General Anesthetics pco 501
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Questions and Answers

What is one of the goals of preanaesthetic medication?

  • Relieve anxiety and apprehension (correct)
  • Increase blood pressure
  • Eliminate the need for anaesthesia
  • Induce sleep immediately

Emergence delirium is a common occurrence after anaesthesia.

True (A)

Name one drug used for the induction of anesthesia.

Thiopental

Preanaesthetic medication can help to decrease _____ and volume of gastric juice.

<p>acidity</p> Signup and view all the answers

Match the following phases of anaesthesia with their corresponding drugs:

<p>Preanesthetic care = Diazepam, Atropine Induction of anesthesia = Thiopental Maintenance of anesthesia = Inhaled anesthetics Postanesthetic care = Metoclopramide</p> Signup and view all the answers

Which of the following describes general anesthesia?

<p>It renders the patient unaware of pain during surgical procedures. (D)</p> Signup and view all the answers

Local anesthesia produces a loss of consciousness and sensation throughout the body.

<p>False (B)</p> Signup and view all the answers

Name one common drug used for local anesthesia.

<p>Lidocaine</p> Signup and view all the answers

The cardinal features of general anesthesia include loss of sensation, ______, immobilization, and abolition of reflexes.

<p>unconsciousness</p> Signup and view all the answers

Match the stages of general anesthesia with their characteristics:

<p>Analgesia = Patient remains conscious with dream-like state Delirium and excitement = Nausea, vomiting, hyperreactivity Stage of Recovery = Patient gradually comes back to consciousness Stage of Maintenance = Sustaining anesthesia for surgical procedures</p> Signup and view all the answers

Which statement about inhalation anesthetics is true?

<p>They induce unconsciousness in patients during surgery. (B)</p> Signup and view all the answers

Stage 1 of general anesthesia is characterized by unconsciousness and amnesia.

<p>False (B)</p> Signup and view all the answers

What is the primary role of an anesthesiologist during surgery?

<p>To administer anesthetics and monitor the patient's state of anesthesia.</p> Signup and view all the answers

Which inhalation anesthetic is contraindicated in patients with seizure disorders?

<p>Enflurane (A)</p> Signup and view all the answers

Desflurane has a pungent odor and is recommended for pediatric use.

<p>False (B)</p> Signup and view all the answers

What is the main advantage of using propofol over thiopentone?

<p>Lower incidence of postoperative nausea and vomiting</p> Signup and view all the answers

_________ is a fast-acting intravenous anesthetic that produces unconsciousness within 15-45 seconds.

<p>Propofol</p> Signup and view all the answers

Match the anesthetic agents with their characteristics:

<p>Methoxyflurane = Non irritant, weak analgesic Thiopentone = Ultrashort acting thiobarbiturate Nitrous oxide = Causes diffusion hypoxia Ketamine = Used for inducing general anesthesia</p> Signup and view all the answers

What is a common side effect of halothane?

<p>Hepatotoxicity (A)</p> Signup and view all the answers

Benzodiazepines can produce unconsciousness within minutes.

<p>False (B)</p> Signup and view all the answers

Name one mechanism of action for thiopentone.

<p>Enhances GABA-mediated transmission</p> Signup and view all the answers

______ is used as a pre-anesthetic medication and for inducing sedation.

<p>Benzodiazepines</p> Signup and view all the answers

Match the following side effects with the respective anesthetics:

<p>Sevoflurane = Minimal CVS adverse effects Enflurane = CNS stimulation Desflurane = Airway irritation Methoxyflurane = Slow induction and recovery</p> Signup and view all the answers

Which intravenous anesthetic is known for potential excitatory effects and involuntary movements?

<p>Propofol (A)</p> Signup and view all the answers

Nitrous oxide can lead to megaloblastic anemia.

<p>True (A)</p> Signup and view all the answers

What effect does thiopentone have on blood pressure immediately after injection?

<p>It causes a fall in blood pressure due to vasodilation.</p> Signup and view all the answers

How long does it typically take for a patient to become responsive after administration of diazepam without other anaesthetics?

<p>1 hour (A)</p> Signup and view all the answers

Benzodiazepines significantly depress respiration when used with opioids.

