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Index
»
PHARMACOLOGY 1
»
CHAPTER 13 general anesthetics
»
Definitions
level: Definitions
Questions and Answers List
level questions: Definitions
Question
Answer
• would induce smooth and rapid loss of consciousness, while allowing for a prompt recovery after its administration is discontinued • wide margin of safety • devoid of adverse effects
Ideal Anesthetic Drug
For minor superficial surgical procedures provide profound analgesia but with retention of the patient's ability to maintain a patent airway and to respond to verbal commands
• Oral or parenteral sedatives in combination with local anesthetics (Monitored Anesthesia Care Techniques)
For more extensive surgical procedures: • Anesthesia includes:
1 preoperative BZD 2 induction of anesthesia with an intravenous anesthetic 3 maintenance of anesthesia with a combination of inhaled & intravenous drug
• Combination of inhaled and intravenous anesthetic drugs • Also includes muscle relaxants, opioid analgesics and local anesthetics
Balanced Anesthesia
Phases of Anesthesia
•Induction •Maintenance •Emergence
derived from the effects of INHALED DIETHYL ETHER, which has a slow onset of central action owing to its high solubility in the blood
Guedel's Signs
• the patient initially experiences analgesia without amnesia • later, both analgesia and amnesia are produced
STAGE OF ANALGESIA
• the patient often appear delirious and may vocalize but is definitely amnesic • respiration is irregular both in volume and rate, retching and vomiting may occur • these effects are limited by rapidly increasing the concentration of the drug
STAGE OF EXCITEMENT
• begins with the recurrence of regular respiration and extends to complete cessation of spontaneous respiration (apnea) • changes in ocular movements, eye reflexes, and pupil size which may represent signs of increasing depth of anesthesia
Stage of Surgical Anesthesia
• includes severe depression of the CNS, including the vasomotor center in the medulla, as well as the respiratory center in the brain stem • without circulatory and respiratory support, death rapidly ensues
IV. STAGE OF MEDULLARY DEPRESSION
reliable indications that stage 3 has been achieved
1 loss of purposeful motor 2 autonomic responses to noxious stimuli 3 reestablishment of a regular respiratory pattern
The concentration of an inhaled anesthetic in a mixture of gases is proportional to its __
partial pressure (or tension)
one of the most important factors influencing the transfer of an anesthetic from the lungs to the arterial blood
SOLUBILITY
useful index of solubility and defines the relative affinity of an anesthetic for the blood compared with that of inspired gas
Blood:Gas Partition Coefficient
Increases in the inspired anesthetic concentration increase the rate of induction of anesthesia by increasing the rate of transfer into the blood according to Fick's Law.
Anesthetic Concentration in the Inspired Air
The rate of rise of anesthetic gas tension in arterial blood is directly dependent on both the rate and depth of ventilation
Pulmonary Ventilation
increases the speed of induction of anesthesia with inhaled anesthetics that would normally have a slow onset.
Hyperventilation
Changes in blood flow to and from the lungs influence transfer processes of the anesthetic gases.
Pulmonary Blood Flow
The anesthetic concentration gradient between arterial and mixed venous blood is dependent mainly on uptake of the anesthetic by the tissues, including nonneural tissues
Arteriovenous Concentration Gradient
the median concentration that results in immobility in 50% of patients when exposed to a noxious stimuli
Minimum Alveolar Concentration (MAC)
the lower the MAC, the more __ the agent
potent