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how is induction defined...
occurs when the anethesia agent reaches a level of partial pressure in the brain. The brain is the final site of anethesia
Grundel's signs of anethisia
stage 1 Amnesia

stage 2 Delirium

stage 3 Surgical plane

stage 4 Overdose

What is MAC 95?
Mac x 1.3 to prevent movement in 95 % of patietns.
MAC is reduced by adding N2O under the second gas effect, further decreased by other opiods
MAC and color of N2O
104% and Blue
MAC of Halothane
0.75%
Color of Halothane
Red
Other name for Halothane
Fluothane
Mac of Isoflurane
1.15%
Color of Isoflurane
Purple
Alternate name for Isoflurane
Forane
MAC of Sevoflurane
2%
Color of Sevoflurane
yellow
Alternate name for Sevoflurane
Ultane
MAC of Desflurane
7%
Color of Desflurane
blue
Alternate name for Desflurane
Suprane
Nitrous Oxide pros
only gas which provides analgesia, rapid uptake and elimination, minimal cardiac a respiratory depression
Nitrous Oxide cons
Exspands in air filled spaces, alters B12 metabolism, limits Fi02 which can be administered, carcinogenic to providers and triatragenic to pregnant women
Halothane Pros
Minimal airway irritation/ can be used for mask induction

uterine relaxation
Halothane Cons
Slow uptake, hepatic necrosis, cardiac depression and arrythmia
Isoflurane Pros
good muscle relaxer and cardiac stable
Isoflurane Cons
pungent odor (Not for mask induction)

slow uptake

longer to awaken
Sevoflurane Pros
good mask induction agent
sevoflurane cons
not to be used with renal patients, flow must be greater than 2l because it reacts with barrowlime to cause compound A
Desflurane Pros
rapid induction and emergence
Deflurane Cons
difficult to handle

requires special heated vaporizer so it will not evaporate

needs to be stair stepped, 2% per 4 breaths or will cause htn and tachycardia
MOA of barbituates
Depress reticular activating system via GABA receptors, they have no analgesic properties
Methohexital generic name
Brevital
Methohexital induction dose
1-1.5 mg/kg/IV

25mg/kg rectal for kids
Benzos MOA
have no analgesic property and are therorized to cause retrograde amnesia in large doses. The MOA which causes antegrade amnesia is the cerebral cortex GABA receptors
Doses for Versed

Intubation
Sedation
Pre Op
intubation 0.1-0.2 mg/kg/iv

sedation 0.01-0.1 mg/kg/iv

pre opĀ  0.07-0.15 mg/kg/iv
Benzo reversal agent and it's dose.
flumazinil

0.2mg IV Q 1min
Etomidate dose for induction
0.2-0.3mg/kg/iv induction

good for unstable cardiac patients

bad because supressed adrenocortical function for 8 hours
Propofol doses
2-2.5mg/kg IV induction
3-3.5mg/kg LMA induction
100-200 mcg/kg/min genteral anethesia
Who cannot have propofol?
people whom are allergic to egg yolks
Ketamine induction doses
1-2mg/kg/IV induction
5-10mg/kg/IM induction
MOA of Ketamine
interfers with communication between the limbic and thalmus. NO respiratory depression occurs, Increased in oral secretion and SNS stimulation
Which patients is Ketamine indicated for and contraindicated for?
IDEAL for trauma patients and Hypovolemic patients
BAD for CAD and ICP patients
MOA of opiod drugs
antinocioception, decreased neurotransmittion of substance P, increased potassium conductiance causing hyperpolarization of membrane thus reducing transmission.
Binds to receptors Mu 1and 2, kappa and Delta
MOA of Narcan
competes for opiod receptors specifically mu receptors
Narcan dose?
20-40mcg/kg/iv
Narcan peak and duration
peak 1-2min
duration 30-45 min
SE of narcan include
ventricular arrythmiasand HTN.

Note: don't completely reverse or it will be very painful.
MOA of ACH within the mucle
Nerve influx of Ca+ causes vesicle to release ACH into cleft. ACH attaches to nicotinic receptors causing decreased Na+ and increased K+ depolarizing the muscle. It is then hydrolyzed by acetylcholinesterase.
Treatment of a larengyo spasm
20mg IV Succs and positive pressure ventilation in attempt to break the spasm
Six things which prolong Succs
abd genes
decreased pseudochol
pregnancy
echothiophate for glocoma
hypothermia
anticholinesterase drugs
Five SE of Succs
Bradycardia
Fasiculations
Hyperkalemia
Increased gsatric, intraocular, and ICP
MH
Non-depolarizing NMBA's MOA
resembles ACH, binding to receptors but fails to depolarize. Can last upwards of 90 minutes thus it is not used with questionable airways.
When should a Non-depolarizting NMBA NOT be used?
Questionable airways, as brain death can occur within 4-8 minutes.
Atracurium's generic name?
Tracurium
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