<p>True (A)</p> Signup and view all the answers

What drug is used to rapidly reverse the anesthetic action of benzodiazepines?

<p>flumazenil</p> Signup and view all the answers

Ketamine induces dissociative anesthesia, characterized by sedation, immobility, analgesia, anterograde amnesia, and a strong feeling of __________ from the environment.

<p>dissociation</p> Signup and view all the answers

What is the elimination half-life of ketamine?

<p>2-4 hours (B)</p> Signup and view all the answers

Fentanyl can be used as an adjunct to spinal anaesthesia.

<p>True (A)</p> Signup and view all the answers

Name one common side effect of fentanyl administration.

<p>respiratory depression</p> Signup and view all the answers

Which intravenous anesthetic has a risk of causing psychotomimetic effects?

<p>Ketamine (D)</p> Signup and view all the answers

Opioid drugs can cause __________, which is marked by reduced respiratory function.

<p>respiratory depression</p> Signup and view all the answers

Match the intravenous anesthetics with their main side effects:

<p>Thiopentone = CVS collapse and respiratory depression Etomidate = Adrenocortical suppression Propofol = Excitation and respiratory depression Ketamine = Psychotomimetic effects</p> Signup and view all the answers

What is a potential complication of general anesthesia during its use?

<p>All of the above (D)</p> Signup and view all the answers

Involuntary movements are stimulated by benzodiazepines.

<p>False (B)</p> Signup and view all the answers

What major physiological response does ketamine induce that differs from traditional anesthetics?

<p>bronchodilation</p> Signup and view all the answers

The average dose of ketamine for IV administration is __________ mg/kg.

<p>1.5</p> Signup and view all the answers

Which stage of surgical anesthesia ends with the loss of corneal and laryngeal reflexes?

<p>Stage III (Surgical Anesthesia) (D)</p> Signup and view all the answers

Stage I of surgical anesthesia involves the loss of pain sensation while the patient remains conscious.

<p>True (A)</p> Signup and view all the answers

What is the main characteristic of Stage IV anesthesia?

<p>Medullary/Respiratory Paralysis</p> Signup and view all the answers

Inhalation anesthetics are primarily halogenated hydrocarbons that end with the suffix '______.'

<p>flurane</p> Signup and view all the answers

Match the following inhalation anesthetics with their solubility (Blood: gas partition coefficient):

<p>Methoxyflurane = Slow Sevoflurane = Rapid Nitrous Oxide = Rapid Halothane = Slow</p> Signup and view all the answers

Which of the following is a dissociative anesthetic?

<p>Ketamine (D)</p> Signup and view all the answers

Nitrous Oxide is considered a potent anesthetic.

<p>False (B)</p> Signup and view all the answers

Name one potential adverse effect of Nitrous Oxide.

<p>Diffusion hypoxia</p> Signup and view all the answers

Halothane is metabolized to toxic metabolites, which may cause _______ toxicity.

<p>hepatotoxic</p> Signup and view all the answers

Match the anesthetic agents with their primary effect:

<p>Isoflurane = Stable compound with low biotransformation Enflurane = Renal toxicity from fluoride ions Halothane = Cardiac arrhythmias due to vagomimetic action Sevoflurane = Rapid induction and recovery</p> Signup and view all the answers

What is the induction time characteristic of Sevoflurane?

<p>Rapid (A)</p> Signup and view all the answers

All inhalation anesthetics are considered non-inflammable.

<p>False (B)</p> Signup and view all the answers

List one contraindication for using Nitrous Oxide.

<p>Pregnancy</p> Signup and view all the answers

The rapid elimination of anesthetics occurs primarily during the ______ phase.

<p>recovery</p> Signup and view all the answers

Which of the following stages involves pupil dilation and loss of light reflex?

<p>Stage III (B)</p> Signup and view all the answers

Enflurane is less potent than Halothane but provides better muscle relaxation.

<p>True (A)</p> Signup and view all the answers

Flashcards

What is Anaesthesia?

A state of comfort and inactivity achieved through medications, allowing for painless surgery within safe physiological limits.

What is General Anesthesia (GA)?

