Podcast
Questions and Answers
What is the primary purpose of volatile anesthetics during a surgical procedure?
What is the primary purpose of volatile anesthetics during a surgical procedure?
- To eliminate pain entirely
- To maintain normal blood pressure
- To induce immediate unconsciousness
- To offer good minute-to-minute control over the depth of anesthesia (correct)
Stage II of anesthesia involves a patient experiencing complete loss of consciousness.
Stage II of anesthesia involves a patient experiencing complete loss of consciousness.
False (B)
What role do opioids, such as fentanyl, play during anesthesia?
What role do opioids, such as fentanyl, play during anesthesia?
They are used for pain management in conjunction with inhalation agents.
The stage characterized by severe depression of respiratory and vasomotor centers is Stage ___.
The stage characterized by severe depression of respiratory and vasomotor centers is Stage ___.
Which stage of anesthesia is described as having regular respiration and relaxation of skeletal muscles?
Which stage of anesthesia is described as having regular respiration and relaxation of skeletal muscles?
Recovery from anesthesia typically involves the reverse of induction processes.
Recovery from anesthesia typically involves the reverse of induction processes.
What does MAC stand for in anesthesiology?
What does MAC stand for in anesthesiology?
Match the stages of anesthesia with their characteristics:
Match the stages of anesthesia with their characteristics:
Balanced anesthesia typically includes a mixture of ___ and intravenous agents.
Balanced anesthesia typically includes a mixture of ___ and intravenous agents.
It is acceptable to allow a patient to remain in Stage II during a surgical procedure.
It is acceptable to allow a patient to remain in Stage II during a surgical procedure.
What is a primary reason for using general anesthesia?
What is a primary reason for using general anesthesia?
Halogenated hydrocarbons are used exclusively for intravenous delivery of general anesthetics.
Halogenated hydrocarbons are used exclusively for intravenous delivery of general anesthetics.
Name one category of preanesthetic medication.
Name one category of preanesthetic medication.
The process of administration of anesthetics typically begins with the ______ stage, where the patient is induced into a state of unconsciousness.
The process of administration of anesthetics typically begins with the ______ stage, where the patient is induced into a state of unconsciousness.
Match the following types of anesthetics with their method of delivery:
Match the following types of anesthetics with their method of delivery:
Which of the following is NOT a stage of anesthesia?
Which of the following is NOT a stage of anesthesia?
Muscle relaxants are used to enhance muscle tone during surgery.
Muscle relaxants are used to enhance muscle tone during surgery.
What is a key patient factor to consider before administering anesthetics?
What is a key patient factor to consider before administering anesthetics?
Anesthesia administered via the ______ method involves inhaled volatile agents.
Anesthesia administered via the ______ method involves inhaled volatile agents.
What is the primary purpose of using preanesthetic medications?
What is the primary purpose of using preanesthetic medications?
What is the primary goal of general anesthesia?
What is the primary goal of general anesthesia?
General anesthesia results in the patient being aware of their surroundings during a surgical procedure.
General anesthesia results in the patient being aware of their surroundings during a surgical procedure.
Which receptor do most intravenous anesthetics predominantly act upon?
Which receptor do most intravenous anesthetics predominantly act upon?
General anesthesia is characterized by unconsciousness, analgesia, and __________.
General anesthesia is characterized by unconsciousness, analgesia, and __________.
Match the anesthetic agents with their classifications:
Match the anesthetic agents with their classifications:
What can increased concentrations of enflurane cause?
What can increased concentrations of enflurane cause?
Inhalation anesthetics are used primarily for inducing anesthesia.
Inhalation anesthetics are used primarily for inducing anesthesia.
What is one potential side effect of general anesthesia related to body temperature?
What is one potential side effect of general anesthesia related to body temperature?
General anesthetics can target potassium channels, glycine receptors, and __________ receptors.
General anesthetics can target potassium channels, glycine receptors, and __________ receptors.
Which of the following describes the mechanism of action of inhalational anesthetics?
Which of the following describes the mechanism of action of inhalational anesthetics?
Which inhalation anesthetic is known for having a low blood:gas partition coefficient?
Which inhalation anesthetic is known for having a low blood:gas partition coefficient?
Nitrous Oxide is a volatile anesthetic.
Nitrous Oxide is a volatile anesthetic.
What is the primary characteristic of intravenous anesthetics like Propofol?
What is the primary characteristic of intravenous anesthetics like Propofol?
The risk associated with anesthetics is indicated by their steep dose-response curves and narrow __________.
The risk associated with anesthetics is indicated by their steep dose-response curves and narrow __________.
