p.3
Benzodiazepines in Anesthesia
What type of amnesia do benzodiazepines produce?
Dose-dependent anterograde amnesia.
p.6
Propofol: Pharmacology and Effects
What is the primary characteristic of Propofol kinetics?
Propofol is redistributed to mucus and fat.
p.31
Minimum Alveolar Concentration (MAC) Concepts
Why is nitrous oxide used in higher doses compared to other anesthetics?
Because it has a higher blood/gas solubility.
p.6
Propofol: Pharmacology and Effects
What does the redistribution of Propofol affect?
It affects its pharmacokinetics and duration of action.
p.31
Minimum Alveolar Concentration (MAC) Concepts
What does low blood/gas solubility indicate in inhalation anesthetics?
It allows for faster induction and recovery.
p.18
Autonomic and Cardiac Pharmacology
How is Ephedrine prepared for administration?
1 mL (50 mg) + 9 mL of NS flush = 50 mg/10 mL = 5 mg/mL.
p.18
Autonomic and Cardiac Pharmacology
What is the mechanism of action (MOA) of Ephedrine?
It acts as a direct ⍺ & β agonist and indirectly causes the release of endogenous catecholamines.
p.25
Minimum Alveolar Concentration (MAC) Concepts
What is the significance of MAC in anesthesia?
It is the concentration of anesthetic required to prevent movement in 50% of patients in response to a surgical stimulus.
p.7
Common Intraoperative Agents
What type of receptor is the GABA A receptor?
A ligand-gated ion channel receptor.
p.28
Minimum Alveolar Concentration (MAC) Concepts
What factors can affect the MAC value?
Age, body temperature, and concurrent medications.
p.28
Minimum Alveolar Concentration (MAC) Concepts
What is the significance of MAC in anesthesia?
It measures the potency of inhalation anesthetics.
p.18
Autonomic and Cardiac Pharmacology
What conditions is Ephedrine utilized for?
Hypotension and bradycardia.
p.7
Common Intraoperative Agents
What is the mechanism of action (MOA) of Propofol?
It acts on the GABA A glycoprotein receptor complex.
p.27
Minimum Alveolar Concentration (MAC) Concepts
What levels of MAC are associated with anterograde amnesia and unconsciousness?
Anterograde amnesia at 0.3 MAC and unconsciousness at 0.5 MAC.
p.29
Inhalation Anesthetics and Their Mechanisms
How is potency related to oil/gas solubility?
Greater oil/gas solubility indicates greater drug potency.
p.32
Pharmacokinetics of Inhalation Agents
What is the significance of the 'racecar' analogy in induction rate?
It illustrates how faster-moving molecules can lead to quicker induction.
p.18
Autonomic and Cardiac Pharmacology
What happens to the effect of subrequent doses of Ephedrine?
They have lost less effect.
p.32
Pharmacokinetics of Inhalation Agents
What is a key factor impacting the induction rate in anesthesia?
The solubility of the anesthetic agent.
p.3
Benzodiazepines in Anesthesia
How do benzodiazepines affect seizure activity?
They increase the threshold to seizure activity.
p.7
Common Intraoperative Agents
Can different binding sites affect the same receptor?
Yes, different binding sites can influence the same receptor.
p.28
Minimum Alveolar Concentration (MAC) Concepts
What does a lower MAC value indicate?
Higher potency of the anesthetic agent.
p.32
Pharmacokinetics of Inhalation Agents
What role does blood flow play in the induction rate of anesthetics?
Increased blood flow to the lungs enhances the induction rate.
p.21
Autonomic and Cardiac Pharmacology
In what conditions is Labetalol utilized?
Hypertension with tachycardia and gestational hypertension.
p.1
Common Intraoperative Agents
What are neuromuscular blockers used for in anesthesia?
To induce muscle relaxation.
p.15
Non-Depolarizing Muscle Relaxants: Rocuronium
What is the RSI dose of Rocuronium?