A type of anesthesia that affects the entire body, causing unconsciousness and pain relief.

What is Local Anesthesia (LA)?

A type of anesthesia that only affects a specific area, numbing it and preventing pain signals.

What are General Anesthetics?

Drugs used to induce or maintain general anesthesia, allowing for surgery without pain or awareness.

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What is Stage 1 of General Anesthesia: Analgesia?

The first stage of general anesthesia, marked by pain relief without loss of consciousness.

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What is Stage 2 of General Anesthesia: Delirium and Excitement?

The second stage of general anesthesia, characterized by delirium, excitement, and irregular breathing.

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What is Stage 3 of General Anesthesia: Surgical Anesthesia?

The third stage of general anesthesia, marked by surgical anesthesia, where the patient is unconscious and relaxed, allowing for surgery.

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What is Stage 4 of General Anesthesia: Medullary Depression?

The final stage of general anesthesia, characterized by respiratory failure and cardiac arrest.

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What is preanesthetic medication?

Drugs given before anesthesia to make it smoother and safer. They relieve anxiety, induce amnesia, and enhance the effects of general anesthesia.

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What is Induction of anesthesia?

A phase of general anesthesia where the patient transitions from consciousness to unconsciousness. Drugs like thiopental or propofol are used.

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What are the phases of general anesthesia?

The phase of general anesthesia where anesthesia is maintained to keep the patient unconscious and pain-free during surgery.

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What is Postanesthetic Care?

Drugs given to reduce nausea, vomiting, and pain after surgery.

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What are preanesthetic medications used for?

Drugs used before anesthesia to reduce anxiety and apprehension.

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Stage III (Surgical Anesthesia)

Stage of surgical anesthesia that starts with regular breathing and ends with the cessation of spontaneous breathing. Divided into 4 planes with increasing depth of anesthesia.

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Stage I (Analgesia)

The patient is conscious and conversational. They experience loss of pain sensation.

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Stage IV (Coma and Death)

Stage of surgical anesthesia where the patient's breathing stops, circulation fails, and death may occur. Characterized by widely dilated pupils, flabby muscles, imperceptible pulse, and very low blood pressure.

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Nitrous Oxide (N2O)

A colorless, odorless gas with a sweet taste. It is a weak anesthetic but a potent analgesic. It has rapid induction and recovery, but not a good muscle relaxant.

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Halothane

A potent anesthetic with slow induction and recovery. It is a weak analgesic and muscle relaxant. It is metabolized to toxic metabolites (trifluroethanol) which can cause hepatotoxicity.

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Enflurane

Less potent than halothane, with better muscle relaxation and analgesic properties. It is metabolized to fluoride ion which can cause renal toxicity.

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Isoflurane

A volatile liquid with a pungent odor, used for both induction and maintenance of anesthesia. It has a rapid induction and recovery, and it is less potent than halothane. It is metabolized to toxic metabolites causing hepatotoxicity.

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Induction

The time taken from administration of the anesthetic to the onset of effective surgical anesthesia.

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Maintenance

The time during which the patient is anesthetized and surgery can be performed.

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Recovery

The time from discontinuation of the anesthetic drug until the patient regains consciousness.

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Blood Solubility

The higher the solubility, the slower the induction and recovery. It is inversely related to the induction rate.

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Inhalation Anesthetics

Drugs that are inhaled to induce general anesthesia. They are usually halogenated hydrocarbons ending in the suffix 'flurane.'

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Intravenous Anesthetics

A substance that is administered intravenously to induce general anesthesia.

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General Anesthetics

Includes various drugs and their properties, which are classified under different categories based on their actions and mechanisms.

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Diazepam's effects (conscious sedation)

Diazepam is a benzodiazepine used for conscious sedation, its effects are short-lived due to redistribution, while amnesia and sedation last longer.

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Benzodiazepine effectiveness in conscious sedation

Benzodiazepines are effective drugs for conscious sedation but are weak analgesics, requiring an opioid or N2O for pain relief during procedures.

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Benzodiazepines' effect on muscle tone

Benzodiazepines primarily decrease muscle tone through a central action, but require neuromuscular blocking drugs for surgical-level relaxation.

