Anesthesia

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  1. nitrous oxide
    • inhalation agent
    • vaporized @ RT
    • potent
    • low solubility in blood
    • minimally metabolized
    • depth of anesthesia depends on partial pressure in the brain
    • high MAC (104%) - limited as a single agent so used in conjunction with other volatiles
  2. isoflurane, sevoflurane, and desflurane
    • inhalation agent
    • vaporized @ RT
    • potent
    • low solubility in blood
    • minimally metabolized
    • depth of anesthesia depends on partial pressure in the brain
    • isoflurane has highest blood-gas partition coeff, oil-gas partition coeff, and thus highest MAC
  3. propofol
    • induction agent, can be used in procedural sedation
    • 2,6-diisopropylphenol - potentiation of GABAa receptor
    • emulsion containing soybean oil, glycerol, and egg lecithin
    • rapid onset, short duration, less hangover
    • rapid hepatic metabolism (can be used as infusion)
    • adverse effects: hypotension, profound respiratory depressant
  4. thiopental
    • barbiturate, can be used in procedural sedation
    • potentiation of GABAa receptor
    • sulfur atom increases lipid solubility; higher potency, shorter onset and duration
    • rapid onset, short duration
    • long elimination half-life (cannot be used as infusion)
    • adverse effects: hypotension and tachycardia, upper airway obstruction and apnea
    • barbiturates are sometimes used for reducing cerebral oxygen demand or reducing intracranial pressure
  5. etomidate
    • potentiates GABAa receptor, can be used in procedural sedation
    • pain on injection
    • rapid onset, rapid redistribution
    • most CARDIO-STABLE of IV induction agents
    • ventilation less affected than other agents
    • adverse effects: adrenocortical suppression, myoclonus
  6. ketamine
    • NMDA antagonist,┬ácan be used in procedural sedation
    • dissociative anesthesia - sensory impulses dissociated from awareness
    • - patient may appear to be conscious yet unable to process or respond to sensory input
    • mild analgesic, amnestic
    • commonly administered IV or IM
    • central stimulation of sympathetic nervous system
    • beneficial in hypovolemic shock; ventilatory drive is minimally affected
    • adverse effects: hallucinations, disturbing dreams, delirium (can be prevented with benzos)
  7. midazolam
    • benzodiazepine, can be used in procedural sedation
    • potentiates action of GABA at GABAa receptor
    • most commonly used benzodiazepine
    • used as premedication and for procedural sedation
    • produce sedation and amnesia, but potent respiratory depressant
    • antagonized by flumazenil
  8. procaine
    • local anesthetic ester
    • 14-18min onset
    • metabolized rapidly (plasma cholinesterase), less systemic toxicity
  9. bupivacaine
    • local anesthetic amide
    • 5-8min onset
    • metabolized slowly (hepatic carboxyesterase), more likely vs ester to have systemic toxicity
    • higher lipid solubility vs lidocaine = longer duration of action and higher potency, but also increases toxicity
  10. lidocaine
    • local anesthetic amide
    • 2-4 min onset
    • metabolized slowly (hepatic carboxyesterase), more likely vs ester to have systemic toxicity
  11. dexmedetomidine
    ╬▒2 agonist, can be used in procedural sedation

Card Set Information

Author:
jboi
ID:
323426
Filename:
Anesthesia
Updated:
2016-09-21 16:37:35
Tags:
MOHD4 pharmacology
Folders:

Description:
MOHd 55-56
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