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Mod 19 Flashcards

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1
Q

is the art and science of administration of anesthesia

A

Anesthesiology

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2
Q

is the production of reversible loss of sensibility and in some cases consciousness

A

Anesthesia

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3
Q

Objectives of GENERAL ANESTHETICS

A

To minimize or eliminate pain

Relax muscle and facilitate patient restraint during surgical, obstetrical and other medical, diagnostic and therapeutic procedures

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4
Q

What is Balanced Anesthesia

A

It is the used of multiple drugs in low dosage to take advantage of desirable features of selected drugs while minimizing the potential for harmful depression of homeostatic mechanism

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5
Q

It is the used of multiple drugs in low dosage to take advantage of desirable features of selected drugs while minimizing the potential for harmful depression of homeostatic mechanism

A

Balanced Anesthesia

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6
Q

Components of Balance Anesthesia

A

Sensory blocking
Motor blocking
Mental blocking
Reflex blocking

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7
Q

loss of sensitivity to pain (analgesia)

A

Sensory blocking – loss of sensitivity to pain (analgesia) • Example of agen

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8
Q

Sensory blocking
Example

A

Nitrous oxide, Morphine, Meperidine, Fentanyl, Xylazine, Enflurane , Ketamine

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9
Q

muscle relaxation diminish motor response to noxious stimulation

A

Motor blocking-

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10
Q

Motor blocking
Example

A

relaxation – Xylazine

Slight relaxation – Ethyl chloride

Medium – Chloral hydrate, Isoflurane, Enflurane, Halothane, Barbiturate

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11
Q

Components of Balance Anesthesia

A

Mental blocking
Reflex blocking

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12
Q

loss of awareness (unconsciousness) and no recall of events at the conscious level (amnesia)

A

Mental blocking

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13
Q

Mental blocking
Example

A

Ataraxia – Phenothiazine derivatives; Ketamine

Light sleep – Fentanyl-droperidol

Delirium – all that produces deep sleep

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14
Q

minimize autonomic nervous system response to noxious stimuli

A

Reflex blocking

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15
Q

Reflex blocking
Example

A

Blocking undesirable reflexes – Atropine
Respiratory circulatory and digestive reflexes - Barbiturate

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16
Q

Components of Balance Anesthesia

A

Sensory blocking – loss of sensitivity to pain (analgesia) • Example of agents: Nitrous oxide, Morphine, Meperidine, Fentanyl, Xylazine, Enflurane , Ketamine

Motor blocking- muscle relaxation diminish motor response to noxious stimulation.• relaxation – Xylazine• Slight relaxation – Ethyl chloride• Medium – Chloral hydrate, Isoflurane, Enflurane, Halothane, Barbiturate Anesthesia

Mental blocking – loss of awareness (unconsciousness) and no recall of events at the conscious level (amnesia) • Ataraxia – Phenothiazine derivatives; Ketamine• Light sleep – Fentanyl-droperidol• Delirium – all that produces deep sleep

Reflex blocking – minimize autonomic nervous system response to noxious stimuli• Blocking undesirable reflexes – Atropine • Respiratory circulatory and digestive reflexes - Barbiturate

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17
Q

STAGES OF ANESTHESIA

A

Stage I: Induction or Stage of Voluntary Excitement
Stage II: Stage of Involuntary Excitement
Stage III: Surgical Anesthesia Plane 1 Plane 2 Plane 3
Stage IV: Overdose

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18
Q

Explain
Stage I: Induction or Stage of Voluntary Excitement

A

Consciousness still present
• Forcible efforts to avoid being anesthetized
• Breath-holding, but may not be observed in all cases
• Fear and apprehension leading to increased respiratory rate and pulse rate
• Pupillary dilatation (mydriasis)
Urination and defecation

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19
Q

Explain
Stage II: Stage of Involuntary Excitement

A

Loss of consciousness
• Reflex response to stimuli such as exaggerated limb movement may become violent necessitating restraint
• Pronounced vocalization
• Unpredictable degree of violence which bears no relationship with the normal temperament of the animal, some may pass quietly through this stage
• Irregular respiration; sometimes breath holding
• Persistent pharyngeal reflex which becomes progressively depressed

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20
Q

Explain
Stage III: Surgical Anesthesia Plane 1

A

Irregular automatic breathing
• Limb movement stops
• Side to side movement of the eyeballs
• Disappearance of palpebral, conjunctival and corneal reflexes
• Brisk pedal reflex may still be present
• May be adequate for minor surgery

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21
Q

Explain
Stage III: Surgical Anesthesia Plane 2

A

Laryngeal reflex persist until the middle of plane 2
Eyeballs fixed in the center in the horse, cats, sheep and pigs, downward in dogs
• Pedal reflex becomes sluggish
• Progressive muscle relaxation
• Adequate for all surgical procedure except abdominal surgery