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Ketamine's mechanism of action

Ketamine's mechanism of action involves blocking NMDA-type glutamate receptors, leading to a dissociative state with sedation, immobility, analgesia, and amnesia, but not loss of consciousness.

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Ketamine's effects: Dissociative state

Ketamine induces a dissociative state characterized by sedation, immobility, analgesia, and anterograde amnesia, with a strong feeling of detachment from the environment, but no actual loss of consciousness.

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Ketamine's dissociative state duration

Ketamine's dissociative state typically lasts 10-15 minutes due to rapid redistribution, but full recovery often takes several hours.

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Ketamine: Analgesic effects

Ketamine has notable analgesic effects, providing pain relief.

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Ketamine's effects on respiration

Ketamine's effects on respiration include well-maintained breathing, retained pharyngeal and laryngeal reflexes, and bronchodilation.

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Ketamine's effects on cardiovascular system

Ketamine's effects on cardiovascular system include increased heart rate, cardiac output, and blood pressure due to sympathetic stimulation.

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Ketamine's emergence delirium

Ketamine's emergence delirium involves hallucinations and involuntary movements, which occur in about half of patients during recovery.

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Fentanyl's characteristics and uses

Fentanyl is a short-acting, potent opioid analgesic used for pain relief during procedures and often supplemented with other anesthetic agents.

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Opioid analgesics: Fentanyl family

Fentanyl, Alfentanil, Sufentanil, and Remifentanil are opioid analgesics that share the characteristics of rapid onset, short duration of action, and potent analgesia.

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Fentanyl's main side effects

Fentanyl commonly causes respiratory depression, which can be countered with naloxone. It also decreases heart rate due to vagus nerve stimulation.

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Fentanyl's typical side effects during recovery

Patients may experience nausea, vomiting, or itching during recovery from fentanyl. It is important to monitor for these issues.

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Methoxyflurane

A potent anesthetic that is non-irritating. It has weak analgesic properties and can be used in children. However, it can cause slow induction and recovery, sensitization of the heart to catecholamines, hepatotoxicity, and malignant hyperthermia.

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Sevoflurane

A potent analgesic that is a weak anesthetic. It has minimal cardiovascular adverse effects, but is contraindicated in pregnancy.

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Nitrous Oxide

An anesthetic gas used as an adjunct in general anesthesia. It is a weak anesthetic, but has analgesic effects. It can cause diffusion hypoxia, nausea and vomiting, and inactivation of B12, leading to megaloblastic anemia and congenital anomalies. It is also associated with slow induction and recovery.

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Thiopentone

A barbiturate that is a commonly used inducing agent. It is highly soluble in water and is prepared freshly before injection. It is used as an ultra-short acting barbiturate and acts by enhancing GABA-mediated transmission by prolonging the opening of Cl- channels, facilitating GABA action.

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Thiopental

A commonly used anesthetic drug that causes unconsciousness in 15-20 seconds. It is a poor analgesic and painful procedures should not be carried out under its influence. However, it has the advantage of not irritating air passages.

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Propofol

An anesthetic drug that has risen to the top for both induction and maintenance of anesthesia, providing rapid onset of action. Its effects are transient due to rapid metabolism and distribution. It is a highly effective anesthetic, but is associated with pain on injection.

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Propofol

A drug that has replaced thiopentone as the leading choice for induction and maintenance of anesthesia, with a rapid onset of action. It is known for its low incidence of postoperative nausea and vomiting and good patient acceptability. It has minimal airway irritancy and is preferred for asthmatics.

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Benzodiazepines

A type of anesthetic drug that enhances GABA-mediated transmission, increasing the frequency of opening of Cl- channels and facilitating GABA action. They are commonly used for induction and maintenance of anesthesia.

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Benzodiazepines (e.g. diazepam, lorazepam, midazolam)

Anesthetic drugs that belong to the benzodiazepine class, frequently used for inducing, maintaining, and supplementing anesthesia, as well as for conscious sedation. (e.g. diazepam, lorazepam, midazolam).

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Fast Acting IV Drugs

They are drugs that, when administered intravenously, result in rapid loss of consciousness within one arm-brain circulation time (approximately 11 seconds).