0.6-1 mg/kg (ideal body weight).
p.30
Pharmacokinetics of Inhalation Agents
What is a common characteristic of inhalation agents regarding solubility?
Inhalation agents vary in their blood-gas solubility, affecting their onset and offset of action.
p.24
Inhalation Anesthetics and Their Mechanisms
What is the effect of hypothermia on CMRO2 and CBF?
Hypothermia decreases both CMRO2 and CBF.
p.20
Autonomic and Cardiac Pharmacology
What is the recommended dose for Esmolol?
500 mcg/kg IV with an infusion of 100-300 mcg/kg/min.
p.33
Pharmacokinetics of Inhalation Agents
What does the term 'V/Q deficits' refer to?
Ventilation/perfusion mismatches that can affect gas exchange.
p.9
Common Intraoperative Agents
How does Propofol affect bronchodilation?
It has minimal bronchodilating effects.
p.13
Depolarizing Muscle Relaxants: Succinylcholine
How does Succinylcholine affect intracranial pressure?
It can increase intracranial pressure by approximately 10 mmHg for 5 minutes.
p.14
Depolarizing Muscle Relaxants: Succinylcholine
What muscle condition is a contraindication for succinylcholine?
Muscle Myopathy/Dystrophy.
p.28
Minimum Alveolar Concentration (MAC) Concepts
What does MAC stand for in anesthesia?
Minimum Alveolar Concentration.
p.18
Autonomic and Cardiac Pharmacology
What is tachyphylaxis in relation to Ephedrine?
It refers to a reduced response to the drug after repeated doses.
p.27
Minimum Alveolar Concentration (MAC) Concepts
What does MAC-awake refer to?
The minimum alveolar concentration that suppresses responsiveness to verbal command in 50% of patients (0.3 MAC).
p.32
Pharmacokinetics of Inhalation Agents
How does the molecular weight of an anesthetic affect induction rate?
Lighter molecules generally have a faster induction rate.
p.7
Common Intraoperative Agents
What effect does the influx of chloride ions have on the cell?
It causes hyperpolarization.
p.30
Inhalation Anesthetics and Their Mechanisms
How do inhalation agents affect the body?
They alter the central nervous system to produce anesthesia.
p.30
Minimum Alveolar Concentration (MAC) Concepts
What is the significance of Minimum Alveolar Concentration (MAC) in inhalation agents?
MAC is the concentration required to prevent movement in 50% of patients in response to a surgical stimulus.
p.12
Depolarizing Muscle Relaxants: Succinylcholine
What are the components formed from the hydrolysis of Succinylcholine?
Succinylmonocholine & Choline.
p.10
Common Intraoperative Agents
Does Propofol cross the placental barrier?
Yes, it crosses the placental barrier.
p.9
Common Intraoperative Agents
What effect does Propofol have on the respiratory center's sensitivity to CO2?
It results in decreased sensitivity of the respiratory center to CO2.
p.19
Autonomic and Cardiac Pharmacology
In what conditions is Vasopressin utilized?
Septic shock, refractory hypotension, and to decrease vasopressor dosage.
p.13
Depolarizing Muscle Relaxants: Succinylcholine
What gastrointestinal effect can Succinylcholine cause?
Increased intragastric pressure.
p.14
Depolarizing Muscle Relaxants: Succinylcholine
What is a contraindication for using succinylcholine related to potassium levels?
Hyperkalemia (>5.5 meq/L).
p.14
Depolarizing Muscle Relaxants: Succinylcholine
What is the age limit for using succinylcholine in children?
Children < 8 years (unless emergent).
p.14
Depolarizing Muscle Relaxants: Succinylcholine
What potassium-related conditions are contraindications for succinylcholine?
Hypo/Hyperkalemic Period.
p.28
Minimum Alveolar Concentration (MAC) Concepts
How is MAC defined?