Match the following intravenous anesthetics with their characteristics:
Match the following intravenous anesthetics with their characteristics:
Which factor does NOT affect the speed of induction for inhalation anesthetics?
Which factor does NOT affect the speed of induction for inhalation anesthetics?
Recovery is faster with anesthetics that have a high blood:gas partition coefficient.
Recovery is faster with anesthetics that have a high blood:gas partition coefficient.
What potential side effect can occur during the induction of anesthesia using Propofol?
What potential side effect can occur during the induction of anesthesia using Propofol?
Desflurane and sevoflurane are examples of __________ anesthetics.
Desflurane and sevoflurane are examples of __________ anesthetics.
Which of the following is a major factor in eliminating inhalation anesthetics?
Which of the following is a major factor in eliminating inhalation anesthetics?
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Study Notes
General Anesthesia
- Reversible state of CNS depression where the patient loses response and perception of external stimuli
- Used for surgical and medical procedures
- Offers benefits such as sedation, reduced anxiety, lack of awareness, amnesia, skeletal muscle relaxation, suppression of undesirable reflexes, and analgesia
- Low therapeutic indices
- Modern anesthetics act more rapidly and achieve deep anesthesia quickly
Stages of Anesthesia
- Induction: period between administering anesthetic and achieving effective surgical anesthesia
- Induction typically starts with IV anesthetic like propofol
- Maintenance: patient is surgically anesthetized and anesthesiologist monitors and adjust anesthetic dose based on vital signs and response to stimuli
- Recovery: involves withdrawing anesthetic mixture and monitoring patient's return to consciousness
Depth of Anesthesia
- Divided into four stages
- Each stage characterized by increased CNS depression
- Stage I: Analgesia, amnesia and reduced awareness of pain
- Stage II: Disinhibition, excitement, patient experiences delirium and possibly violent behavior, avoid this stage
- Stage III: Surgical anesthesia, regular respiration, relaxation of skeletal muscles, eye reflexes decrease progressively until eye movements cease and pupil is fixed
- Stage IV: Medullary depression/paralysis, severe depression of respiratory and vasomotor centers, death can rapidly ensue
Anesthesia Overview
- Three main objectives: minimize deleterious effects of anesthetics, sustain physiologic homeostasis during surgery, improve postoperative outcomes
- Depress the central nervous system
- IV and inhalational administration preferred
Molecular Actions
- Most IV anaesthetics act through GABAA receptor
- NO, Ketamine and Xenon likely to produce unconsciousness via inhibition of NMDA receptor and glutamate receptors
Mechanism of Action
- CNS depressants
- Increase firing threshold of CNS neurons by acting on ion channels and receptor targets
- Increase chlorine conductance and reduce cell firing by facilitating GABA-mediated action at GABAA receptors
- General anaesthetics can also target potassium, glycine, and serotonin receptors
General Effects of Anesthesia
- CNS Effects: decreased vascular resistance and increased cerebral blood flow, can cause increased intracranial pressure
- Hemodynamic Effects: decrease in systemic arterial BP, direct vasodilation, myocardial depression
- Respiratory depression
- Malignant hyperthermia
- Nausea and vomiting
- Postoperative pneumonia
Inhalation Anesthetics
- Mainstay of anesthesia
- Primarily used for maintaining anesthesia after administering an IV agent
- Depth of anesthesia can be rapidly altered by changing the concentration of the drug
- Reversible because most are rapidly eliminated from the body by exhalation
- Steep dose-response curves and narrow therapeutic indices
- Potency roughly proportional to lipid solubility
Current Inhalation Anesthetics
- Nitrous Oxide (a gaseous anesthetic)
- Vapourised liquid halogenated hydrocarbons (halothane, desflurane, enflurane, isoflurane, and sevoflurane)
- Speed of induction dependent on several factors: solubility, inspired gas partial pressure, ventilation rate, pulmonary blood flow, and arteriovenous concentration gradient
- Elimination: inhaled agents redistributed from the brain to the blood, from blood to alveolar air, and eliminated through the lungs
Recovery
- Recovery rate from anesthesia using agents with low blood: gas partition coefficients are faster than anaesthetics with high blood solubility
- Low blood solubility leads to shorter recovery time
Intravenous Anesthetics
- Propofol: produces anesthesia and recovery rapidly, has antiemetic action, commonly used component of balanced anesthesia, can cause marked hypotension during induction
- Barbiturates: Thiopental and methohexital, high lipid solubility, promote rapid entry into the brain, result in surgical anesthesia in one circulation time
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