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Fast Acting IV Drugs

These drugs are generally used for induction because of their rapid onset of action.

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Maintenance Anesthetics

These drugs are used for maintaining anesthesia once it has been induced. They work by keeping the patient unconscious and preventing pain signals from reaching the brain.

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Study Notes

General Anesthetic Agents

  • Definition of Anesthesia: A reversible condition of comfort and inactivity for a patient before, during, and after a surgical procedure, within physiological limits.

  • Types of Anesthesia:

    • General anesthesia: Used for surgical procedures to render the patient unaware of painful stimuli.
    • Local anesthesia: Involves reversible inhibition of nerve impulse generation and propagation to allow for painful procedures like surgery or dentistry.

General Anesthesia

  • General Anesthetics: Drugs that produce reversible loss of sensation and consciousness, mainly given via inhalation or intravenously.
  • Administration: Usually by an anesthesiologist to induce and maintain anesthesia during surgery.

Cardinal Features of General Anesthesia

  • Loss of all sensation, especially pain.
  • Sleep (unconsciousness) and amnesia.
  • Immobility and muscle relaxation.
  • Abolition of somatic and autonomic reflexes.

Stages of General Anesthesia

  • Stage 1 (Analgesia):

    • Loss of pain sensation, patient conscious and conversational.
    • Difficult to maintain for extended periods.
    • Used only for short procedures.

  • Stage 2 (Delirium and Excitement):

    • Loss of consciousness to regular respiration.
    • Patient may shout, struggle, hold breath, increased muscle tone.
    • Irregular respiration, vomiting, micturition, defecation possible.
    • Usually avoided with modern anesthesia techniques.

  • Stage 3 (Surgical Anesthesia):

    • From regular respiration to cessation of spontaneous breathing.
    • Divided into 4 planes based on eye movement, corneal/laryngeal reflexes, and pupil dilation.
      • Plane 1: Roving eyeballs, ending when eyes become fixed.
      • Plane 2: Loss of corneal and laryngeal reflexes.
      • Plane 3: Pupil dilation, loss of light reflex.
      • Plane 4: Intercostal paralysis, shallow abdominal respiration, dilated pupil.

  • Stage 4 (Medullary/Respiratory Paralysis):

    • Cessation of breathing, circulatory failure, and death.
    • Pupils widely dilated, muscles flabby, imperceptible pulse, very low blood pressure.

Classification of General Anesthetics

  • Inhalation Anesthetics:

    • Gases: Nitrous oxide.
    • Volatile liquids: Ether, Halothane, Enflurane, Isoflurane, Desflurane, Sevoflurane.

  • Intravenous Anesthetics:

    • Inducing agents: Thiopentone, Methohexitone sodium, propofol, etomidate.
    • Benzodiazepines: Diazepam, Lorazepam, Midazolam.
    • Dissociative anesthetic: Ketamine.
    • Neurolept analgesia: Fentanyl.

Inhalation Anesthetics - Pharmacokinetics

  • Induction: Time from administration to surgical anesthesia.
  • Maintenance: Time patient is anesthetized.
  • Recovery: Time from discontinuation to regaining consciousness.
  • Factors affecting induction/recovery:
    • Inspired anesthetic concentration.
    • Ventilation rate/depth.
    • Blood solubility (Blood: gas partition coefficient).
  • Solubility and speed table (blood: gas partition coefficient):
    • Methoxyflurane: high solubility; slow induction/recovery.
    • Halothane: medium solubility; medium induction/recovery.
    • Enflurane: medium solubility; medium induction/recovery.
    • Isoflurane: medium solubility; medium induction/recovery.
    • Sevoflurane: low solubility; rapid induction/recovery.
    • Desflurane: very low solubility; rapid induction/recovery.
    • Nitrous Oxide: very low solubility; rapid induction/recovery.

Nitrous Oxide (Nâ‚‚O)

  • Properties: Colorless, odorless, sweet taste, weak anesthetic, rapid induction/recovery.
  • Uses: Outpatient procedures, balanced anesthesia, neurolept analgesia, delivery.
  • Contraindications: Pregnancy, pernicious anemia, immunosuppression.
  • Adverse Effects: Diffusion hypoxia, nausea/vomiting, B12 inactivation (anemia), bone marrow depression (leukopenia), abortion/congenital anomalies.

