27632523
Descripción
Fichas por Majd Fawaz, actualizado hace más de 1 año
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Creado por Majd Fawaz
hace más de 3 años
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| Pregunta | Respuesta |
| What are the 4 stage of general anesthesia? | 1) Analgesia 2) Delerium 3) Surgical Anesthesia 4) Respiratory paralysis Note: * Theses stages where describe for Diethyl Ether *Good GA pass through stage 1 and 2 very quickly |
| Stage 1: Analgesia (Induction) | - Drowsiness --> Loss of consciousness - Analgesia (depends on drug) - Amnesia -Euphoria - Mainly useful for surgical procedures that require minimal muscle relaxation |
| Stage 2: Delirium | - Loss of consciousness --> Onset of regular breathing + loss of eyelid reflex - Excitement (Irregular movement such as involuntary urination and vomiting) - Delerium - Combative behaviour |
| Stage 3: Surgical anesthesia | - Onset of regular breathing --> cessation of breathing - Subdivided in to 4 planes: * Plane 3: Paralysis of intercostal muscle (decrease reflex muscle and eye movement) * Plane 4: Muscle tone disappears (not preferable) |
| Stage 4: Respiratory Paralysis | - Onset of apnea --> failure of respiration and circulation --> Death (intervention) - Medullary depression - Respiratory arest - Cardiac depression and arrest - No eye movement |
| What are the different points the GA takes? | - Dynamic equilibria - The process is reversible |
| Solubility of GA | - Blood gas partition coefficient: conc. of GA in blood/ conc. of GA gas form (at eq.=1) - Used to express the solubility of an agent - We use oil/gas PC instead because its easier to quantify - Low blood/gas PC --> Rapid onset/recovery - High blood/gas PC --> Slow onset/recovery - The blood flow plays a role aswell |
| M.A.C | - Conc. at 1 atm of anesthetic in the alveoli that is needed to produce immobility in 50 of 40 year-old individuals - Expressed in % volume in air - Used as a measure of potency - MAC is additive - Higher MAC --> Less potent |
| How do GA work? | Interaction with ion channels - Chloride channels (inhibitory) - Sodium channles (excitatory - Potasium channel (Rabak 3alim) |
| - Diethyl Ether - High potency with strong analgesia and neuromuscular relaxation - Very slow induction/recovery + slow stage 2 - Flammable when combined with air... | |
| Short Chain Hydrocarbons | - Bigger chain --> More potent - n<10 n-alkane - n<8 cycloalkane Note: Cyclo > Straight in potency (same n) - Flammable + Cardiotoxicity --> Not used |
| How does adding a halogen affects GA | - Increase potency and stability - Decrease flamability and toxicity - Higher atomic mass --> Better (Br>Cl>F) |
| - Chloroform - Very potent anesthetic - Significant analgesia + neuromuscular relaxation - Arrhythmia, carcinogenic,cardiotoxic, hepatotoxic, hypotension, nephrotoxic - Has toxic metabolites | |
| - Halothane - High potency - Rapid onset/recovery - Sweet odor - Used on children - Decomposes to HCl/Br spontaneously --> Amber dark glass vile - Inhibits synaptic destrcution of GABA - Thymol to preserve - No hepatocyte oxygenation --> Inc. liver transaminase --> Hepatotoxicity | |
| - Desflurane (2nd least potent) - Rapid induction/Recovery - Used in outpatient surguries - Pungent --> Mild laryngospasm - Minimal metabolism --> No toxicity --> Commanly used | |
| - Enflurane - No pungent smell - High dose --> convulsion - Inc HR, Arrhythmia, at high conc. circulatory depression - Relaxes the uterus (No Labor) - Minimal Hepatotoxicity (20%) | |
| - Isoflurane - Pungent (irritation) - Inhibits synaptic destrcution of GABA + Dec. glutamate release and inc. its removal - Fewer heart complications - Lower hepatotoxicity (5%) | |
| - Sevoflurane - Rapid induction recovery - Pleasant odor - Metabolite is nephrotoxic | |
| 1) Process produces heat 2) The more dry the absorbent --> More degradation 3) Compound A (major), 2- (fluoromethoxy)-1,1,3,3,3-pentafluoro-1-propene is nephrotoxic | |
| - Methoxyflurane - Most potent - Slowest induction/recovery - Discontinued by FDA | |
| - Half the dose of methoxyflurane is metabolised into toxic metabolites (F-) --> Nephrotoxic | |
| NO2 | - Nitrous oxide (laughing gas) - Least potent GA - Fastest Onset - Euphoric effect - Sweet smell - Mainly used as an adjunct - Inactivation of Vit. B12 (degeneration of spinal cord) |
| - Cyclopropane - More potent than n-propane - Flamable - Cadiotoxic | |
| - Propofol - IV GA - Used in outpatient (infrequent vomiting) - Used for induction and maintenance - Fast onset/recovery - Inc. GABAergic neurotransmision in CNS - Poor water solubility --> oil-water emulsion - Undergoes glucoronidation (inactive) | |
| - Ketamine (Vit.K) - Very potent - Causes dissociative anesthesia - Hallucinations - Onset relatively slow - Short DOA - Block NMDA - Used in short procedures that dont need muscle relaxation - Undegoes N-demethylation (Norketamine) - Inc. BP and HR | |
| - Thiopental - Ultra short acting Barbiturate - Rapid induction (use other GA to maintain) - Short DOA - Enhance GABAergic effect | |
| - Etomidate - Potent, rapid, shortacting, hypnotic - Binds to GABA receptor - Lack analgesia (combine with another) - Gives inactive acid metabolite by hepatic esterases - Possible seizures (depends) |
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