Podcast
Questions and Answers
What is the primary characteristic of neuromuscular blockers that exhibit a ceiling effect?
What is the primary characteristic of neuromuscular blockers that exhibit a ceiling effect?
- No increase in potency beyond a certain dose (correct)
- Increased potency with increased dose
- Reversal by anticholinesterases
- Spontaneous degradation in plasma
Which inhalation agent is favored in pediatric cases due to its sweet smell?
Which inhalation agent is favored in pediatric cases due to its sweet smell?
- Nitrous oxide
- Sevoflurane (correct)
- Desflurane
- Isoflurane
What is the primary mechanism of Hoffman degradation?
What is the primary mechanism of Hoffman degradation?
- Enhanced metabolism of inhalation agents
- Enzymatic degradation of neuromuscular blockers
- Spontaneous degradation of non-depolarizing neuromuscular blockers in plasma (correct)
- Reversal of neuromuscular blockers by anticholinesterases
What is the primary contraindication for the use of nitrous oxide?
What is the primary contraindication for the use of nitrous oxide?
What is the primary characteristic of opioids that exhibit a ceiling effect?
What is the primary characteristic of opioids that exhibit a ceiling effect?
What stage of anesthesia is characterized by a deeply unconscious patient with increasing muscle relaxation and absence of protective airway reflexes?
What stage of anesthesia is characterized by a deeply unconscious patient with increasing muscle relaxation and absence of protective airway reflexes?
What occurs during emergence when discontinuing N2O administration?
What occurs during emergence when discontinuing N2O administration?
What is an absolute contraindication to regional anesthesia?
What is an absolute contraindication to regional anesthesia?
What is the mechanism of action of local anesthetics?
What is the mechanism of action of local anesthetics?
What is a relative contraindication to regional anesthesia?
What is a relative contraindication to regional anesthesia?
What is the effect of local anesthetics on the resting transmembrane potential?
What is the effect of local anesthetics on the resting transmembrane potential?
What is the binding characteristic of local anesthetics to open and inactivated channels?
What is the binding characteristic of local anesthetics to open and inactivated channels?
Which characteristic does not make an inhaled anesthetic ideal for use in all patient populations, including pregnancy?
Which characteristic does not make an inhaled anesthetic ideal for use in all patient populations, including pregnancy?
What does a lower MAC indicate about an inhaled anesthetic’s potency?
What does a lower MAC indicate about an inhaled anesthetic’s potency?
Which phase of general anesthesia involves administration of a hypnotic agent and confirmation of loss of consciousness?
Which phase of general anesthesia involves administration of a hypnotic agent and confirmation of loss of consciousness?
What occurs during the MAC bar stage?
What occurs during the MAC bar stage?
How does nitrous oxide (N2O) affect the cardiovascular system?
How does nitrous oxide (N2O) affect the cardiovascular system?
What is measured to determine the potency of inhaled anesthetic agents?
What is measured to determine the potency of inhaled anesthetic agents?
Which of the following is a common result of rapid administration of desflurane?
Which of the following is a common result of rapid administration of desflurane?
During which stage of general inhalational anesthesia is amnesia typically provided?
During which stage of general inhalational anesthesia is amnesia typically provided?
Which property of total intravenous anesthesia (TIVA) is considered advantageous?
Which property of total intravenous anesthesia (TIVA) is considered advantageous?
Which of the following sedative-related effects is specific to Etomidate?
Which of the following sedative-related effects is specific to Etomidate?
What is a primary pulmonary effect of Propofol?
What is a primary pulmonary effect of Propofol?
Which phenomenon is a disadvantage of the N2O-narcotic technique?
Which phenomenon is a disadvantage of the N2O-narcotic technique?
Which general anesthesia technique is characterized by a higher risk of opioid-induced hyperalgesia?
Which general anesthesia technique is characterized by a higher risk of opioid-induced hyperalgesia?
Which sedative should be avoided in patients with advanced cardiovascular disease?
Which sedative should be avoided in patients with advanced cardiovascular disease?
Which anesthetic drug is known for causing pain on injection and carries a high incidence of nausea and vomiting?
Which anesthetic drug is known for causing pain on injection and carries a high incidence of nausea and vomiting?
What type of sedation is characterized by a reversible state of unconsciousness?
What type of sedation is characterized by a reversible state of unconsciousness?
Which component of general anesthesia involves sensory blockade?
Which component of general anesthesia involves sensory blockade?