Halothane

  • Properties: Potent anesthetic, slow induction/recovery. Weak analgesic, weak muscle relaxant. Fluorinated volatile liquid.
  • Metabolism: Metabolized to potentially hepatotoxic metabolites (trifluoroethanol).
  • Adverse Effects: Hepatotoxicity (repeated use), malignant hyperthermia, cardiac arrhythmias, CVS depression (hypotension, bradycardia).

Enflurane

  • Properties: Less potent than halothane, better muscle relaxation and analgesia. Metabolized to fluoride, which can cause renal toxicity.
  • Adverse Effects: Pungent odor, potential CNS stimulation (seizures), can depress myocardial function, sensitization of heart to adrenaline.

Isoflurane

  • Properties: Similar to enflurane, but slightly more potent, rapid induction/recovery, low biotransformation. No nephrotoxicity or hepatotoxicity. Good analgesic properties.
  • Adverse Effects: Pungent odor

Intravenous Anesthetics

  • Fast-acting: Thiopentone, propofol, etomidate.
  • Slow-acting: Benzodiazepines(diazepam, lorazepam, midazolam), ketamine, fentanyl.

Thiopentone

  • Mechanism: Enhances GABA-mediated transmission.
  • Effects: Rapid loss of consciousness, returns quickly due redistribution; poor analgesic, weak muscle relaxant.
  • Adverse Effects: Respiratory depression, hypotension, tachycardia (reflex), laryngospasm, shivering/delirium. Contraindicated in acute intermittent porphyria.

Propofol

  • Properties: Oily liquid emulsion, used for induction and maintenance. Rapid distribution/elimination.
  • Effects: Rapid loss of consciousness, lacks airway irritancy.
  • Adverse Effects: CVS and respiratory depression, excitatory effects, induction apnea, pain at injection site.

Benzodiazepines (BZDs)

  • Mechanism: Enhance GABA-mediated transmission.
  • Effects: Sedation, amnesia, and unconsciousness; slower action than propofol, prolonged recovery. Poor analgesic properties.
  • Uses: Induction/maintenance/supplemental anesthesia, conscious sedation.
  • Reversal: Flumazenil.

Ketamine

  • Mechanism: Blocks NMDA-type glutamate receptors.
  • Effects: Dissociative anesthesia (sedation, immobility, analgesia, amnesia), rapid action.
  • Adverse Effects: Psychotomimetic effects (hallucinations/delirium) during recovery, rapid metabolism, elevated heart rate, cardiac output, blood pressure.

Opioids (Fentanyl, Alfentanil, Sufentanil, Remifentanil)

  • Properties: Rapid onset and short duration of action, potent analgesics. Neurolept analgesia or anesthesia(with other drugs).
  • Effects: Analgesia, drowsiness, consciousness maintained.
  • Adverse Effects: Respiratory depression, hypotension, nausea/vomiting.

Complications of General Anesthesia

  • During: respiratory depression/hypercarbia, salivation/respiratory secretions, cardiac arrhythmias/asystole, hypotension, aspiration, laryngospasm/asphyxia, awareness during surgery.
  • After: nausea/vomiting, persisting sedation, pneumonia/atelectasis, organ toxicity, nerve palsies, emergence delirium, cognitive defects.

Preanesthetic Medications

  • Aims: Reduce anxiety, provide amnesia, enhance analgesia, decrease secretions/vagal stimulation, antiemetic effect, limit gastric acidity, facilitate induction.
  • Examples: Diazepam, lorazepam, chlorpromazine, haloperidol, atropine, morphine/meperidine.

Modern Balanced General Anesthesia

  • A combination of drugs for different phases.
  • Includes pre-medication, induction, maintenance, and post-anesthesia care.

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Test your knowledge on anesthesia, including preanaesthetic medication, drugs used for induction, and the phases of general anesthesia. This quiz covers essential facts and characteristics related to local and general anesthesia. Perfect for medical students or anyone interested in anesthesia practices.

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