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22
Q

Explain
Stage III: Surgical Anesthesia Plane 3

A

Breathing still automatic but the respiratory rate increases while the depth decreases
Noticeable pause between inspiration and expiration

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23
Q

Explain
Stage IV: Overdose

A

Complete paralysis of the thoracic muscles, only the diaphragm functions
Jerky diaphragmatic movement
Respiratory movement gasping in nature
Wide papillary dilatation

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24
Q

Which stage of anesthesia

Consciousness still present • Forcible efforts to avoid being anesthetized • Breath-holding, but may not be observed in all cases • Fear and apprehension leading to increased respiratory rate and pulse rate • Pupillary dilatation (mydriasis) • Urination and defecation

A

Stage I: Induction or Stage of Voluntary Excitement

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25
Which stage of anesthesia Loss of consciousness • Reflex response to stimuli such as exaggerated limb movement may become violent necessitating restraint • Pronounced vocalization • Unpredictable degree of violence which bears no relationship with the normal temperament of the animal, some may pass quietly through this stage • Irregular respiration; sometimes breath holding • Persistent pharyngeal reflex which becomes progressively depressed
Stage II: Stage of Involuntary Excitement
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Which stage of anesthesia Irregular automatic breathing • Limb movement stops • Side to side movement of the eyeballs• Disappearance of palpebral, conjunctival and corneal reflexes • Brisk pedal reflex may still be present • May be adequate for minor surgery
Stage III: Surgical Anesthesia Plane 1
27
Which stage of anesthesia Laryngeal reflex persist until the middle of plane 2• Eyeballs fixed in the center in the horse, cats, sheep and pigs, downward in dogs • Pedal reflex becomes sluggish • Progressive muscle relaxation • Adequate for all surgical procedure except abdominal surgery
Plane 2
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Which stage of anesthesia Breathing still automatic but the respiratory rate increases while the depth decreases •Noticeable pause between inspiration and expiration
Plane 3
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Which stage of anesthesia Complete paralysis of the thoracic muscles, only the diaphragm functions • Jerky diaphragmatic movement • Respiratory movement gasping in nature d. Wide papillary dilatation
Stage IV: Overdose
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Stages of anesthesia is best recognized when anesthesia in induced by a relatively slow-acting drugs such as
diethyl ether
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These substances do not induce stage III.
ketamine, nitrous oxide, and enflurane
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Useful Signs in Assessing Anesthetic Depth
Cardiovascular system : heart rate, arterial blood pressure, color of mucus membrane, capillary refill time Respiratory system: rate, ventilatory volumes, character of breathing, PCO2 Eye: position and movement, Pupil size and response to light, palpebral reflex, corneal reflex Muscle: jaw and limb tone, presence or absence of gross movement, shivering or trembling Others: body temperature, swallowing, coughing, vocalization, urine flow, salivation
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PRE-ANESTHETIC MEDICATION Objectives
Mitigate fear and apprehension Minimize salivation that may cause aspiration pneumonia (induce by cholinergic blocking agents) Reduce pain and discomfort specially during stages I an II Improve the response to and recovery from general anesthesia.
34
Pre-anesthetic agents
Tranquilizers – acepromazine, promazine •Analgesics – morphine, meperidine •Anesthetics - Xylazine, ketamine •Anticholinergic – atropine
35
Injectable Anesthetics• Examples
thiopental, alphaxolone, propofol, etomidate, ketamine, tiletamine-zolazepam, methohexital, pentobarbital
36
belong to the barbituric acid group, which are classified according to either duration of action of chemical substitution on the parent molecule.
Thiopental, methohexital and pentobarbital
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ulta-short-acting agents
Thiopental and methohexital a
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classified as a short-acting barbiturate
Pentobarbital
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are dissociative anesthetic agents
Ketamine and tiletamine
40
steroidal anesthetic
Alphaxolene
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alkylphenol
propofol
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imidazole anesthetic agent
etomidate
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given for induction before gaseous anesthesia; • may be administered as sole agent for short procedures that are minimally painful.
THIOPENTAL
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If an inadequate dose of thiopental is given to an unsedated or poorly sedated animal which of the following is the effect Dilation Constriction hyperalgia Hypertension
Hypertension
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If an inadequate dose is given to an unsedated or poorly sedated animal there is excitement, hypertonous and hyperalgia may be seen
THIOPENTAL
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Mechanism of action THIOPENTAL
Enhances GABA-mediated inhibition of synaptic transmission by opening membrane chloride channels, causes cellular hyperpolarization
47
Adverse effects: THIOPENTAL
CNS: decrease in cerebral oxygen requirement, cerebral blood flow and intracranial pressure. Cardiovascular: reduced blood pressure, ventricular dysrhythmias Respiratory: dose-dependent respiratory depression Liver: hepatic dysfunction Kidneys: impaired renal function depress neonates during cesarean section