What is the blood gas coefficient?
What is the blood gas coefficient?
What is the relationship between blood gas coefficient, solubility in blood, and rate of onset?
What is the relationship between blood gas coefficient, solubility in blood, and rate of onset?
What are the 4 stages of general inhalational anesthesia?
What are the 4 stages of general inhalational anesthesia?
Where is the local anesthetic (LA) placed in a spinal block?
Where is the local anesthetic (LA) placed in a spinal block?
What medications can be used in a spinal block?
What medications can be used in a spinal block?
What are some potential complications of neuroaxial blocks?
What are some potential complications of neuroaxial blocks?
What are fascial plane blocks?
What are fascial plane blocks?
What are common sites of fascial plane blocks?
What are common sites of fascial plane blocks?
What is a Bier block?
What is a Bier block?
How is a Bier block performed?
How is a Bier block performed?
Which is a component of general anesthesia?
Which is a component of general anesthesia?
What is the most cardiostable sedative?
What is the most cardiostable sedative?
What complication can etomidate cause?
What complication can etomidate cause?
What is neostigmine used for?
What is neostigmine used for?
What are examples of non-depolarizing neuromuscular blockers?
What are examples of non-depolarizing neuromuscular blockers?
What is the least potent inhalation agent?
What is the least potent inhalation agent?
Which inhalation agent can prolong QT?
Which inhalation agent can prolong QT?
What does minimum alveolar concentration (MAC) mean?
What does minimum alveolar concentration (MAC) mean?
What is the effect of inhaled anesthetics on blood pressure?
What is the effect of inhaled anesthetics on blood pressure?
How long should a procedure using a Bier block last?
How long should a procedure using a Bier block last?
What is the effect of a higher blood-gas partition coefficient on the rate of induction of anesthesia?
What is the effect of a higher blood-gas partition coefficient on the rate of induction of anesthesia?
Which of the following anesthetic agents is likely to have a faster onset of anesthetic action due to its lower blood-gas partition coefficient?
Which of the following anesthetic agents is likely to have a faster onset of anesthetic action due to its lower blood-gas partition coefficient?
What is the relationship between the partial pressure of a volatile anesthetic agent and its blood-gas partition coefficient?
What is the relationship between the partial pressure of a volatile anesthetic agent and its blood-gas partition coefficient?
Why do newer anesthetic agents tend to have a faster onset of anesthetic action compared to older agents?
Why do newer anesthetic agents tend to have a faster onset of anesthetic action compared to older agents?
What happens when more anesthetic is taken into the blood, resulting in a higher BGC?
What happens when more anesthetic is taken into the blood, resulting in a higher BGC?
What is anesthesia?
What is anesthesia?
What is the balanced anesthesia technique?
What is the balanced anesthesia technique?
What is the goal of inhalational anesthesia?
What is the goal of inhalational anesthesia?
Alveolar partial pressure mirrors the brain partial pressure
Alveolar partial pressure mirrors the brain partial pressure
Which of the following inhalational anesthetics are known to cause airway irritation?
Which of the following inhalational anesthetics are known to cause airway irritation?
What is ataraxia?
What is ataraxia?
What is the mechanism of action of propofol?
What is the mechanism of action of propofol?
What is the drug class of etomidate?
What is the drug class of etomidate?
What is a complication of etomidate?
What is a complication of etomidate?
What is the mechanism of action for ketamine?
What is the mechanism of action for ketamine?
What is the mechanism of action of midazolam?
What is the mechanism of action of midazolam?
What is a pulmonary complication of midazolam?
What is a pulmonary complication of midazolam?
What is a renal complication of sevoflurane administration?
What is a renal complication of sevoflurane administration?
What are bispectral index (BIS) monitors used for?
What are bispectral index (BIS) monitors used for?
What level of anesthesia is conscious sedation?
What level of anesthesia is conscious sedation?
What characteristics do patients in deep sedation have?
What characteristics do patients in deep sedation have?
What medications are used in a Bier block?
What medications are used in a Bier block?
What local anesthetics are commonly used in peripheral nerve blocks?
What local anesthetics are commonly used in peripheral nerve blocks?
Order these inhalational anesthetics from the least to the most potent: nitrous oxide, sevoflurane, isoflurane, desflurane
Order these inhalational anesthetics from the least to the most potent: nitrous oxide, sevoflurane, isoflurane, desflurane
What is a common characteristic of inhalation anesthetics?
