1. PharmacologyJeopardy • Block 2 Part II • Peter O. Beaumont, M.Sc. (Pharm) • St. Vinnie’s Fall 2000

2. Local and General Anaesthesia

3. The Five Goals of General Anaesthesia

4. What are… • Analgesia, amnesia, muscle relaxation, LOC and Loss of somatic & visceral reflexes • The first three are universal, the last two are somewhat secondary

5. The Surgical Stage of Anaesthesia,and the easiest test to determine it

6. What are… • Stage III, and the eyelash reflex test

7. The greatest medical concern in Guedel’s stage II of anaesthesia

8. What is… • Aspiration of vomit • During this stage, delirium and excitement are often accompanied by retching,vomiting and incontinence. • Intubation must unfortunately wait until the patient loses gag reflexes

9. The earliest feature of Guedel’s stage I

10. What is… • analgesia • this is soon accompanied by amnesia, but consciousness is not lost. • Remember, not all anaesthetics show all stages, and further, not all agents are good analgesics e.g. halothane

11. The only true anaesthetic ‘gas’

12. What is… • Nitrous Oxide • The others are all volatile liquids

13. The rate of onset of an excellently soluble anaesthetic

14. What is… • Very slowly • The sooner the point of saturation is reached, the sooner the blood is willing to give up the agent to the brain tissues

15. The rate of onset of anaesthesia in a patient with heart failure

16. What is… • Faster than normal • This is is a tough concept • slowly flowing blood will reach its saturation sooner than fast flowing blood • A greater fraction of the CO goes to the brain in failure

17. Once you stop the flow of Nitrous and oxygen, this may happen to the patient post-op

18. What is… • Diffusion Hypoxia • A high partial pressure of gas coming out of solution dilutes oxygen in the lungs in the post-op patient • Only happens with nitrous oxide, others are used a too low partial pressure

19. When 1/2 your patients do not jump off the table following induction, this point is reached

20. What is… • MAC • By definition… when 50% of patients do not respond to a painful stimulus • highly dependent on degree of stimulation • Elderly and children have lower MAC

21. This prototypic GA has good effect, but high metabolism makes it undesirable these days

22. What is… • Halothane • Release of halogens can cause hepatotoxicity (methoxyflurane does this as well, so it is rarely used)

23. If you use halothane for a D&C, you must also use these two adjuncts

24. What are… • Opiods and oxytocin • Halothane has virtually no analgesic effect • oxytocin causes uterine contraction to counteract the relaxant effect of halothane

25. Were it not for concurrent muscle paralysis, patients induced with this agent might hurt themselves

26. What is… • Enflurane • Seizure complexes on EEG • EEG goes with Enflurane

27. This GA is great for maintenance, but rarely used for induction

28. What is… • Desflurane • Extreme sympathetic stimulation during induction. Also has a sharp irritating odour • Rapid post-op recovery

29. Some consider this GA to be the ‘Cadillac’ inhalation agent for short procedures

30. What is… • Sevoflurane • rapid onset and recovery • little airway irritation • 2-5% hepatic metabolism makes it less desirable for long procedures • Sevo is the “Seville”

31. Were it not for a high MAC, this agent would be a nearly ideal GA

32. What is… • Nitrous Oxide • No CV depression, excellent analgesia • Must be used with a second GA and paralytic agent

33. This class of IV GA’s are the prototypical induction agents

34. What are… • Barbiturates • Thiopental was the first - Still used widely today • Onset in 1 minute

35. While inhalation agents terminate their effect by exhalation, this is the mechanism for barbiturates

36. What is… • Redistribution • Also known as gamma phase redistribution • 99% hepatic metabolism to inactive compound AFTER termination of sedation effect

37. Incapable or reaching stage III themselves, these agents provide sedation and amnesia

38. What are… • benzodiazepines • Diazepam, lorazepam and midazolam are short acting agents • Slower onset than barbiturates • used as part of “balanced anaesthesia”

39. Occasionally used alone in Cardiac Sx, these agents typically support GA agents with analgesia

40. What is… • Opiods • patient may be ‘aware’ of or recall the Sx • Chest tightness impairing ventilation may occur

41. Opiod + neuroleptic + Nitrous Oxide =

42. What is… • Neuroleptanesthesia • Important for painful, invasive procedures requiring patient cooperation

43. Dr’s and patients agree, this drug is the ‘real Pro’ of the induction agents

44. What is… • Propafol • Similar induction to barbiturates, but faster recovery • Patients feel much better post-op • May even have anti-emetic properties • much much more expensive than thiopental

45. Catatonia, amnesia and analgesia without LOC

46. What is… • dissociative anesthesia • Produced by ketamine alone • Similar to PCP • only CVS stimulant • good for Sx on patients in shock

47. This untoward effect of ketamine is obviated by pre-medication with diazepam or fentanyl

48. What is… • Emergence Phenomenon • hallucinations and perceptual illusions

49. This iv induction agents shares one shortcoming with halothane and one with nitrous oxide

50. What is… • Etomidate • No analgesia (halothane), no muscle relaxant effect (nitrous)