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induction before gaseous anesthesia; • sole agent for short procedures that are minimally painful
METHOHEXITAL
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METHOHEXITAL Mechanism of action:
Enhances GABAmediated inhibition of synaptic transmission by opening membrane chloride channels, causes cellular hyperpolarization
50
Adverse effects: METHOHEXITAL
CNS: Can produce excitatory CNS effects and seizures havebeen reported; not to be administered to patients with epilepsyand those undergoing myelography. Respiratory: transient dose-dependent respiratory depression
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• sole agent for procedures • struggling may be seen at early stages of anesthesia • Inadequate dose may cause hyperesthesia
PENTOBARBITAL
52
PENTOBARBITALMechanism of action
Enhances GABA-mediated inhibition of synaptic transmission by opening membrane chloride channels, causes cellular hyperpolarization.
53
PENTOBARBITAL Adverse effects:
CNS: dose-dependent CNS depression Cardiovascular: increased heart rate, decrease stroke volume;transient fall in cardiac output and arterial blood pressure;perivascular injection may occasionally cause local irritationand necrosis. Respiratory: respiratory depression Other: As anesthesia deepens, the pupil constricts rather thandilates and in dangerously deep anesthesia the pupil is tiny
54
Contraindications for injectable anesthetics
Cesarean section Brachycephalic breeds Uremic patients Any patient in which prolonged anesthesia or recoveryis contraindicated
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may be administered as the sole agent for short-term anesthesia in cats. Contraindicated in dogs because of severe histamine release.
ALPHAXOLONE
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Induction is rapid and smooth retching and vomiting if the induction dose is too slow. Facial and peripheral muscle twitching may occur followed by relaxation. There is rapid return to consciousness
ALPHAXOLONE
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ALPHAXOLONE Mode of action
Believed to be via binding to or near the GABA receptor and enhancing chloride conductance; may stimulate chloride channels independently.
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Adverse effects: ALPHAXOLONE
CNS: cerebral depression is similar to thiopental Cardiovascular:decrease in arterial blood pressure.Most cardiovascular effect is due to vehicle rather thanthe active ingredients Respiratory: Minimal respiratory depression.
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Contraindications of ALPHAXOLONE
hypotension, cardiac disease.
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PROPOFOLClinical applications:
• A very short-acting for induction before inhalational anesthesia or as the sole agent for short procedures Induction of anesthesia is rapid and generally smooth It produces a rapid emergence from anesthesia fetal depression is minimal
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PROPOFOL Mechanism of action:
GABA receptor binding to a different site from thiopental but resulting in the same opening of the chloride channels, causing cellular hyperpolarization
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ETOMIDATEClinical applications:
• sole agent for non-painful procedures induction prior to gaseous anesthesia with rapid induction unconsciousness Fetal transfer is poor
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ETOMIDATE Mechanism of action:
Produces dose-dependent cortical depression; activates GABA receptors to open chloride channels.
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ETOMIDATE Contraindications
Hypoadrenocorticism unsedated or poorly sedated patient Critical patients requiring long-term sedation
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KETAMINE Clinical applications:
for induction before gaseous anesthesia • rarely administered as the sole agent but is usually given in conjunction with xylazine or diazepam. • It does not produce a true anesthetic state but induces dissociation from the environment, amnesia and peripheral analgesia. • Muscle tone is increased • provide greater analgesia for somatic or peripheral pain
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Ketamine Mechanism of action
It appears to cause dissociative state and analgesia by acting as an NMDA (N-methyl-Daspartate) receptor antagonist and sigma agonist. NMDA is an excitatory amino acid mimicking the action of glutamate in the CNS.
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Ketamine Adverse effects:
CNS: ketamine alone raises intracranial pressure, but not when combined with benzodiazepine; hallucinatory behavior, delirium, excitement and purposeless muscle activity. Cardiovascular: Has a direct depressant effect and indirect stimulatory effect Respiratory: respiratory depression Liver: no effect on hepatic function Renal effect: no effect on renal function Skeletal muscle: extreme muscle tone and spontaneous movements Others: hypersalivation; increased bronchial secretion; increased intraocular pressure
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TILETAMINE-ZOLAZEPAM Clinical applications:
administered as the sole agent for short to moderate duration sedation or for induction before gaseous anesthesia Separately, do not have ideal sedative or anesthetic properties together they produce dissociative anesthesia, muscle relaxation and some analgesia.
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halogenated organic substances
hydrocarbon or ethers
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has been shown to increase anesthetic potency while improving stability
halogenation
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quantifying the amount of anesthetic vapor or gas in a mixture:
(a) concentration (volume %) (b) partial pressure (mm Hg) (c) mass (mm or g).
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Pressure of the gas in equilibrium with its liquidm (dissolved) form
