Anesthetics

Inhaled general anesthetics

• end in THANE

Halothane, Enflurane, Isoflurane, Desflurane, Sevoflurane

Sweet inhaled general anesthetics

Halothane and Sevoflurane; enflurane is mild

He aint stable but hes sweet “esh”

Pungent general anesthetics

DI

Desflurane and Isoflurane

Not Stable to soda lime

Halothane and Sevoflurane

He aint stable but he’s super sweet esh

Stable to soda lime

DEI

Desflurane, Enflurane, Isoflurane

Highest metabolism

Halothane is high metabolized

Lowest metabolism

Desflurane

Fastest onset and recovery

between sevoflurane and desflurane (won’t give both as an answer choice)

injectable general inhaled anesthetic

Etomidate, Procaine, Tetracaine, Dibucaine, Lidocaine, Mepivacaine, Prilocaine

mechanism for barbiturates

modulation of GABA receptor

bind to beta subunit to make GABA work better

propofol mechanism

interaction with GABA receptors increase GABA sensitivity

Cocaine

a2 blockage → CNS stimulation and increase of NE → vasoconstriction

ketamine

inhibits the NMDA receptor by binding to PCP binding site

consideration for pts with liver disease

Should not receive Lidocaine (lidocaine = liver)

If Lidocaine is metabolized by the liver then WHY would you give it to someone with liver disease. Use a ester Benzoic acid or PABA type instead

Benzoic Acid types of local anesthesia

These are ester benzoic acid types

Cocaine

Hexylcaine

PABA ester type

benzocaine, procain, chloroprocaine, tetracaine

Lidocaine types

amide

Lidocaine, mepivacaine, prilocaine, bupivacaine

Propofol ADR

decrease BP, Greater respiratory depression compared to barbiturates

Etomidate ADR

Little change in blood pressure, less respiratory depression than barbiturates

Inhibits adrenal cortical stress response

Ketamine ADR

dissociative amnesia

Increase cerebral blood flow, increase IOP and intracranial pressure, increase BP and HR, potent bronchodilator (oddly less respiratory depression)

PABA type metabolism and inactivation

These are esters

Benzoic acid and PABA type decomposition takes place in esterases in the tissues

Lidocaine type metabolism and inactivation

Amides so

Metabolism takes place in the liver

if you have AchE deficiency…

Do not use Benzoic or PABA types (these are esters)

Use lidocaine instead

barbiturates examples

thiopental, thiamylal, methohexital

etomidate is good for pts with

at risk for hypotension

ketamine is good for

pts at risk for bronchospasms

1. Is a primary amine -> NOT ACTIVE

2. Tertiary amine PABA type -> ACTIVE (just okay) 

3. Has Chlorine -> Shorter duration due to C=O being more positive (more attractive to H2O and hydrolysis) but also MORE lipophilic -> fast onset  

4. More Lipid due to ethyl groups and tail (Lipophilic -> fast onset) ; presence of EDG carbons on the left increases negative charge -> longer duration due to resistance to hydrolysis 

general anesthesia includes

inhaled anesthetics (thanes) and propofol, etomidate, and ketamine

local anesthetics include

Benzoic Acid types, PABA, Lidocaine

adr of enflurane

relaxation of the uterus

adr of halothane

arrhythmia and hepatotoxicity