory action of glutamate on NMDA receptors |
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inhibition of neurons in the ____ _____ occurs before inhibition of neurons in the ____ _____ _____
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pain pathways
midbrain reticular formation |
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what percentage mixture is an inhaled anesthetic with a partial pressure of 380mmHg?
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50%
(760mmHg is atm pressure) |
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a drug that equilibrates quickly with the blood has (high/low) solubility, (high/low) blood:gas partition, and will act on the brain (quickly/slowly)?
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low solubility
low blood:gas partition acts quickly |
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at high pulm blood flow, the speed of induction is (faster/slower)
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slower
|
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the rate of recovery from an agent with a low blood:gas partition coefficient is (fast/slow)
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fast
|
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the alveolar concentration required to eliminate the response to a painful stimulus in 50% of patients is called what?
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the minimum alveolar anesthetic concentration (MAC)
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which populations have lower MACs?
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infants and elderly
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high concentrations of this drug may cause spike-and-wave activity and muscle twitching
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enflurane
|
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even though it has a high MAC, this drug has marked analgesic and amnestic actions
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nitrous oxide
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what is the effect on MAC when anesthetic agents are used simultaneously?
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their MACs are additive
|
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CNS effects of inh GAs?
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decrease brain metabolic rate
inc cerebral blood flow (by dec vasc resistance) |
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CV effects of:
1. Enflurane and halothane? 2. Isoflurane, desfluane, sevoflurane? |
1. myocardial depressants (dec CO)
2. peripheral vasodilation |
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GAs that sensitize the heart to arrythmogenic effects of catecholamines?
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Halothane, isoflurane
|
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all inh GAs have what effect on respiration?
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dec tidal volume, dec minute ventilation, inc art CO2 tension, dec ventilatory response to hypoxia
|
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most inh GA's are broncho(dilators/constrictors)?
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bronchodilators
|
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which inh GA is hepatotoxic?
in which pts does this occur? |
halothane
in pts in hypovolemic shock or other severe stress |
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which inh GAs can cause renal insufficiency d/t release of fluoride?
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methoxyflurane (enflurane, sevoflurane)
|
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nitrous oxide can cause _____ anemia d/t dec _____ _____ activity?
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megaloblastic
methionine synthase |
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use of GAs with neuromuscular blockers like succinylcholine can cause what?
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malignant hyperthermia
|
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tx for malignant hyperthermia rxn to anesthetic/neuromuscular blocker combinations?
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Dantrolene
|
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IV GA's with rapid onset d/t lipid solubility, and are resp and circ depressants?
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Thiopental, methohexital
(Barbiturates) |
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what initially terminates the effects of thiopental?
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distribution to other highly perfused tissues
(followed by hepatic metab) |
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flumazenil accelerates recovery from this IV GA that causes severe postOp resp depression
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midazolam
(benzos) |
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drug most commonly used to induce dissociative anesthesia
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Ketamine
|
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what drugs are used to reduce "emergence reactions" in recovery from ketamine?
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preOp benzos
|
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IV GAs that cause chest wall rigidity
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morphine, fentanyl
(opioids) |
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drug used postOp for reversal of resp depression from IV opioids?
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naloxone
|
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IV opioid with fastest recovery time
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Remifentanil
|
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IV GA that produces anesthesia as fast as IV barbiturates but has faster recovery and has antiemetic actions
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Propofol
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IV GA useful for prolonged sedation in critical care pts?
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propofol
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IV GA with rapid induction but lacking analgesic effects; useful for pts with limited cardiac or respiratory reserve?
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Etomidate
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Side effects of Etomidate?
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pain and myoclonus on injection
post Op nausea |
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why are IV opioids used in cardiac surgery?
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they provide full anesthesia, and less cardiac depression than inhalation agents
|
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what are disadvantages of full anesthesia using IV opioids?
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pt recall
(dec by using benzos) HTN response to surgical stimuli (dec by using vasodilators or b-blocker) |
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inh anesthetic that is not used for induction d/t pulmonary irritation and bronchospasm?
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desflurane
|
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what predisposes a pt to malignant hyperthermia when given halogenated anesthetics and skeletal muscle relaxants?
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mutations in the gene for the skeletal muscle ryanodine receptor or L-type calcium channels
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