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Pharmacology > EXAM #3: GENERAL ANESTHESIA > Flashcards

EXAM #3: GENERAL ANESTHESIA Flashcards

1
Q

What are the advantages of general anesthesia?

A

Body wide anesthesia

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2
Q

What are the disadvantages of general anesthesia?

A

Disturbance of all organ systems

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3
Q

What are the advantages of local anesthesia?

A

Minimal system disturbance

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4
Q

What is the disadvantage of local anesthesia?

A

Anesthesia may not be adequate

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5
Q

What are the six characteristics of an ideal anesthetic agent?

A

1) Unconsciousness
2) Amnesia
3) Analgesia
4) Skeletal muscle relaxation
5) Areflexia
6) Good minute-to-minute control

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6
Q

What is the “Triad of Anesthesia?’

A

1) Asleep
2) Pain-free
3) Still

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7
Q

What is the pharmacologic synonym of unconsciousness?

A

Hypnosis

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8
Q

What are the four major things that you want to know about a patient as an anesthesiologist?

A

Patient history and/or blood relative history of:

1) Malignant hyperthermia
2) Cardiovascular disease
3) Respirator disease
4) Allergies

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9
Q

What is “balanced anesthesia?”

A

Use of a combination of drugs to produce all the effects of ideal anesthesia

No anesthetic is ideal

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10
Q

What are the PHASES of anesthesia?

A

1) Induction
2) Maintenance
3) Emergence
4) Recovery

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11
Q

What are the STAGES of anesthesia?

A

1) Analgesia
2) Excitement
- Body is “fighting” the anesthetic drug and patient can become combative
3) Surgical anesthesia
4) Medullary depression

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12
Q

What is the main purpose for inhalable anesthetics?

A

Maintenance of anesthesia

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13
Q

What is the main purpose of IV anesthetics?

A

Induction of anesthesia

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14
Q

What are the three general mechanisms of action of the general anesthetic agents?

A

1) Increased GABA-A channel activity
2) Activation of K+ channels
3) Inhibit glutamate NMDA receptors

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15
Q

What are the advantages of gaseous general anesthesia?

A

1) Easy to control depth of anesthesia

2) Minute-to-minute control

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16
Q

What is the disadvantage of gaseous anesthesia?

A

Anesthesia induction is not as fast or smooth as IV

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17
Q

Which “direction” do gas molecules move?

A

Down their partial pressure gradient

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18
Q

What factor results in a faster achievement of anesthetic concentration in the blood?

A

Higher initial concentration in air

–>leads to higher partial pressure in the lungs–>bloodd

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19
Q

What is the effect of alveolar ventilation on anesthesia onset?

A

Higher alveolar ventilation leads to more gas molecules/time and a faster rate of onset

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20
Q

What is the Otswald Coefficient?

A

Blood: gas partition coefficient i.e. the solubility of the anesthetic in the blood

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21
Q

What does a low Otswald Coefficient mean?

A

Low solubility

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22
Q

Otswald Coefficient is preferable for a fast rate of anesthesia onset, high or low? Why?

A

Low solubility i.e. low Otwald Coefficient, which translates to a faster buildup of the agent in the blood

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23
Q

What does the blood: brain partition coefficient translate into?

A

Solubility of the agent in lipid

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24
Q

What does a high lipid solubility of an anesthetic agent translate into?

A

More potent

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25
Q

What does a high pulmonary blood flow translate into in general anesthesia?

A

Slower onset

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26
Q

What does a low pulmonary blood flow translate into in general anesthesia?

A

Faster onset

27
Q

How does the Otswald Coefficient effect elimination?

A

Low solubility equals faster elimination

28
Q

What is the MAC value?

A

Minimum alveolar concentration i.e. the concentration of anesthetic in alveolar air at which there is no response to noxious stimuli in 50% of patients

29
Q

What does a low MAC value translate into?

A

More potent anesthetic

30
Q

What does a high MAC value translate into?

A

Less potent anesthetic

31
Q

How are the MAC values of combinations of inhaled anesthetic described?

A

Additive

32
Q

What important clinical factor will decrease the MAC value?

