Term
| General anesthesia keeps patients alive by not inducing what? |
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Definition
| physiologic response to stress |
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Term
| What is a drug induced level of controlled unconsciousness. |
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Definition
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Term
True or False:
Anesthesia consists of separable and independent components or substates, each of which involves distinct, but possibly overlapping, mechanisms at different sites in the central nervous system. |
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Definition
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Term
| General anesthetics act by binding to _____________ in proteins. |
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Definition
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Term
True or false:
The effects of inhaled anesthetics cannot be explained by a single molecular mechanism |
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Definition
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Term
| The immobilizing effect of inhaled anesthetics involves a site of action in the __________, whereas sedation/hypnosis and amnesia involve ___________ mechanisms. |
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Definition
spinal cord
supraspinal mechanisms (pons) |
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Term
What would an ideal general anesthetic all compose of?
Which is the ONLY thing we have currently? |
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Definition
few to no side effects
would provide for hemodynamic stability (keep normal BP)
would be relatively inexpensive
rapidly reversible
easy to administer (only one we have) |
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Term
True or False:
General anesthesia is a form of deep sleep. |
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Definition
false
General anesthesia is NOT sleep! (sleep is safer, we're anesthetizing them to get them in controlled unconsciousness) |
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Term
| What is the difference between a person going to sleep and a person who is anesthetized on an EEG? |
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Definition
You see sleep spindles when going to sleep
The action is more rapid and uniform instead of broken up and then there's a burst suppression when cerebral metabolic rate for oxygen consumption levels out to ~50% (more drugs won't change CMR-to keep us alive) |
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Term
| What are the steps (3) that occur in establishing general anesthesia. |
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Definition
Intravenous or inhalational induction of anesthesia
controlling the airway
administering a volatile anesthetic agent. |
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Term
| What 4 intravenous induction agents? |
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Definition
Sodium Pentothal
Propofol
Etomidate
Ketamine (?) |
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Term
| Out of Sodium Pentothal, Propofol , Etomidate, and Ketamine, which one do we no longer have? |
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Definition
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Term
| Out of Sodium Pentothal, Propofol , Etomidate, and Ketamine, which one is the most used? |
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Definition
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Term
Out of Sodium Pentothal, Propofol , Etomidate, and Ketamine, which doesn't have as as big of an effect on the cardiovascular system and suppresses your adrenal glands?
What would you give someone with heart disease along with this drug to cover that? |
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Definition
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Term
| What are the 4 volatile inhalational agents? |
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Definition
Isoflurane
Sevoflurane
Desflurane
Nitrous Oxide (not used much in OR, used for "stunning") |
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Term
| Of the steps between delivered and brain anesthetic partial pressure, none is more pivotal than that between the _________ and ___________ |
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Definition
| Of the steps between delivered and brain anesthetic partial pressure, none is more pivotal than that between the inspired and alveolar gases |
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Term
| _____________ governs the partial pressure of anesthetic in all the body tissues. |
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Definition
| Alveolar partial pressure governs the partial pressure of anesthetic in all the body tissues. |
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Term
| Do you want to keep the alveolar partial pressure high or low when administering anesthetic? |
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Definition
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Term
True or false:
As you administer oxygen, after about 30 seconds you are no longer picking up any more oxygen, though you are still breathing 100% because the solubility has not changed, the cardiac output has not changed, the alveolar-to-venous partial pressure is getting smaller and smaller all the time. |
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Definition
| True (venous and alveolar concentration are the same) |
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Term
| what are the factors that effect the uptake of a volatile anesthetic agent. |
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Definition
Solubility
Cardiac Output
Alveolar-to-venous partial pressure difference |
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Term
__________ coefficients what drives the rapidity with which the anesthetic goes on board and the rapidity with which it leaves.
Do we want this to be high or low? |
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Definition
Blood-Gas partition coefficients or solubility coefficients
we want solubility to be low |
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Term
True or False:
The fraction of inspired oxygen is different in here and mt. everest, so that drives the pick-up of anesthesia. |
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Definition
false
it is barometric pressure (want a low barometric pressure=uptake will be greater) |
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Term
| What happens if you increase ventilation? |
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Definition
| increase alveolar concentration, increasing amour of gas available in the alveolus, the "knee" on the chart is a little higher |
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Term
| What happens if you increase cardia input and keep ventilation the same? |
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Definition
| decrease alveolar partial pressure so concentration drop |
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Term
| What happens if you increase ventilation and cardiac output? |
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Definition
| ventilation wins (will bring more gas to alveoli--can change ventilation but can't change your cardiac output) |
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Term
The Partial pressure of a Volatile anesthetic agent is governed by?
A. blood gas solubility
B. Cardiac Output
C. Alveolar Partial Pressure
D. Length of time an anesthetic agent is inhaled |
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Definition
| Alveolar partial pressure |
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Term
| What is a concept used as a universal measure for inhaled anesthetic potency. |
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Definition
| Minimum Alveolar Concentration (MAC) |
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Term
MAC is defined as the minimum alveolar concentration of an ___________ at atmospheric pressure required to prevent movement in response to a noxious stimulus in ___% of patients.
Is this a good definition? |
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Definition
inhaled anesthetic
50%
No (you only have to be right 50% of the time) |
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Term
| The brain takes ____% of cardiac output in your body. |
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Definition
| 25-20% (very metabolically active) |
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Term
| What is it called when cerebral blood flow (CBF) stays stead while different things are changing (mean arterial pressure)? |
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Definition
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Term
| When blood pressure drops, the ability of our brain to auto regulate (increases or decreases), and our cerebral blood flow (increases or decreases). |
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Definition
decreases
decreases
(when people get light headed and pass out) |
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Term
| **What is the most important regulator of cerebral blood flow? |
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Definition
| PaCO2 (arterial partial pressure of CO2) in the artery |
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Term
If PaCO2 is decreased, MAP (increases or decreases).
If PaO2 is decreased, MAP (increases or decreases). |
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Definition
decreases (can turn ischemic to infarcted area)
increases (increases CBF to extract O2) |
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Term
What happens when you first give barbiturates?
Does this keep happening as you give more barbiturates? |
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Definition
immediate rapid decrease in cerebral metabolic rate of O2 consumption because we are starting to put the cell to sleep
Decreases until you have silent/flat EEG and it stays the same no matter what to support the basal metabolic requirement to stay alive |
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Term
| Cerebral metabolic rate can only be lowered below the iso-electric point of the EEG by ___________ |
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Definition
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Term
| How do we know that we can take babies down to 15 to 17 degrees, turn off the pump and rebuild their heart in 1 hour? |
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Definition
| because we know that there is 0% function, but still 8% integrity at that point |
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Term
| All intravenous agents except which one doesn't decrease both cerebral blood and cerebral metabolic rate? |
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Definition
| ketamine (decrease CBF, but increase CMR) |
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Term
| How do intravenous agents decrease cerebral blood flow? |
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Definition
| it decreases blood pressure --> decreases mean arterial pressure --> decrease CBF |
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Term
| In volatile/potent anesthetic agents on global basis, as CBF increases, CMR (increases or decreases)? |
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Definition
| decrease (cerebral protection from potent inhalation agent- demand is going down and supply is going up) |
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Term
Intravenous anesthetic agents, except for ketamine, maintain CMR/CBF (coupling or uncoupling).
Volatile anesthetic agents causes (coupling or uncoupling) of the CMR/CBF ratio |
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Definition
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