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General Anesthetics

General Anesthetic Drugs

Potency of the anesthetic agent is most related to? lipid solubility
Most anesthetics increase the sensitivity of? GABA-A and glycine receptors to GABA and glycine, respectively
Most anesthetics also generally inhibit the activity of excitatory transmitters such as? acetylcholine (Nicotinic) and serotonin.
Ketamine and nitrous oxide inhibit ____ activity? glutamate
Partial pressure is? the pressure exerted by a gas in a mixture of gases (Dalton's Law). For our purposes it is a measure of the concentration of a gas
Blood/Gas partition coefficient is? measure of the solubility of an anesthetic gas in the blood
The speed of induction and emergence (recovery) is determined by the rate of? change of the partial pressure (concentration) of the gas in the brain, which is determined by the partial pressure of the gas in arterial blood
The best correlation with speed of induction is? with blood/gas partition coeffcient (inverse correlation)
Halothane has blood/gas coefficient of ___ and a rapidity of onset of___? 2.3, 3
N2O has blood/gas coefficient of ___ and a rapidity of onset of___? .47, 1
MAC is defined as? the Minimal Alveolar Concentration that will block movement of 50% of patients in response to incision
How is the potency of anesthetic gases expressed? MAC
Lipid/Gas coefficient is related to? potency
Blood/gas coefficient is related to? speed of onset
MAC correlates with? lipid/gas partition coefficient (low MAC indicates high lipid/gas solubility)
N20 has MAC of ___ and a lipid/gas coefficient of___? 105, 1.4
Why is N20 considered an "incomplete anesthetic"? because it can’t produce all stages of anesthesia without producing hypoxia because its MAC is 105%.
The therapeutic index for most general anesthetics is? low, 2-4, which indicates low margin of safety
What are the characteristics of an ideal general anesthetic? Provide a smooth and rapid induction of unconsciousness; Produce amnesia; Block troublesome reflexes; Produce skeletal muscle relaxation; Produce analgesia; Provide a smooth and rapid emergence and recovery without long lasting adverse effects.
What is the pre-anesthetic effect of midolazam? Reduce anxiety, Sedation, Amnesia, “Conscious sedation”
What is the pre-anesthetic effect of atropine/glycopyrollate (robinul)? Inhibit secretion, bradycardia, vomiting, and laryngospasms
What is the pre-anesthetic effect of Opioid analgesics? Sedation to decrease tension, anxiety, and provide analgesia
What are the general pharmacological effects of anesthetics gases on the CNS? dose dependent depression of all portions of CNS. Order of sensitivity (most to least) is RAS and cortex > hippocampus > basal ganglia > cerebellum > spinal cord > medulla (irregularly descending anesthesia)
What are the general pharmacological effects of anesthetics gases on the ANS? Inhibition of sympathetics; Stimulation of parasympathetics; Nausea and vomiting
What are the general pharmacological effects of anesthetics gases on the cardiovascular system? Dose related negative inotropic effect; decreased BP; Arrhythmias; Sensitization to circulating catecholamines
What are the general pharmacological effects of anesthetics gases on the respiratory system? Dose dependent depression of medullary respiratory center
What are the general pharmacological effects of anesthetics gases on the thermoregulatory system? Altered thermoregulatory control induced hypothermia d/t anesthesia of the hypothalamus and reduced metabolic rate
Anesthetic gas responsible for developing an induced hepatitis? halothane
First non-explosive alternative to ether? halothane
an isomer of enflurane that is a commonly used anesthetic for adults? isoflurane
A rarely used gas similar to isoflurane, except has increased risk of seizures? enflurane
Anesthetic gas similar to isoflurane except has faster emergence and increased airway irritation? desflurane
Anesthetic gas similar to desflurance but less irritating to airway? sevoflurane
dissociative anesthetic similar to PCP? ketamine
What is ketamines MOA? blocks NMDA receptors inducing a "dissociative" state
IV anesthetic agent used for brief procedures in ER etomidate
IV anesthetic used in ICU for patients requiring prolonged intubation dexmedetomidine (Precedex)
a carboxylated imidazole etomidate
a substituted isopropylphenol propofol
IV anesthetic that decreases the rate of dissociation of GABA from its receptors, thereby increasing the duration of GABA-activated opening of chloride channels, with resulting hyperpolarization of cell membranes propofol
How is propofol cleared? tissue reuptake (redistribution)
Dosage for propofol for induction? 1.5 - 2.5 mg/kg IV
MOA of barbituates? mimic the activation of GABA receptors
How is thiopental cleared? redistribution and metabolism however large or repeated doses of thiopental may saturate inactive tissue sites resulting in prolonged effects.
Which is cleared faster: thiopental or etomidate? Etomidate is cleared 5 times faster
a phencyclidine derivative? ketamine
What receptor does ketamine NOT interact with? GABA
T or F: All inhaled anesthetics depress the CV system. F. N2O produces sympathetic stimulation
What drug increases the neuromuscular blocking effects of isoflurane? polymyxin B sulfate
Created by: psfisher50