Uiowa Pharm – Anesthesia – Flashcards
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What does general anesthesia do?
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Analgesia Amnesia Unconsciousness Sensory and autonomic reflex suppression Muscle relaxation - immobility
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3 Stages of Anesthesia
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Induction Maintenance Recovery
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Stage I of Depth of Anesthesia
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Analgesia - Pt feels no pain but pt is conscious and conversational
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Stage II of Depth of Anesthesia
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Excitement - Pt experiences delirium and violent combative behavior
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Stage III of Depth of Anesthesia
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Surgical Anesthesia - Regular respiration and relaxation of skeletal muscles occur
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Stage IV of Depth of Anesthesia
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Medullary paralysis - Severe depression of the respirator center and vasomotor center
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Which Stage of Depth of Anesthesia is to be avoided?
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Stage II
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Generally, are IV agents used as induction agents or maintenance agents?
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Induction agents
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Which induction agent is the most widely used IV general anesthetic STRICTLY for induction?
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Thiopental
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Short acting barbiturate that produces unconsciousness in 25 seconds and is highly lipid soluble?
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Thiopental
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Which induction agent works by blocking the excitatory membrane effects of NMDA?
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Ketamine
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Which induction agent produces a dissociated state in which the patient appears awake but is unconscious and does not feel pain?
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Ketamine
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For which patients is Ketamine considered useful?
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Poor-risk geriatric patients Pts in unstable (cardiogenic/septic) shock Low cardiac output
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Which induction agent is used in low doses with Propofol in children undergoing painful procedures like changing burn dressing?
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Ketamine
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Ketamine Side Effects
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Increased cerebral blood flow and O2 consumption Increased intracranial pressure Decreased respiratory rate Post-op disorientation (sensory, perceptual illusions and vivid dreams)
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What drugs minimize the post-op disorientation when given prior to the induction agent?
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Midazolam (Versed) or Diazepam (Valium)
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Which induction agent potentiates the actions of GABA and starts working in 20 seconds?
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Propofol
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Which anesthetic agent is used for induction AND maintenance?
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Propofol
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What advantage does Propofol have over other anesthetic agents?
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Makes patients feel better after surgery Has antiemetic actions
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Which anesthetic agent has antiemetic actions?
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Propofol
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Which anesthetic agent can be used to produce prolonged sedation in critical care when given as a continuous infusion AND can be used in day surgery when given as an IV push (lasting only 5-10 minutes)?
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Propofol
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Side Effects Propofol
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Use in children in ICU has led to severe acidosis in prescence of respiratory infection Apnea and pain at injection site HOTN Involuntary muscle movements, hypotonia, tremors (rarely) Bacterial infections
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Why have antimicrobial agent been added to Propofol?
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To prevent bacterial infections due to emulsion properties of a drug
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Which induction agent works on GABA receptor complex like the benzos?
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Etomidate
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How rapid is the onset of Etomidate?
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30-60 seconds
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Does Etomidate have any analgesic effects?
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No
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Which induction agent is used in pts with compromised cardiovascular function and intracranial bleeds due to the agent having less cardiovascular and respiratory depressive effect?
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Etomidate
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Why can't you use Etomidate in continuous IV?
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Because of its adrenocortical suppression
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Side effects Etomidate
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Post-op N/V Pain at injection site Adrenocortical suppression Myoclonus
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What are inhaled anesthetic agents used for?
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Maintenance of anesthesia after administration of an IV agent
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What is the non-halogenated inhalation agent
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Nitrous oxide
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What are the halogenated gases?
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Halothane Enflurane Isoflurane Desflurane Sevoflurane
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Adverse effects of inhalation anesthetic agents
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Malignant Hyperthermia (increase temp, rigidity, muscle destruction, and kidney failure) Arrhythmias Uterine relaxation
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Reversal agent for malignant hyperthermia
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Dantrolene
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Benzo's used to calm patient, relieve pain and protect against undesirable effects of anesthesia and surgery?
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Valium Ativan Versed
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Opioids used as a preanesthetic med s for analgesia and sedation
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Morphine Demerol Fentanyl Sufentanyl Remifentanyl
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Anticholinergics used as preanesthetic meds to inhibit secretions and to promote sedation/amensia
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Atropine Scopolamine Glycopyrrolate
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Which preanesthetic meds are used for analgesia and sedation?
