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General anesthetics

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alex0624's version from 2016-06-27 23:52

Section 1

Question Answer
Inhaled General AnestheticsHalothane, Enflurane, Desflurane Sevoflurane
IV general AnestheticsBarbiturates(Thipentol), Dissosiative(Ketamine), opiodes(Fentanyl), Midazolam(BZD)
MOA of Anesthetics(3)Directly activate of GABA A, NMDA receptor antagonist, Inhibit nicotinic Ach receptors
Administered as gasesNitrous Oxide
Vaporized liquid halogenated hydrocarbonsHalothane, Esflurane, Desflurane, Sevoflurane, Isoflurane, methoxyflurane.
A measure of inhaled anesthetic concentration called asPartial pressure or tension
If Increased in BLood FLow occur, what happen with BAless because same amount of drug in the alveoli is diffused in large amount of blood
The more soluble an anesthetic in blood is?the more must be dissolved to raise the partial pressure
Insoluble gas agents?Fills more quicly,; fill the compartment more quickly
The higher the blood:gas ratioMore blood soluble(slow onset action)
The lower the Blood: Gas ratiothe more insoluble(fast ibset action/fast recovery)
Higher the pulmonary blood flow, the______ the onset of anesthesia.Slower
Anesthesia action is terminated by? Redistribution of drug from brain and elimination of gases through the lungs
Potency measurementMinimun alveolar concentration
The least MAC the Higher______Potency
concentration at which 50% of patients do not respond to a surgical stimulusMAC
Mosto potent inhaled anestheticMethoxyflurane(.16=MAC)
Decrease brain metabolic rate, reduce vascular resistance, increase cerebral blood flow--> increase Intracranial pressure(carful in head trauma)Inhaled anesthetics
Changes in EEG-muscle twitchingEnflurane
Hypotension by direct myocardial depression; decrease the cardiac outputEnflurane, halothane
VasodilatesIsoflurane
Inhaled anesthetic that is less likely to affect cardiac and respiratory functionNitrous Oxide
Sensitizes the myocardium to catecholaminesHalothane(arrythmogenic effect)
Most inhaled Anesthetic agents are bronchodilators exceptDesflurane
Cause bronchospasmDesflurane
when Halogenated (HEDS) are combined with succinylcholineMalignant Hyperthermia
Malignant hyperthermia is treated withDantrolene
May cause Megaloblastic anemia after prolonged exposure due to decreases in methionine syntase by Vit B12 def.Nitrous oxide
drugs used for induction anesthesiaPropofol, Etomidate, Ketamine, BZD, Barbiturates, opioids
Only inhaled anesthetic which act on glutamate instead of GABA AKetamine
are also GABA mimetic, block Na channels & NMDA/glutamate ReceptorsBarbiturates at high doses
Barbiturates used in IV. Fast acting/action terminated by redistributionThiopentol and methohexital
barbiturates used in induction of anesthesia and short proceduresThiopental and methohexital
Sedation prior to induction of GA with another agentMidazolam
Benzodiazepine effects are reversed by Flumazenil
Barbiturates effects are reversed byAlkalating the urine(Na Bicarbonate or acetazolamide)
Produces anesthesia quick(same as Barb) but recovery is more rapidPropofol
Has antiemetic effect(Antivomit)Propofol
Commonly used as an anesthetic in outpatient surgical proceduresPropofol
Post operative vomiting inhibitorPropofol
Rapid induction and short duratio/ Primarily used in patients with limited cardiac or respiratory reserve due to little effect on CV and respirationEtomidate
State of analgesia and amnesia produced when fentanyl is combined with droperidol and Nitrous oxideNeurolept anesthesia
Drugs that cause Neurolept analgenisNitrous oxide, Droperidol and fentanyl
Opiod overdose can be reversed byNaloxone and neltroxane
analog of phencyclidineKetamine(dissociative anesthetic-Time person place)
Blocks actions of glutamate on NMDA receptorKetamine
can be used in hypotensive(shock states) or patients with bronchospasm); cardiac stimulatn(increase HR and BP)Ketamine(NMDA antqgonist)
Ketamine is used in whic populationchildren and young adults
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Section 2

Question Answer
Local anesthetics
Esterscocaine, procaine, tetracaine, Bensocaine
AmideLidocaine, Bupivacaine...(2 i.i.
Have to be ionized in order to act, but first need to be non-ionized to pass trough the axonal membrane and reach the nerveMOA of local anesthetics
Extracellular acidosis equals more ionized--> meaningDecrease Local Anesthetic effect
block the NA channles in the inactivated state preventing depolarizationLocal anesthetics
Local anesthetics are coadministered with _______ in order to improve effectsand decrease systemic side effectsA1 agonist- Epinephrine
Can be used locally in nasal surgeriesCocaine
Esters are metabolizaed byPseudocholinesterase
Amides are metabolized byCYP enzymes in the liver.
Liver diseases can lead to _____toxicity of Local anesthetics(Amide)
Type B &C > Type A delta > Type A beta> Type A gama > Type Aα order sensitivity to Local anesthetics
Unmyelinated fibers are___ _________ sensitiveMoreeee!!
tongue numbness, metallic taste(early sign of); Seizures may occurLocal anesthetic toxicity.
DOC in seizuresDiazepam
all LA are vasodilators exceptCocaine
Most cardiotoxic LA drugBupivacaine
block of Na channels in heart- depress cardiac pacemaker activity, conduction- Arrhythmias, Cardiovascular collapse!!!Bupicavine
Surface anaesthesia(topical apllication) useful for painful ulcersLidocaine and Benzocaine
Injected subarachnoid space L2-3 or L3-4 Used in surgeries of lower limbs and abdomen Spinal anesthesia
Used in obstretivsEpidural anaesthesia
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