MindMap Gallery 13——General anesthetics
13——Mind map of general anesthetics, which have the effect of inhibiting the function of the central nervous system, causing consciousness, sensation and reflexes to temporarily disappear, and relaxing skeletal muscles. The effects include: analgesia (basic), hypnosis, muscle relaxation, amnesia, and consciousness. Eliminate and inhibit abnormal stress responses.
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This is a mind map about bacteria, and its main contents include: overview, morphology, types, structure, reproduction, distribution, application, and expansion. The summary is comprehensive and meticulous, suitable as review materials.
This is a mind map about plant asexual reproduction, and its main contents include: concept, spore reproduction, vegetative reproduction, tissue culture, and buds. The summary is comprehensive and meticulous, suitable as review materials.
This is a mind map about the reproductive development of animals, and its main contents include: insects, frogs, birds, sexual reproduction, and asexual reproduction. The summary is comprehensive and meticulous, suitable as review materials.
general anesthetic
Effect 1: Inhibit the function of the central nervous system, temporarily disappear consciousness, sensation and reflexes, and relax skeletal muscles Functions include: analgesia (basic), hypnosis, muscle relaxation, amnesia, loss of consciousness, and suppression of abnormal stress responses
inhalation anesthetic
Volatile liquids (isoflurane, enflurane, sevoflurane, desflurane) Gas (Nitrous Oxide) Common characteristics: fat soluble
Pharmacokinetics
absorb
Minimum alveolar concentration (MAc)
The concentration of drug in alveolar gas that can eliminate pain in 50% of patients at one atmospheric pressure The lower the mAC, the stronger the anesthetic effect of the drug
blood/gas distribution coefficient
The ratio of the drug concentration in the blood to the concentration of the inhaled drug at equilibrium Large blood gas distribution coefficient and long drug induction period
distributed
brain/blood distribution coefficient
Refers to the ratio of drug concentration in the brain to blood concentration when equilibrium is reached Drugs with large coefficients easily enter the brain tissue and have a short induction period.
metabolic elimination
The alveoli are excreted in their original form; those with low brain/blood and blood/gas distribution coefficients are easily carried away by the blood and wake up quickly.
Mechanism
lipid theory
High fat solubility, strong anesthetic effect
General anesthetics integrate into the lipid layer of cell membranes and broadly inhibit the transmission of nerve impulses.
protein theory
Inhibit excitatory synapses and enhance inhibitory synapses (GABA)
installment
I (analgesic period)
Loss of consciousness, analgesia, and amnesia
II (exciting period)
Loss of consciousness and feeling
Anesthesia induction period (no surgery/examination allowed)
III (surgical anesthesia period)
Divided into four levels; general surgeries are performed at the third level, and the amount of surgery required at the fourth level is reduced.
IV bulbar anesthesia period
Stop medication, rescue
drug
Ether
Colorless and volatile
Curare-like effect → muscle relaxation
Long anesthesia induction period and recovery period
Special odor → stimulates tracheal mucus secretion and causes aspiration pneumonia
Flammable and explosive → rarely used clinically
Halothane
Unstable; neither flammable nor explosive at clinical concentrations
Small blood/gas distribution coefficient, short anesthesia induction period, and quick recovery
Dilate cerebral blood vessels, increase intracranial pressure; increase sensitivity to CA, induce arrhythmia
Causes uterine relaxation and induces postpartum hemorrhage → contraindicated in patients with dystocia/cesarean section
Repeated use may occasionally cause hepatitis and liver necrosis.
Isoflurane Enflurane
isomers of each other
Short induction period, quick recovery, easy adjustment of anesthesia depth, and good muscle relaxation
Does not increase myocardial sensitivity to catecholamines
Repeated action has no side effects on the liver
Mainly used for anesthesia maintenance
Desflurane
Advantages: short induction period and rapid recovery
Disadvantages: Because the required concentration is too high, it can irritate the respiratory tract and cause coughing, respiratory arrest, and laryngeal spasm.
Suitable for anesthesia maintenance in adults/children
Sevoflurane
Little impact on cardiopulmonary function Short induction period of anesthesia and quick recovery It is currently widely used for the induction and maintenance of general anesthesia in in-hospital and outpatient surgeries for adult and pediatric patients.
nitrous oxide
Most of them are exhaled through the lungs in their original form.
Non-flammable, non-explosive, non-irritating, short induction period, fast recovery, low anesthetic efficacy, strong analgesic effect
Mainly used for inducing anesthesia in combination with other general anesthetics
intravenous anesthetic
Excellent: no induction period; no irritation to respiratory tract Disadvantage: Difficult to grasp the depth of anesthesia
Thiopental sodium
Features
Quick onset of effect; short maintenance time
application
Induction anesthesia, basic anesthesia, incision and drainage of abscesses, closed reduction of fractures and dislocations, and other short-term surgeries
Contraindications
Newborns, infants and young children (suppression of respiratory center) Bronchial asthma (can induce spasm of the larynx and bronchial tubes)
Ketamine
It is a blocking drug for NMDA receptors; it blocks the conduction of pain impulses and excites the brainstem and limbic system.
Causes "dissociative anesthesia": a state of separation of consciousness and sensation
Causes confusion, short-term memory loss, complete loss of pain, dreams and increased muscle tone
Strong analgesic effect on body surface, poor analgesic effect on internal organs Minor surgeries and short-term surface surgeries such as burn debridement, escharectomy, and skin grafting
Propofol
Quick onset of action and quick recovery; weak analgesic effect Can inhibit laryngeal reflex → facilitate tracheal intubation Reduce cerebral metabolic rate, intracranial pressure, and intraocular pressure Inhibits the circulatory system (decreased BP, decreased peripheral resistance) and respiratory function
General anesthesia induction, maintenance anesthesia and sedation-hypnosis auxiliary drugs Adjuvant medication for outpatient short-acting surgery
etomidate
Powerful, ultra-short-acting; no obvious analgesic effect
Little impact on the heart, especially suitable for CHD and valvular disease
Disadvantages: nausea and vomiting during recovery; inhibition of adrenocortical hormone synthesis
midazolam
Benzodiazepines Can be used for critically ill patients
Dexmedetomidine
compound anesthesia
Pre-anesthetic administration
Phenobarbital/Diazepam: relieves tension and fear
Basic anesthesia
Pediatric anesthesia
Induce anesthesia
Thiopental sodium/nitrous oxide
Combined muscle relaxants
Succinylcholine, tubocurarine
hypothermic anesthesia
Combined with chlorprozine to lower body temperature → reduce heart and brain oxygen consumption and improve tolerance
Cardiovascular and brain surgery
controlled blood pressure reduction
Brain surgery that is difficult to stop bleeding
neuroleptic analgesia
Droperidol:Fentanyl=50:1