A

Presence of CNS depressants

33
Q

What is the hallmark gaseous general anesthetic?

A

Nitrous Oxide

34
Q

Why is NO described as almost an ideal anesthetic agent?

A

1) Good analgesia
2) Relatively nontoxic
3) Rapid onset and recovery

35
Q

What is the major limitation of NO?

A

Incomplete anesthetic b/c MAC value is 110%

I.e. in 50% of patients, NO cannot be given in sufficient quantities to eliminate response to noxious stimuli

36
Q

What is the common use for NO?

A

Carrier agent for another anesthetic gas

37
Q

What is the second gas effect?

A

Utilizing the additive MAC of gaseous agents by combining two gases to reduce induction time

38
Q

What are the advantages of the 2nd gas effect?

A

1) Reduced induction time
2) Reduced concentration of primary agent
3) Reduced toxicity of primary agent

39
Q

What are the major disadvantages of NO?

A

1) Lack of potency
2) Diffusion hypoxia
3) Increased risk of spontaneous abortion and decreased probability of concenptoin

40
Q

What is diffusion hypoxia?

A
  • When d/c NO rapidly diffuses from the body into the alveoli
  • Diffusion into the alveoli dilutes the gases in the alveoli i.e. oxygen
  • PAO2 decreases leading to hypoxia

Note that this is combated by progressive d/c of NO and administration of 100% oxygen*

41
Q

Clinically, what do you need to remember about NO?

A

Cannot be used as sole anesthetic agent for surgical anesthesia

42
Q

List the halogenated anesthetic agents.

A

Halothane
Enfulrane
Isoflurane
Desflurane

43
Q

Why are anesthetic agents halogenated?

A

1) Reduces flammability

2) Increased potency

44
Q

What is the drawback to halogenation?

A

Increased toxicity and side effects

45
Q

What are halogenated agents primarily used for in anesthesia?

A

Maintenance of anesthesia

46
Q

What is the prototypical halogenated agent?

A

Halothane

47
Q

What toxicity is associated with Halothane?

A

Hepatitis

48
Q

What are the side effects associated with Enflurane?

A

CNS stimulant effects

49
Q

What is the clinical utility of Isoflurane?

A

Primary anesthetic agent used for maintenance of anesthesia

With lower toxicity compared to other halogenated agents

50
Q

What is Desflurane?

A

Second most common agent used for maintenance of anesthesia

51
Q

What side effect is associated with Desflurane?

A

Respiratory irritant producing bronchioconstriction, cough, and laryngeal spasm

52
Q

What is Sevoflurane?

A

Newest and most popular halogenated anesthetic agent

53
Q

What is the advantage of Sevoflurane?

A

Low airway irritation vs. Desoflurane

54
Q

What is malignant hyperthermia?

A
  • Hypermetabolic crisis when an MH-susceptible (MHS) individual is exposed to a volatile anesthetic
  • Exposure leads to elevated intracellular Ca++ in skeletal muscle, causing sustained contraction
  • Sustained muscle contraction generates more body heat than can be dissipated

–>Result is marked hyperthermia (life-threatening)

55
Q

What is Thiopental?

A

Barbiturate general anesthetic used for induction of anesthesia

56
Q

What is Propofol?

A
  • “Milk of Amnesia”

- Newer drug and most frequently used anesthesia induction agent

57
Q

How does Propofol differ from Thiopental in terms of maintenance?

A

Propofol can be given as a continuous IV drip

58
Q

What is the major advantage of Propofol clinically?

A

Excellent recovery from anesthesia

59
Q

What type of anesthesia does Ketamine result in?

A

Dissociative anesthesia

60
Q

What is the mechanism of action of Ketamine?

A

NMDA receptor antagonist i.e. glutamate antagonist

61
Q

What is the side effect of Ketamine?

A

Emergence pheomenon

62
Q

What is the mechanism of action of Midazolam?

A

Benzodiazepine that increases the frequency of GABA-A receptor opening

63
Q

What are the role of Midazolam in general anesthesia?

A

Adjuvant agent

64
Q

What are the indications for Midazolam?

A

1) Sedation for painful procedures

2) Induction agent in high risk patients

Pharmacology (64 decks)

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