Term
| what does general anesthesia supres |
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Definition
| reversible loss of sensation and consciousness: analgesia, amnesia, LOS, relax skeletal muscle, somatic, autonomic, endocrine reflexes, hemodynamic stability |
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Term
| what are three things that affect transfer of drug from machine to alveoli |
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Definition
inspired PP
alveolar ventilation
characteristics of the breathing system |
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Term
| what are three things that effect the transfer of drug from alveoli to arteriole |
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Definition
blood bas partition coefficient
cardiac output
alveolar to venous PP difference |
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Term
| what are three things that affect transfer of drug from arterial blood to brain |
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Definition
brain blood partition coefficient
cerebral blood flow
arterial to venous PP difference |
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Term
| how does the PP of a anesthetic change its effect in a person |
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Definition
it is proportional to fractional concentration of the mixture
increased amount dissolved (solibility) decreases partial pressure in solution
driving force that moves gas from machine to lung, lung to blood, blood to brain
at equlribium PP are equal in all body tissues, alveoli, inspired mixture |
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Term
| how does solubility of a anesthetic change its effect in a person |
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Definition
blood gas partition coefficient: relationship between arterial PP and solubility
higher solubility means more dissolved and less PP of gas
more dissolved (water soluble) means faster distribution but slower induction
lipid soluble means slow distribution but fast induction into tissue |
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Term
| how is alveolar ventilation of anesthetic calculated |
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Definition
| = RR x (TV - dead space) x rate of drug induction |
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Term
| why do we care about alveolar ventilation of anesthetic |
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Definition
more dead space means that same drug gets to lung less in some people
it is adjusted in respiratory depressants (opioids, barbs), pulmonary disease, emphysema, COPD |
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Term
| what is the law of mass action |
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Definition
| initially at alveoli PP of anesthetic is higher than alveolar blood so gas move sinto PP and PP in blood increases and as gradient lessens it slows |
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Term
| how does changes in cardiac output effect inhaled anesthetics |
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Definition
CO determines pulmonary flow, increased pulmonary flow decreases induction of anesthetic
same volume of gas from alveoli diffuse into larger volume of blood per time
initially reduced concentration in blood and PP is proportional to its concentration
any increase in CO means more perfusion to tissues other than the brain |
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Term
| what does increase in anesthetic concentration, alveolar ventilation, solubility of anesthetic, and CO do to rate of induction |
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Definition
concentration: increases
ventilation: increases
solubility: decreases
CO: decreases |
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Term
| what actions of the drug in the body determine potency of general anesthetic |
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Definition
concentration in the brain
correlates with lipid solubility |
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Term
| what is the minimum alveolar concentration |
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Definition
expression of potency of inhaled anesthetic
concentration that prevents 50% from responding to painful stimuli like incision
range for surgery 1-2
MAC 1.3 gives ED99 |
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Term
| what is the volume of expansion theory |
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Definition
molecules of drug dissolve in lipid bilayer causing neuronal membrane to expand stopping ion channels and propagation of AP
specific receptor binding on GABAa
NO effect on Cl channel like BDZ and barbs |
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Term
| 6 inhaled general anesthetics |
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Definition
no one deserves seven isolated halos en florance
nitrOUS oxide
desflurane
sevoflurane
isoflurane
halothane
enflurane |
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Term
| inhaled general anesthetic most commonly used |
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Definition
|
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Term
| inhaled general anesthetic not able to be used alone in surgery |
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Definition
|
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Term
| inhaled general anesthetic often delivered with opioids or volitale anesthetics |
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Definition
|
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Term
| nitrous oxide: potency and why |
|
Definition
low lotency, poor blood solubility
allows rapid achievement of alveolar to brain PP of lung |
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|
Term
|
Definition
not flamable but can support combustion
minimal skeletal muscle relaxation
inhaled anesthetics are addictive
considered safest |
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Term
|
Definition
low incidence of toxic effects, not flammable
rapid awakening
low margin of safety: circulatory depression, decreased CO, hypotension, bradycardua
halothane hepatitis: hepatic failure and death due to metabolism of immunologic biproducts
releases bromide
malignant hypothermia with succinylcholine (TX dantrolene) |
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Term
|
Definition
decreased BP due to decreased vascular tone
no renal of hepatic metabolism
irritating to airway |
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Term
|
Definition
significant release of fluoride with prolonged use and high doses
seizure with high doses
less proability of arrhythmia |
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Term
|
Definition
less irritating to airway
no tachycardia (preferred in pt prone to MI)
potential nephrotoxicity due to compound A: degradation made by sevofluraine, CO2, and sodalime |
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Term
|
Definition
laryngeal spasm: not indicated for inhalation induction
special delivery system to make liquid at room temp |
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Term
| why use IV anesthetic over inhaled |
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Definition
| add flexability and permit administration of lower concentrations of inhaled agents |
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Term
| drugs used as IV anesthetics 7 |
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Definition
barbituates
benzos
kit, amy, e tom dated droned pairs of dolls on fentanyl and propfol
ketamine
etomidate
doperidol
fetanyl
propfol |
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Term
| barbs used in IV anesthetics 2 |
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Definition
thios penpal sent him meth in a hexagon envelope
thiopental
methohexital |
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Term
| benzos used for IV anesthetics 1 |
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Definition
mydalzing lamb had no pain
midazoloam |
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Term
| barb as IV anesthetic: 1 good 1 bad |
|
Definition
sedation
poor analgesia, may increase response to pain |
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Term
| benzos as IV anesthetic: use, effects |
|
Definition
midazoloam is only one used in anesthesia
other benzos provide anesthesia without analgesia and can only be used in procedures with little pain or adjunct to inhaled anesthetic |
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|
Term
| doperidol and fentanul: use, SE |
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Definition
neuroleptic anesthesia
slow induction
may need ventilation |
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Term
|
Definition
opioid sigma agonist
NMSA antagonist |
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|
Term
|
Definition
dissociative amnesia: dissociation from enivornment (eyes open, unresponsive to pain)
analgesia
amnesia
hallucinations
bad dreams
delirium: days to weeks later
increased ICP: do not use in cerebral ischemia risk pt
potent bronchodilator: good for patients with bronchospasm risk |
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Term
|
Definition
interacts with GABAa receptors
rapid redistribution and elimination for short procedures and out patient surgery
low nausea and vomiting
pain on ijection |
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Term
|
Definition
interacts with GABAa receptors
high incidence of myclonus
pain on injection |
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