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Opioids
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Which preanesthetic meds are used to inhibit secretions and promote sedation and amnesia?
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Anticholinergics
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Which preanesthetic meds are used to make the gastric contents less acidic?
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H2 Receptor Antagonists
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H2 Receptor Antagonists used as preanesthetic meds to increase gastric pH
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Cimetidine Ranitidine Famotidine
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Which preanesthetic meds are used to reduce gastric volume, speed gastric emptying and act as an antiemetic?
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Gastric Motility Stimulants Reglan
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Gastric Motility Stimulant
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Reglan
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Aspiration Pneumonitis
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Rare but potentially fatal condition that occurs as a result of regurgiation and aspiration of gastric contents
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Aspiration Pneumonitis Prophylaxis
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Gastric Motility Stimulants H2 receptor antagonists
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Indications for neuromuscular blockers
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Facilitate endotracheal intubation Paralyze mechanically ventilated patients Relax skeletal muscles during surgery after general anesthesia has been induced
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Do neuromuscular blockers affect consciousness or pain threshold?
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No
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Two types of neuromuscular blockers
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Nondepolarizing (competitive) Depolarizing
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MOA of Nondepolarizing neuromuscular blockers
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Competitively blocks access of ACh at the neuromuscular junction end plates
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MOA of depolarizing neuromuscular blockers
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Agent occupies Ach receptor at the neuromuscular end plate. Produce their block by binding to and activating the receptor, causing contraction (Phase I) and after that paralysis (phase II)
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Neuromuscular blockers (non-depolarizing)
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atracurium Cisatracurium Mivacurium Pancuronium Rocuronium** Vecuronium** End in curium or curonium
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Side effects of nondepolarizing agents
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Respiratory depression HOTN Tachycardia Bronchospasm Prolonged duration of action in age > 70 years old
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Meds that treat overdose of neuromuscular blockers
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Cholinesterase inhibitors: Neostigmine** Pyridostigmine** Edrophonium
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Neuromuscular blocker (depolarizing) agent?
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Succinylcholine
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What is Succinylcholine primarily used for?
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Procedures lasting <3 minutes Rapid intubation - follow with nondepolarizer Endoscopic exams Pharmacologically induced convulsive therapy
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What is the Phase I Block for Succinylcholine?
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Depolarizing block that is unable to be reversed by cholineesterase inhibitors. Mimics ACh and produces longer effect at NMJ
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What is the Phase II bock for Succinylcholine?
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Desensitizing block and resembles a nondepolarizing block that is reversible by cholinesterase inhibitors.
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Side effects of Depolarizing Agents
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Respiratory depression Hyperkalemia Increased ocular pressure Increased intragastric pressure - risk of vomiting Muscle pain Malignant hyperthermia
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MOA Local Anesthetics (The Little Rock)
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Decreases the permeability of nerve cell membranes to sodium ions by: slowing rate of depolarization increase threshold for electrical excitability prevent propagation of action potential
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Adverse effects of local anesthetics
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Seizures Arrhythmias Allergic (hypersensitivity) reactions
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What can be added to a local anesthetic to help reduce systemic toxicity and increase the DOA due to local vasoconstriction?
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Epinephrine
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Typical uses of local and regional anesthesia
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Epidural Spinal (Intrathecal) Peripheral nerve block Topical and local infiltration
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Two types of local anesthetics
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Esters and Amides
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Which type of local anesthetic usually has a shorter duration of action and is metabolized by pseudocholinersterase?
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Esters
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Which type of local anesthetic usually has a longer duration of action and is metabolized by P450 enzyme system?
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Amides
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Topical Ester Anesthetics
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BCT Benzocaine** Cocaine Tetracaine**
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Ester Anesthetics used for local infiltration, nerve block, and epidural
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Nesacaine
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Ester Anesthetics used for local infiltration, nerve block, and spinal
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Novocaine
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Only amide anesthetic used topically
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Dibucaine
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What amides are used for local infiltration?
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Septocaine Bupivacaine** Lidocaine** Mepivacaine Prilocaine Ropivacaine**
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This topical anesthetic for use on intact skin for local analgesia for superficial minor surgeries - circumcisions
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Lidocaine/Prilocaine (EMLA cream)
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This topical anesthetic is used for pain associated with post-herpetic neuralgia
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Lidocaine 5% patch (Lidoderm)
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What is the TAC solution?
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Tetracaine, Adrenaline, Cocaine
