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anesthesia pre-clinical med review


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What is the b:g of n2o?
What is the mac of n2o?
svp of halo
245 mmHg
svp of iso
238 mmHg
svp of des
669 mmHg
svp of sevo
170 mmHg
b:g of halo
b:g of iso
b:g of des
b:g of sevo
mac of halo
mac of iso
mac of des
mac of sevo
Dose of edrophonium and atropine for reversal
1mg/kg + .01mg/kg

(70/0.7 for 70 kg pt)
Onset and duration of edrophonium/atropine reversal
1 min, lasts 60 min
Dose of neostigmine/glyco reversal
onset and duration of neo/glyco reversal
10min, lasts 60 min
dose for pyridostigmine reversal with atropine or glyco
pyrido .25mg/kg
plus .015mic/kg atropine
or .2mg glyco for every 5 pyrido

*so 20mg/1mg pyrido/atro
or 20mg/.8mg pyrido/glyco
onset and duration of pyridostigmine reversal (with atropine or glyco)
10min, lasts 90 min
dose of glycopyrolate for tx secretions preop
.1-.2mg, may repeat if needed.
o/d of glycopyrolate iv
2min onset

vagal effects last 2 hours,
salivation decreased for ~7h
dose of scopalimine patch
1.5mg patch, place behind ear
o/p/d scopalimine patch
hydralizine action
vasodilator, art>veins
hydralizine dose
5-10mg q15min
o/d hydralizine
nitro action
venodilator, preload reducer
iv bolus dose of ntg
iv gtt of ntg formula and rates
50mg in 250 d5w

start at 5 mic/min and titrate up
o/d of ntg gtt
nitroprusside action
arterio and venous dilator, afterload reducer

probably via NO which is a potent vasodilator
nitroprusside o/d
1m/5m (same as NTG)
nitroprusside bolus dose
25-50mic bolus (same as ntg)
nitroprusside gtt and rates
50mg in 250 d5w = 200mic/cc
(same as ntg)

start at 0.5 mic/kg/min and increase in 0.5 mic/kg/min increments until effect
name the ester local anesthetics
procaine, chloroprocaine, tetracaine
name the amide local anesthetics
lido, prilo, mepiva, etido, ropiva, bupiva
what is the condition that precludes pts from getting ester anesthetics?
atypical plasma cholinesterase
morphine action
acts as agonist at mu,kappa, delta receptors in the CNS
morphine iv dose
1-4 mg usually
what is the metabolite of morphine and why is it important
morphine-6 glucoronide is an active metabolite
does morphine release histamine
o/p/d of morphine
meperidine action
a synthetic atropine-like opioid. agonist at mu, kappa and delta receptors in cns. Also stops shivering via kappa receptors.
what is the relative potency of meperidine to mso4
dose of meperidine for shivering and pain
shivering ~25mg iv

pain 25-100 mg slow iv
o/p/d meperidine
1m/10m/4h (same as mso4)
what is the metabolite of meperidine and why do we care
normeperidine is an active CNS stimulant and can cause seizures
What is a SE unique to meperidine (different than other opioids)
tachycardia due to atropine-like structure
what is action of fentanyl
agonist at mu, kappa and delta receptors in CNS
what is iv dose of fentanyl
25-100 mic bolus
o/p/d of fentanyl
does fentanyl stimulate histamine release
what is the relative potency of fentanyl
100x more potent than ms04
what is the action of sufenta
same as other opioids
what is the dose of sufenta
2-10 mic/kg for induction
(150-700 mics)

10-40 mic maintenance boluses
o/p/d of sufenta
what is the relative potency of sufenta
1000x more potent than ms04
does sufenta release histamine
what is the action of alfentanil
same as others
what is the dose of alfentanil
50-75 mic/kg pre-intubation load

pain: 10-75 mic/kg (must watch resps at doses >50 mic/kg)
o/p/d of alfentanil
what is the relative potency of alfentanil
25x potency of mso4
what are 2 benefits of alfentanil
1. small Vd leads to rapid elimination (short action)

2. lower incidence of PONV than other opioids
what is action of remifentanyl
what is dose of remi
induction: 1-3 mic/kg/min
maint: 0.05-2 mic/kg/min
o/p/d of remi
what is unique about remi
ester hydrolysis
what is the relative potency of remi
250x more potent than mso4
what are the classic SE of all opioids?
cns depression, resp depression, n/v, pruritis, biliary spasm, urinary retention, bradycardia, hypotension
what is action of naloxone
competative pure mu, kappa and delta ANTAGONIST
how would you mix and administer naloxone
dilute the 0.4mg ampule into 10cc of nss. This makes 0.04mg/cc.

