General Anesthetics

Question 1

Monitored anesthetic care

Diagnostic/therapeutic

Answer 1

1. Midazolam - mild sedation
2. Propofol - deep sedation
3. Ketamine - minimize discomfort

Question 2

Conscious sedation

Answer 2

1. Benzodiazepines

2. Fentanyl (opoid analgesia)

Question 3

What reverse benzodiazepines effects?

Answer 3

Flumazenil

Question 4

What reverses Fentanyl effects?

Answer 4

Naloxone

Question 5

Deep sedation

Answer 5

1. Propofol
2. Midazolam
   In combo with Ketamine sometimes

Question 6

What reverses Midazolam’s effects?

Answer 6

Flumazenil

Question 7

Volatile inhaled anesthetics

Answer 7

1. Halothane
2. Enflurane
3. Isoflurane
4. Desflurane
5. Sevoflurane

Question 8

Gaseous inhaled anesthetics

Answer 8

NO

Question 9

Low blood solubility - faster onset

Answer 9

1. NO

2. Desflurane

Question 10

High blood solubility - slower onset

Answer 10

Halothane

Question 11

Low solubility –> High solubility

Answer 11

NO > Desflurane > Sevoflurane > Isoflurane > Halothane

Question 12

Bradycardia

Answer 12

Halothane

Question 13

Increase heart rate

Answer 13

1. Desflurane

2. Isoflurane

Question 14

What drug can cause hepatitis?

Answer 14

Halothane

Question 15

What agents release Fl ions and cause renal toxicity?

Answer 15

1. Enflurane

2. Sevoflurane

Question 16

Inhaled volatile anesthetics + succinylcholine causes what?

Answer 16

Malignant hyperthermia

Question 17

What’s an antidote for malignant hyperthermia?

Answer 17

Dantrolene

Question 18

IV - Propofol

Answer 18

• rapid onset/recovery
• hypotension
• short duration (locations outside surgery room)
• poor solubility
• GABAa Rc –> Cl
• metabolized by liver; high plasma clearance = low hangover effect

Question 19

High context-sensitive (short infusion duration) –> low context-sensitive (long infusion duration)

Answer 19

Diazepam > Thiopental > Midezolam > Ketamine > Propofol > Etomidate

Question 20

Propofol - organ effects

Answer 20

1. CNS - low CBF, low CMRO2, low IOP, low ICP
2. Heart - low SBP: Vd, hypotension
3. Resp - depression
4. Pain - on injection

Question 21

IV- Fospropofol

Answer 21

• prodrug of Propofol
• water soluble
• longer onset/recovery
• metabolized by alkaline phosphatase (to make Propofol, phosphate, formaldehyde)
• metabolized by aldehyde dehydrogenase (liver, erythrocytes)

Question 22

IV - Etomidate

Answer 22

• GABAa Rc
• hypnotic, no analgesic effects
• minimal depression (better for use in people with an impaired heart)
• rapid loss of consciousness/less rapid recovery
• metabolized by liver and plasma

Question 23

Etomidate - effects

Answer 23

1. CNS - Cerebral Vc, dec CBF, dec ICP
2. Heart - minimal change in CO
3. Resp - depression is less
4. Endocrine - inhibits 11 b-hydroxylase (cholesterol –> cortisol)

Question 24

IV - Ketamine

Answer 24

• NMDA Rc antagonist

- inc lacrimation, inc salivation

Question 25

Ketamine - effects

Answer 25

1. CNS - inc CBF, inc CMRO2, euphoria = abuse potential, hallucinations etc. 2. Heart - inc SBP, HR, CO, myocardial depressant * ** ONLY 1 to produce analgesia profoundly, stimulate SNS, bronchodilation, minimal resp depression! ****

Question 26

IV - Dexmedetomidine

Answer 26

- alpha 2 agonist - activation of sleep pathway - dec HR, dec R, dec SBP, bradycardia - short term sedation (ICU setting usually)

Question 27

Opioids

Answer 27

1. Fentanyl 2. Sufentanil 3. Remifentanyl 4. Morphine

Question 28

Barbiturates

Answer 28

1. Thiopental | 2. Methohexital

Question 29

Barbiturates - effects

Answer 29

- Lipophilic - dose dep CNS depression - resp depression - GABAa Rc - short procedures: Methohexital (preferred) > Thiopental (slow recovery) - CYP450 enzymes

Question 30

Benzodiazepines

Answer 30

1. Diazepam 2. Lorazepam 3. Midazolam (drug of choice cuz only 1 that is water soluble)

Question 31

Midazolam

Answer 31

- rapid onset/short elimination - steeper dose-response curve - given BEFORE you enter your surgery

Question 32

Benzodiazepines - effects

Answer 32

- GABAa Rc - anterograde amnesia (used in pre-operative period) - anticonvulsant - treatment for epilepticus, alcohol withdrawal, local-anesthetic induced seizures