What is a common characteristic of inhalation anesthetics?
Where can local anesthetic be placed in an epidural?
Where can local anesthetic be placed in an epidural?
Epidural blocks can be adjusted
Epidural blocks can be adjusted
Patient must be able to maintain their airway in monitored anesthesia care
Patient must be able to maintain their airway in monitored anesthesia care
What are the indications for a combined spinal/epidural block?
What are the indications for a combined spinal/epidural block?
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Study Notes
Phases of General Anesthesia
- Pre-operative anesthesia evaluation: transport from holding area to PACU
- Pre-induction: baseline vitals, preoxygenation/denitrogenation, administration of a hypnotic agent, confirmation of LOC, attempt PPV, administration of muscle relaxant, intubation, confirmation of intubation
- Induction: GA induction steps
- Maintenance
- Emergence: post-operative anesthesia evaluation, transport from OR to PACU
Potency of Inhaled Agents
- Measured via MAC (minimum alveolar concentration), blood gas coefficient, or bispectral index monitors (BIS)
- MAC: minimum alveolar concentration of inhaled anesthetic required to prevent 50% of patients from moving in response to painful stimuli
- Lower the MAC, the more potent the agent is
- Variations of MAC:
- MAC awake: allowing of eye opening on verbal command (seen during emergence and induction)
- MAC asleep: loss of consciousness and recall
- MAC bar: MAC to prevent adrenergic and CV response to incision
- MAC intubation: MAC to inhibit movement and coughing during intubation
- MAC incision: MAC to prevent movement during initial incision
Characteristics of Ideal Inhaled Anesthetics
- Potent
- Low blood and tissue solubility
- Resistant to physical and metabolic degradation
- Stable (non-flammable or explosive)
- Odorless and pleasant to inhale
- Rapid onset and offset
- Safe for all ages and in pregnancy
Inhaled Anesthetics
- Characteristics:
- Provide amnesia and immobility
- Decrease BP and SVR
- CO preserved but myocardial depression can occur
- Rapid administration of desflurane can increase BP and HR
- Examples:
- Nitrous oxide:
- Blood gas coefficient: 0.47
- MAC: 104 (least potent)
- Has analgesic and anesthetic properties
- Cautions: pneumothorax, dilated bowels, laparoscopic surgeries, cases with hollow organs
- Isoflurane:
- Blood gas coefficient: 1.4
- MAC: 1.2
- Cardiovascular: increased HR, hypotension, potent coronary artery vasodilator
- Sevoflurane:
- Blood gas coefficient: 0.65
- MAC: 2
- Favored in pediatric cases due to sweet smelling
- Cautions: prolonged QT or other medications that can do the same
- Desflurane:
- Blood gas coefficient: 0.45
- MAC: 6
- CNS: quick induction and recovery
- CV: increased HR and catecholamine production
- Pulmonary: irritating
- Cautions: pediatric pts or reactive airway disease
- Nitrous oxide:
Non-Depolarizing Neuromuscular Blockers
- Benzylisoquinolinium Compounds:
- Atracurium
- Cisatracurium
- Mivacurium
- Doxacurium
- Aminosteroid Compounds:
- Pancuronium
- Vecuronium
- Rocuronium
- Pipecuronium
- Chlorofumarate diesters:
- Gantacurium
- Reversal agents:
- Neostigmine
- Sugammadex
- Calabadion
Stages of General Anesthesia
- Stage 1: Disorientation, analgesia without amnesia
- Stage 2: Delirium/excitement, pt is unconscious but responds reflexively and irrationally to stimuli
- Stage 3: Surgical, ideal stage for surgery, characterized by a deeply unconscious pt with increasing degrees of muscle relaxation and absence of protective airway reflexes
- Stage 4: Medullary depression, life-threatening condition characterized by cardiovascular and respiratory collapse due to depression of the associated centers in the brain
Blood-Gas Partition Coefficient (BGC)
- A higher BGC indicates greater solubility of the anesthetic in blood and tissues, which slows the rate of induction.
- A higher BGC means more anesthetic is taken into the blood, acting as a reservoir for the agent, reducing the alveolar concentration.
- Volatile agents with a lower BGC are less soluble and exert a higher partial pressure.
- A lower BGC leads to a more rapid onset and offset of anesthetic action due to the higher partial pressure.
- Newer anesthetics, such as desflurane, typically have smaller BGCs than older ones, such as ether.
- A smaller BGC leads to a faster onset of anesthesia.
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