The concentration of anesthetic in the alveoli that prevents movement in 50% of patients in response to a surgical stimulus.
p.25
Minimum Alveolar Concentration (MAC) Concepts
What does MAC stand for in the context of inhalation anesthetics?
Minimum Alveolar Concentration.
p.25
Minimum Alveolar Concentration (MAC) Concepts
How is MAC used in clinical practice?
It helps determine the potency of inhalation anesthetics.
p.10
Common Intraoperative Agents
What are the mild antiemetic effects of Propofol?
It helps reduce nausea and vomiting.
p.22
Propofol: Pharmacology and Effects
How much Propofol is needed for induction in a patient weighing 80 kg?
2 mg/kg = 160 mg = 16 mL.
p.17
Autonomic and Cardiac Pharmacology
What type of drug is Phenylephrine?
A synthetic catecholamine.
p.23
Inhalation Anesthetics and Their Mechanisms
When should the ventilator be turned on during the intraoperative process?
If necessary, after confirming the airway.
p.23
Inhalation Anesthetics and Their Mechanisms
What is the final step in the intraoperative process?
Reverse as indicated & emerge from anesthesia.
p.33
Pharmacokinetics of Inhalation Agents
What factors can influence the pharmacokinetics of inhalation agents?
Cardiac output, shunting, obesity, and hypothermia.
p.19
Autonomic and Cardiac Pharmacology
What effect does V1 receptor activation have?
Vasoconstriction in vascular smooth muscle.
p.14
Depolarizing Muscle Relaxants: Succinylcholine
What allergic reaction is a contraindication for succinylcholine?
Allergy/Malignant Hyperthermia.
p.31
Minimum Alveolar Concentration (MAC) Concepts
What is the effect of high blood/gas solubility on anesthetic delivery?
It requires a higher dose to achieve the desired effect.
p.18
Autonomic and Cardiac Pharmacology
What type of drug is Ephedrine?
A synthetic noncatecholamine sympathomimetic.
p.21
Autonomic and Cardiac Pharmacology
What is the mechanism of action (MOA) of Labetalol?
Nonselective β-blocker and alpha blocker (7:1 ratio).
p.3
Benzodiazepines in Anesthesia
Is retrograde amnesia reliable with benzodiazepines?
No, retrograde amnesia is unreliable.
p.2
Benzodiazepines in Anesthesia
What effect does Midazolam produce at low doses and how quickly?
Anterograde amnesia within 2-5 minutes.
p.11
Depolarizing Muscle Relaxants: Succinylcholine
What are the typical uses of Succinylcholine?
It is often utilized for quick onset and short duration.
p.30
Inhalation Anesthetics and Their Mechanisms
What is the role of inhalation agents in anesthesia?
They provide rapid induction and recovery, allowing for precise control of anesthesia depth.
p.23
Inhalation Anesthetics and Their Mechanisms
What does the acronym MOST MAIDS stand for in the intraoperative process?
It is a mnemonic for steps in the intraoperative process.
p.23
Inhalation Anesthetics and Their Mechanisms
What is the purpose of positioning in the intraoperative process?
To ensure optimal access and safety during anesthesia.
p.9
Common Intraoperative Agents
What are the primary causes of decreased mean arterial pressure when using Propofol?
Decreased sympathetic tone and vasodilation.
p.9
Common Intraoperative Agents
In what situation can Propofol be used regarding bronchospasms?
It can be used for bronchospasms.
p.13
Depolarizing Muscle Relaxants: Succinylcholine
What cardiovascular effects can Succinylcholine cause?
Dysrhythmias, which may increase or decrease heart rate.
p.14
Depolarizing Muscle Relaxants: Succinylcholine
What type of injury is a contraindication for succinylcholine?
Extensive Muscle Denervation.
p.3
Benzodiazepines in Anesthesia
What are the central nervous system effects of benzodiazepines?