then give 1-2cc at a time to reverse resp depression/sedation while preserving analgesia
o/p/d of naloxone
who must naloxone be used cautiously with
opioid addicts (may precipitate withdrawl) and cardiac pts (it increased myocardial contractility and may precipitate angina
what is another caution to observed with naloxone
the action of naloxone may be shorter than the opioid and rebound resp depression/sedation may occur.
action of succs
depolarizing NMB
dose of succs
o/p/d of succs
what happens if you give a cholinesterase inhibitor after giving succs
prolongs the block possibly to a phase 2 block
what happens if you give succs and then give more a few minutes later
can lead to a phase 2 block
what are contraindications to succs
MH, APC, myopathies, acute denervation injuries
what is action of atracurium
blocks Ach at motor endplate.
what is dose of atracurium for bolus and drip
0.5 mg/kg

3-15 mic/kg/min
how is atra elim
ester AND hofmann elim
o/p/d of atra
what are 2 problems with atra
1. laudanosine toxicity (rare)
2. histamine release (minimal)
what is action of cisatracurium
non-depol NMBA, benzylisoquinoline
what is dose of cisatracurium as bolus and drip
0.2 mg/kg bolus

1-3 mic/kg/min gtt
o/p/d of cisatracurium
how is cisatracurium metab
hofmann elim
what are benefits of cisatracurium over atracurium
1. no histamine release (very good CV stability)

2. virtually no laudanosine toxicity risk
what is action of doxacurium
non-depol nmba
what is dose of doxacurium
0.05 mg/kg

(3.5 mg)
o/p/d of doxacurium
what are some key facts about doxacurium
1. the most potent nmba and very costly
2. excellent CV stablility
3. no histamine release
what is action of mivacurium
non-depol nmba
what is dose of mivacurium for bolus and gtt
0.2 mg/kg bolus

(~14 mg) bolus

gtt is 5-12 mcg/kg/min
o/p/d of mivacurium
how is mivacurium metab
pseudocholinesterase, so do not use in pts with APC
is mivacurium associated with histamine release
yes, give in divided doses to limit histamine release
what is action of pipecuronium
non-depol nmba
what is dose of pipecuronium
0.1 mg/kg

(7 mg)
what is o/p/d of pipecuronium
what is important to know about pipecuronium

(what is it similar to and why are the SE less)
1. a derivative of pancuronium, but minimal binding to cardiac muscarinic receptors leads to minimal CV SE.
2. no histamine release
what is action of pancuronium
non-depol nmba
what is dose of pancuronium, bolus and gtt
0.1 mg/kg bolus

(~7 mg)

gtt: 1-15 mic/kg/min
o/p/d of pancuronium
what is a key SE of pancuronium
tachycardia via blockade of cardiac muscarinic receptors
what is action of vec
non-depol nmba
what is dose of vec, bolus and gtt
0.2 mg/kg (~14mg)

gtt: 0.8-1.2 mic/kg/min
o/p/d of vec
what effects will liver or renal failure have on vec
slight prolongation with liver failure.

Effect will be prolonged with renal failure.
what is vec similar to
it is a derivative of vec with improved SE profile.
what is action of roc
non-depol nmba
what is dose of roc

bolus and gtt
1 mg/kg bolus (use 1.2-1.5mg/kg for RSI)

5-12 mcg/kg/min
o/p/d roc
how does renal and hepatic disease effect roc
block is prolonged by liver failure but NOT by renal failure.
Which nmba's are prolonged with renal failure
pan and vec
which nmba's are prolonged with hepatic failure
pan, roc and vec
which nmba's are prolonged with APC
succs and mivacurium
which nmba's are not affected by renal or hepatic status
atracurium and cisatracurium.

Also to a certain extent succs and mivacurium unless the hepatic failure is so severe as to impair plasma cholinesterase production.
What is action of epi
A1, B1, B2 agonist
What is dose for epi gtt
1-2 mic/min = B2
4-6 mic/min = B1
10-20 mic/min = mostly A1 with some B1
How do you mix an epi gtt
1mg epi in 250 NSS or D5W

= 4mcg/cc
o/p/d of epi gtt
immediate onset
lasts a few minutes max
What is action of norepi
A and B1 with no effect on B2.
What is dosage of norepi gtt
start at 1 mic/min
(avg dose is 2-12 mic/min)
How do you mix a norepi gtt
4mg of norepi in 250 cc D5W
What is action of phenylephrine?
pure alpha1 agonist. No effect on Beta
What is dose of phenylephrine as bolus and gtt?
100 mic bolus
or 20-50 mic/min gtt
o/d of phenylephrine
IV instant onset
lasts 15 min
what is a problematic SE of phenylephrine?
reflex bradycardia
How do you mix a phenylephrine drip
10mg in 250cc NSS or D5W
= 40mic/cc
What is action of ephedrine
indirect alpha and beta agonist
what is dose of ephedrine
what is improtant to remember about ephedrine dosing
tachyphylaxis, so larger doses are required with redosing

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