tension
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The ratio of gas dissolved in solution to its tension is called
solubility coefficient.
74
As the concentration in the alveoli decreases what happens in the tension in the brain
Decreases
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T or F minimum alveolar concentration (MAC) of the anesthetic must be maintained
T
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Sequence of Flow of Anesthetics
Gas is inhaled Gas is diluted with residual air in the lungs Gas is distributed to the alveoli Alveolar gas equilibrates almost immediately with pulmonary blood Gas dissolved in the blood is distributed throughout the body: into the interstitial fluid and into the brain.
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HALOTHANE• Clinical applications
Halothane is used primarily to maintain anesthesia following induction with an injectable anesthetic.
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How many percent of inspired halothane is exhaled unchanged
75% to 80%
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By what substance is halothane metabolized
By cytochrome P450 in the hepatocytes
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HALOTHANE Adverse effects:
CNS: dose-dependent depression of CNS without significant analgesia Cardiovascular: Reduces cardiac output and blood pressure Respiratory: less respiratory depression Liver: induce mild hepatic damage. Renal: reduce renal blood flow and glomerular filtration rate. Skeletal muscle: the most potent trigger for malignant hyperthermia
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Potentiates the action of non-depolarizing neuromuscular drugs.
drug interactions
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ISOFLURANE Clinical applications
most prevalent inhalation anesthetics It is the inhalation agent of choice in critically ill patients. use in most animals including dogs, cats and horses, certain exotic pets
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ISOFLURANE Adverse effects:
CNS: produces less cerebral vasodilation, while still reducing metabolic oxygen consumption Cardiovascular: does depress myocardial contractility; lower incidence of arrhythmias Respiratory: depresses ventilation to an equal extent than halothane. Liver: hepatic blood flow is better Renal: slight reduction of the renal blood flow and GFR Skeletal muscle: can trigger malignant hyperthermia in susceptible individuals; produces good muscle relaxation.
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DESFLURANE Adverse effects:
CNS: reduces cerebral metabolic rate; increases cerebral blood flow and intracranial pressure. Cardiovascular: increases heart rate and arterial blood pressure; does not sensitize heart to catecholamines Respiratory: dose-dependent respiratory depression Liver and renal: minimal depression of hepatic and renal blood flow.
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Many feature common to desflurane but is more potent and does not cause airway irritation; more suitable for mask induction.
SERVOFLURANE
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SERVOFLURANE Contraindications
raised intracranial pressure; pneumothorax, gastric dilation and volvulus, intestinal obstruction, lung pathology, anemia
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transparent colorless liquid possibility of explosion is great may cause death if liquid is aspirated into the nasal passage
DIETHYL ETHER
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for induction and maintenance of anesthesia specially in small laboratory animals.
DIETHYL ETHER
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DIETHYL ETHER Pharmacological effects:
Nervous effects: Initial excitement; delirium during induction; then; brain depression Cardiac effect: Failure of respiration always precedes cardiac failure Respiratory effects: Irritation to mouth, pharynx, and respiratory tract; Stimulation of salivation; dangerous if saliva is aspirated into the respiratory tract; Coughing and breath holding Cardiosvascular effects: Depression of the cardiovascular system Neuromuscular effects: Relaxes skeletal muscles; Curare-like effect at the neuromuscular junction; Depresses impulse transmission in the spinal cord motor neuron
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It is a heavy sweet smelling liquid• neither inflammable nor explosive
CHLOROFORM
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CHLOROFORM Pharmacological effects
Respiratory effects: Direct and indirect effects; Depressed sensitivity to carbon dioxide; Breath slow and shallow; Respiratory failure may occur during anesthesia. Cardiovascular effects: Effects are complex because the heart, medullary centers and peripheral blood vessels are all affected. Cardiac failure may occur during induction.
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metabolized by cytochrome P450 in the hepatocytes
HALOTHANE
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administered as the sole agent for short to moderate duration sedation or for induction before gaseous anesthesia
TILETAMINE-ZOLAZEPAM
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rarely administered as the sole agent but is usually given in conjunction with xylazine or diazepam
KETAMINE
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inhalation agent of choice in critically ill patients.
ISOFLURANE
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may cause death if liquid is aspirated into the nasal passages.
DIETHYL ETHER
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provide greater analgesia for somatic or peripheral pain
KETAMINE
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• It produces a rapid emergence from anesthesia
PROPOFOL
99
Inadequate doseof pentobarbital may cause
hyperesthesia (increased sensitivity to stimuli)
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