robbypowell's version from 2016-12-01 03:29

General Anesthesia

Question Answer
T/F: General anethesia involves loss of memory, consciousness, as well insensitivity to painful stimuliTrue
T/F: General anesthesia causes loss of consciousness, loss of memory but not insensitivity to painful stimuliFalse
___ ____ is the guy that used Nitrous Oxide for the 1st time for tooth extractionHorace Wells
____ _____ is the guy that developed technique to administer ETHER for tooth extraction and surgery; and is considered the ‘First Anesthesiologist’William Morton (he also invented table salt) (that's not true)
How are most general anesthetics administered?Inhalation (volatile liquids such as halothane)
General anesthesia should relax ______ muscles but NOT ______ musclesSkeletal (relax); NOT Respiratory
______ (adjunct drug to GA) given as pre-op to dec salivation, laryngospasm, and reflex brachycardia; Dec effects of vagus nerve on the heartAtropine***
T/F: Conscious sedation is usually preferable form of general anesthesia in the realm of dentistrytrue
____ _____ _____ is the measurement of potency of inhaled anestheticsMinimum Alveolar Concentration (• Alveolar concentration of anesthetic at which 50% of patients fail to respond to standard surgical stimulus )
High MAC = _____ (more/less) potent; Low MAC = ______ (more/less) potentHigh = less potent; Low = more potent
Methoxyflurane was listed as an example of a general anesthetic agent with a ______ MAC (high/low)LOW (which means it is super potent; not used as much any more because of high amounts of fluoride )
An agent with high lipid solubility would have _____ (high/low) MAC and _____ (high/low) potencyLOW MAC; High Potency
What is the prototype drug for general anesthetic agents?Halothane
General Anesthetic agents affect membrane fluidity of membranes in neurons of brain = cause disturbances that result in general anesthesia... this is referred to as the _____ _____ theoryMembrane Protein theory
Depth of Anesthesia (intensity) is dependent upon concentration in the _____Brain
Depth of Anesthesia ((intensity is dependent upon ___________ of agent in the brainConcentration
Speed of induction and termination/recovery depends on rate of change of _____ in the brainconcentration
term describing movement of anesthetic from resp apparatus to pulmonary alveoli → blood → brain is ______; this Will be more rapid at greater concentrationsINDUCTION
Term describing movement of anesthetic from brain to blood to alveoli and exhalation is _______Termination
______ law: partial pressure (or tension, mm Hg) of gases in a mixture can be summed up together: Total PP = P1 + P2…Dalton's Law
______ law: deals with both solubility of gases in a liquid AND partial pressuresHenry's Law
____ _____ is the relative solublity of a substance in 2 immiscible phases (oil:water, blood:gas)Partition Coefficient (PC)
The blood concentration of a volatile GA agent can be calculated by ... [GA agent in inhaled air] * ____ _____Partition coefficient
Second Gas effects apply to what agent specifically?Nitrous Oxide
If 2nd gas with low induction or conc is given with N2O, its conc in alveoli can be increased in an effect called ____ _____ effectSecond gas effect
What is the second gas effect? What gas administration does it apply to?If 2nd gas with low induction or conc is given with N2O, its conc in alveoli can be increased. (this is the Second Gas Effect)
Solubility in blood is described by _____/______ ______ coefficient and is important for determining induction or recovery → lower solubility of GA in blood/water = faster induction and vice versa (recovery)Blood/gas Partition Coefficient
lower MAC = _____ potencygreater
lower solubility in blood = ______ induction/ recoveryfaster
Halothane has _____ potency bc small amt gives high intrinsic activityHigh potency
Which is more potent, N2O or Halothane?Halothane
Which has faster induction, N2O or Halothane?N2O
Which has a lower blood/gas PC coefficient? NO or Halothane?NO has lower blood/gas PC than halothane (0.47 v. 2.3); --> faster induction to brain
Minimum Alveolar Concentration is ____ for N2O and ____ for halothaneN2O 105; Halothane 0.75
T/F: All general anesthetics depress myocardial activity, but halogenated agents produce greater effectsTrue
T/F: Most general anesthetics decrease peripheral resistance and Blood pressure except for HalothaneFalse (except for N2O)
T/F: Most general anesthetics decrease peripheral resistance and blood pressure except for Nitrous OxideTrue
T/F: Most general anesthetics increase peripheral resistance and blood pressureFalse (decrease)
T/F: Most general anesthetics decrease peripheral resistance and blood pressureTrue (exception is Nitrous Oxide)
T/F: General Anesthetic depress the respiratory centerTrue
What effect do general anesthetic agents have on peripheral chemoceptors?Inhibition
Alteration of Liver function is a more serious concern with what general anesthetic agent?Halothane
T/F: Some metabolites of halothane can sensitize liver tissues → form antigens that end up forming Antigen-Antibody complexes (haptene) that target liver tissueTrue
T/F: Some metabolites of nitrous oxide can sensitize liver tissues → form antigens that end up forming Antigen-Antibody complexes (haptene) that target liver tissueFalse (Halothane)
General anesthetics have what effect on renal blood flow?Decrease (leading to transient kidney impairment)
T/F: Most general anesthetic agents relax skeletal muscle through actions on spinal cord, brain stem motor reflex center, and by direct action on NMJTrue
T/F: Agents Used in General Anesthesia and Sedation have diverse chem structuresTrue
All inhalation general anesthetic agents are _______ volatile liquids except for ______ _____ which is inorganicHalogenated; Nitrous Oxide (N2O)
Nitrous Oxide is not given in a concentration greater than ____ % due to oxygenation problem>70% (can stop resp system)
In dentistry, a N2O concentration of ___ to ___ % provides conscious sedation and analgesia20-50%
T/F: Nitrous oxide is contraindicated in some CVD patientsTrue (causes mild myocardial depression)
T/F: High dose of nitrous oxide can cause dysphoria, nausea and enclosed air pockets in the bodyTrue
______ ______ occurs upon sudden cessation of the administration of N2O; the treatment is delivery of 100% oxygen for 5 minutesDiffusion Hypoxia
Use of ________ may decrease fertility to a decrease in what hormone?Nitrous Oxide; Luteinizing Hormone
Methionine deficiency (due to oxidation of cobalt in b12 and the subsequent inactivation of methionine synthase) is associated with what general anesthetic agent?Nitrous Oxide
_______ deficiency, which can be caused by chronic exposure to N2O, is associated with degenerative changes in CNS, neuropathy, and altered hematopoietic tissuesMethionine (this is bc of inactivation of Methionine synthase)
_____ and _____ inhalation is technique of choice for dental procedures that require min-mod sedation and analgesiaN2O & O2
T/F: Halothane is a poor analgesicTrue (usually used with N2O or opioid analgesics)
_____ ____ is the condition when Ca is not taken up from sarcoplasmic reticulum due to drugs such as halothane or some muscle relaxantsMalignant Hyperthermia
What is the antidote treatment given for malignant hyperthermia?DANTROLENE
T/F: Nitrous Oxide is safe for use with Malignant Hyperthermia patientsTrue
T/F: Halothane is safe for use with Malignant Hyperthermia patientsFalse
This GA agent is similar to halothane with regard to potency and resp effects (moderate depression, increased rate), but differs in that high does relax skeletal muscle and has fewer hepatic effectsIsoflurane
This halogenated GA agent has rapid induction and recovery, but because it is an irritant its use is limited. (also has low potency)DESflurane
This halogenated GA agent has rapid induction and recovery and is not an irritant, but can release toxic fluoride.... may breakdown in soda lime CO2 traps and make toxic products, and is a suitable alternative to halothane for children.Sevoflurane

