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Inhaled anesthetic Very high MAC value = minimal alveolar anesthetic concentartion similar to an ED50 (ie: more lipid soluble the drug the lower the MAC and > potency) Blood gas ratio = 0.5 (how fast to onset) NO :. has rapid onset and recovery, no metabolism, diffusional hypoxia, can cause spontaneous abortions, minimal CV effects |
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inhaled anesthetic MAC is very low :. greater potency Blood-gas ratio = 2.3 slower to onset SE: malignant hyperthermia, hepatitis, cardiac arrhythmias (sensitizes heart to catecholamines) USE: desflurane, sevoflurane most often today |
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IV anesthetic Barbiturate used for induction (draw back is you need a high dose and there is no antidote) Highly lipid soluble, rapid onset, short-acting d/t redistribution |
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IV anesthetic (benzodiazapine) Uses: preop sedation, anterograde amnesia, induction, outpatient surgery Depresses respiratory function |
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IV anesthetic Uses: induction and maintenance Antiemetic |
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IV anesthetic (opiate) Uses: induction and maintenance |
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IV anesthetic (NMDA receptor antagonist) Uses: dissociate anesthetic (catatonic, no sensory input) induction anesthesia SE: emergent delirium, hallucinations, CV stimulation, increased intracranial pressure |
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Definition
Weak bases that cross the axonal membrane in the non-ionized form and from w/in the ionized form blocks inactivated Na+ channel |
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one "i" group procaine, cocaine, benzocaine (metabolized by plasma/tissue estersases) |
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two "i" group lidocaine, bupivacain, mepivacaine (metabolized by liver amidases) |
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| Co-administer alpha 1 agonists (example = Epi) causes vasoconstriction which decreases LA's absorption into the systemic circulation --> prolonged effects |
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neurotoxicity CV toxicity Allergies (via PABA - para aminobenzoic acid formation) |
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Skeletal muscle relaxants (MOA) |
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Definition
| Blocks the 2 ACh that bind to the 2 alpha subunits of the nicotinic ACh receptor of the NMJ |
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Skeletal muscle relaxants Nondepolarizing (competitive) |
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Definition
Atracurium & Mivacurium Block the receptor, nicotinic antagonists Reversible w/ AChE inhibitors = neostigmine Causes progressive paralysis (face, limbs, respiratory) no effect on smooth/cardiac muscle Atracurium: safe in hepatic/renal impairment, spontaneously inactivates to metabolite (laudanosine) |
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Skeletal Muscle Relaxants Depolarizing (noncompetitive) |
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Definition
Nicotinic agonist, succinylcholine MOA: phase I = depolarization, fasciculation, prolonged depolarization, flaccid paralysis phase II = desensitization Rapidly hydrolyzed by pseudocholinesterase SE: watch for those w/ atypical pseudocholinesterases, malignant hyperthermia |
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Centrally acting skeletal muscle relaxants |
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Definition
Benzo's through GABAa receptors Baclofen through GABAb receptors, coupled to K+ channels, less sedating Uses: spasticity in CP, MS, stroke |
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Definition
muscle rigidity, hyperthermia, hypertension, acidosis and hyperkalemia Assoc. w/ succinylcholine > halothane > tubocurarine Tx: dantrolene acts on skeletal muscle to decrease contractility by blocking release of Ca2+ from the sarcoplasmic reticulum |
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