Sedation, anxiolysis, hypnosis, amnesia, and anticonvulsant properties.
p.27
Minimum Alveolar Concentration (MAC) Concepts
What is the purpose of MAC-amnesia?
To suppress recollection or explicit memory in 50% of patients.
p.1
Intraoperative Goals of Anesthesia
What are the intraoperative goals of anesthesia?
Amnesia, analgesia, anesthesia, and muscle relaxation.
p.26
Minimum Alveolar Concentration (MAC) Concepts
What does 1.0 MAC represent?
It represents the dose to produce immobility to noxious stimuli in 50% of patients (ED50).
p.8
Common Intraoperative Agents
What is a key effect of Propofol on consciousness?
It induces a rapid and pleasant loss of consciousness (LOC).
p.26
Minimum Alveolar Concentration (MAC) Concepts
How does the value of MAC vary?
It varies based on patient factors such as age.
p.30
Inhalation Anesthetics and Their Mechanisms
What is a key property of inhalation agents?
They are used to induce and maintain anesthesia during surgical procedures.
p.24
Inhalation Anesthetics and Their Mechanisms
What is the effect of inhalation agents and N2O on cerebrovascular tone?
They decrease cerebrovascular tone.
p.24
Inhalation Anesthetics and Their Mechanisms
How do volatile agents impact CMRO2?
They dose-dependently decrease cerebral metabolic rate (CMRO2).
p.23
Inhalation Anesthetics and Their Mechanisms
What is the purpose of adjusting flow rates during anesthesia?
To maintain appropriate levels of inhalation agents.
p.33
Pharmacokinetics of Inhalation Agents
What is diffusion hypoxia?
A condition that occurs when N2O is rapidly eliminated from the body, leading to a dilution of oxygen in the lungs.
p.33
Pharmacokinetics of Inhalation Agents
How do plastic absorption and liter flow rates affect inhalation agents?
They can influence the delivery and concentration of the agent in the lungs.
p.14
Depolarizing Muscle Relaxants: Succinylcholine
Which muscular condition is a contraindication for succinylcholine?
Duchenne Muscular Dystrophy.
p.14
Depolarizing Muscle Relaxants: Succinylcholine
What weight condition is mentioned in relation to succinylcholine?
LBW (Low Body Weight) only for 150 Kilos.
p.29
Inhalation Anesthetics and Their Mechanisms
What does blood/gas solubility indicate in inhalation anesthetics?
The speed of anesthetic onset and elimination.
p.3
Benzodiazepines in Anesthesia
What happens to CMRO2 and CBF at high doses of benzodiazepines?
High doses decrease CMRO2 and CBF.
p.29
Minimum Alveolar Concentration (MAC) Concepts
What is the relationship between potency and MAC value?
Potency is inversely related to MAC value.
p.11
Depolarizing Muscle Relaxants: Succinylcholine
What enzyme hydrolyzes Succinylcholine?
Plasma cholinesterase, also known as pseudocholinesterase.
p.8
Common Intraoperative Agents
What impact does Propofol have on intracranial pressure (ICP) and intraocular pressure (IOP)?
It decreases both ICP and IOP.
p.12
Depolarizing Muscle Relaxants: Succinylcholine
What is the role of plasma cholinesterase in relation to Succinylcholine?
It hydrolyzes Succinylcholine.
p.24
Inhalation Anesthetics and Their Mechanisms
What is the effect of volatile agents on cerebral blood flow (CBF)?
They dose-dependently increase cerebral blood flow (CBF).
p.33
Pharmacokinetics of Inhalation Agents
Why is the oil/gas partition coefficient important?
It indicates the potency of an inhalation agent and its ability to dissolve in lipids.
p.29
Inhalation Anesthetics and Their Mechanisms
How does greater blood/gas solubility affect anesthetic onset?
It results in slower onset.
p.32
Pharmacokinetics of Inhalation Agents
How does the concentration of the anesthetic affect induction rate?