Comparing N2O and Halothane... each relative to the other... which?

Question Answer
Better AnalgesiaN2O
No muscle relaxationN2O
May increase heart rateN2O
Mild Myocardial depressionN2O
Unchanged cardiac outputN2O
Unchanged vascular resistance (peripheral)N2O
Unchanged Blood pressureN2O
No Arrhythmic potentialN2O
Mild Respiratory depressionN2O
Slightly increased respiratory rateN2O
No effect on BronchiN2O
No airway irritationN2O
no effect on EEGN2O
no effect on renal functionN2O
no birotransformation (0.004%)N2O
no hepatotoxicityN2O
Poor AnalgesiaHalothane
Moderate Muscle RelaxationHalothane
Unchanged heart rateHalothane
Marked Myocardial depressionHalothane
Decreased Cardiac outputHalothane
decreased vascular resistance (peripheral)Halothane
decrease blood pressureHalothane
high arrhythmogenic potentialHalothane
mild airway irritationHalothane
decreased EEG activityHalothane
Biotransformation of 20-40%Halothane
potential to be hepatotoxicHalothane

not sure if this part is right or backwards so disregard until

Question Answer
he _____ (higher/lower) the blood/gas partition coefficient, the more gas stays in the alveoli and not in the bloodLower
The _____ (higher/lower) the partition coefficient, the more gas moves from alveoli into the bloodHigher

which Guedel's stages of anesthesia (don't forget that 1 has 4 substages aka 'planes') (this classification of anesthesia isn't used anymore... WHY ARE WE LEARNING ABOUT IT... oh bc it'll be on the test)

Question Answer
AnalgesiaStage 1
Stage 1Analgesia
DeliriumStage 2
Stage 2Delirium
SurgeryStage 3 (total stage... the substages aka planes are part of this stage)
Stage 3Surgery
Medullary paralysis/deathStage 4
Stage 4Meduallary paralysis/death
Stage 3 plane 1dental and thoracic surgery
stage 3 plane 2abdominal surgery
stage 3 plane 3Deep abdominal surgery
Stage 3 plane 4no surgery (wtf does this mean?)

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