Higher concentrations lead to faster induction rates.
p.11
Depolarizing Muscle Relaxants: Succinylcholine
What is the only depolarizing muscle relaxant licensed in the U.S.?
Succinylcholine (i.e. Anectine).
p.11
Depolarizing Muscle Relaxants: Succinylcholine
What is the chemical structure of Succinylcholine?
It results from the joining of two ACh molecules, also known as diacetylcholine.
p.8
Common Intraoperative Agents
How does Propofol affect cerebral blood flow?
It decreases cerebral blood flow.
p.10
Common Intraoperative Agents
What anticonvulsant properties does Propofol have?
It can prevent seizures, although myoclonus may occur.
p.4
Benzodiazepines in Anesthesia
What is Flumazenil?
The only benzodiazepine antagonist available in the U.S.
p.8
Common Intraoperative Agents
How does Propofol affect cerebral autoregulation?
It maintains cerebral autoregulation and CO2 responsiveness.
p.24
Inhalation Anesthetics and Their Mechanisms
What is the relationship between cerebral metabolic rate (CMRO2) and cerebral blood flow (CBF)?
CMRO2 and CBF are typically directly related (i.e., coupled).
p.4
Benzodiazepines in Anesthesia
Why might Flumazenil need to be redosed?
Because of its short duration of action.
p.23
Inhalation Anesthetics and Their Mechanisms
What should be done after obtaining and confirming the airway?
Dial preferred inhalation agent & concentration.
p.20
Autonomic and Cardiac Pharmacology
What is the dosing interval for Metoprolol?
2.5-5 mg IV in 5-minute intervals.
p.33
Pharmacokinetics of Inhalation Agents
How does N2O diffusion affect the body?
It can lead to diffusion hypoxia upon discontinuation of the gas.
p.19
Autonomic and Cardiac Pharmacology
What is Vasopressin also known as?
Antidiuretic Hormone (ADH).
p.33
Pharmacokinetics of Inhalation Agents
What role does ventilation play in the pharmacokinetics of inhalation agents?
Ventilation affects the concentration of the agent in the alveoli and subsequently in the blood.
p.13
Depolarizing Muscle Relaxants: Succinylcholine
What is a common adverse effect of Succinylcholine related to potassium levels?
Increases potassium by approximately 0.5-1 mEq/L for 10 minutes.
p.14
Depolarizing Muscle Relaxants: Succinylcholine
What condition related to immobility is a contraindication for succinylcholine?
Prolonged Immobilization.
p.25
Minimum Alveolar Concentration (MAC) Concepts
What factors can affect the MAC value?
Age, body temperature, and concurrent medications.
p.27
Minimum Alveolar Concentration (MAC) Concepts
What does MAC-BAR stand for?
Minimum alveolar concentration that blocks adrenergic response in 50% of patients (1.5-2 MAC).
p.8
Common Intraoperative Agents
What are the dose-dependent effects of Propofol?
Anxiolysis, sedation, and amnesia.
p.10
Common Intraoperative Agents
What antipruritic effects does Propofol exhibit?
It helps alleviate itching.
p.10
Common Intraoperative Agents
What is a side effect of Propofol during injection?
It produces mild to moderate pain on injection.
p.4
Benzodiazepines in Anesthesia
What are possible reactions when administering Flumazenil?
Withdrawal reactions possible if the patient is benzodiazepine dependent.
p.24
Inhalation Anesthetics and Their Mechanisms
What happens to CMRO2 and CBF when N2O is administered?
Both CMRO2 and CBF increase.
p.17
Autonomic and Cardiac Pharmacology
What may occur reflexively due to Phenylephrine administration?
Bradycardia due to baroreceptor reflex.
p.17
Autonomic and Cardiac Pharmacology
What is the utilization of Phenylephrine?
To treat hypotension and increased heart rate.
p.9
Common Intraoperative Agents
What respiratory effect is associated with Propofol?
Dose dependent transient respiratory depression, including apnea.
p.19
Autonomic and Cardiac Pharmacology
Where is Vasopressin stored?
In the posterior pituitary.
p.19
Autonomic and Cardiac Pharmacology
How can Vasopressin be prepared for administration?
1 mL (20 units) + 9 mL NS flush = 20 units/10 mL = 2 units/mL.
p.13
Depolarizing Muscle Relaxants: Succinylcholine
What condition can result from large or repeated dosing of Succinylcholine?
Potential Phase 2 Blockade.
p.12
Depolarizing Muscle Relaxants: Succinylcholine
How is Succinylcholine eliminated from the body?
Hydrolysis via plasma cholinesterase.
p.1
Inhalation Anesthetics and Their Mechanisms
What are inhalation anesthetics used for?
To maintain anesthesia during surgery.
p.20
Autonomic and Cardiac Pharmacology
How is Esmolol metabolized?
By nonspecific plasma RBC esterases.
p.33
Pharmacokinetics of Inhalation Agents
What is the second gas effect?
The phenomenon where the presence of one gas (like N2O) enhances the uptake of another gas.
p.9
Common Intraoperative Agents
What are the secondary causes of cardiovascular effects from Propofol?
Direct cardiac and baroreceptor depression.
p.19
Autonomic and Cardiac Pharmacology
What is the role of V2 receptors?
Control of osmolality and volume in distal tubules and collecting ducts.
p.13
Depolarizing Muscle Relaxants: Succinylcholine
What effect does Succinylcholine have on intraocular pressure?
It can increase intraocular pressure by approximately 10 mmHg for 5 minutes.
p.26
Minimum Alveolar Concentration (MAC) Concepts
What does 1.2 MAC indicate?
It indicates the dose to produce immobility to noxious stimuli in 95% of patients (ED95).
p.2
Benzodiazepines in Anesthesia
What type of effects does Midazolam have when used with fentanyl?
Synergistic CNS, CV, and respiratory effects.
p.26
Minimum Alveolar Concentration (MAC) Concepts
At what age does the MAC value peak?
It peaks at approximately 6 months.
p.1
Common Intraoperative Agents
What is the purpose of autonomic agents in anesthesia?
To manage autonomic responses.
p.23
Inhalation Anesthetics and Their Mechanisms
What are the two types of induction mentioned?
Standard and rapid sequence.
p.19
Autonomic and Cardiac Pharmacology
What is the function of V3 receptors?
Regulation of body temperature in the pituitary gland.
p.11
Depolarizing Muscle Relaxants: Succinylcholine
How does Succinylcholine mimic acetylcholine?
It mimics ACh and causes depolarization.
p.26
Minimum Alveolar Concentration (MAC) Concepts
What happens to MAC values as age increases?
MAC values decrease with increasing age.
p.10
Common Intraoperative Agents
What is a common psychological effect when patients emerge from Propofol sedation?
Patients often experience mild euphoria.
p.4
Benzodiazepines in Anesthesia
What is the initial dose of Flumazenil?
0.2 mg IV every 30 seconds to a maximum of 3 mg.
p.10
Common Intraoperative Agents
What is a potential side effect of Propofol related to muscle activity?
Twitching or myoclonus may occur.
p.33
Pharmacokinetics of Inhalation Agents
What is the significance of blood/gas partition coefficient in inhalation agents?
It determines the rate at which an inhalation agent is absorbed into the bloodstream.
p.9
Common Intraoperative Agents
What is a primary cardiovascular effect of Propofol?
Dose dependent decrease in mean arterial pressure.
p.19
Autonomic and Cardiac Pharmacology
What is another method to prepare Vasopressin?
1 mL (20 units) + 20 mL syringe with 19 mL NS = 20 units/20 mL = 1 unit/mL.
p.14
Depolarizing Muscle Relaxants: Succinylcholine
Why should succinylcholine be avoided in burn patients?
If they are more than 24 hours post-injury.
