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ANESTHETICS, Malignant hyperthermia (MH):, only for patients with coronary…

- - - - The ionized form interacts with the protein receptor of the sodium
        channel to inhibit its function.
- - - - Nitrous oxide
        
        “laughing gas
        
        potent analgesic
        
        weak general anesthetic
        
        It alone cannot produce surgical anesthesia
        
         It is poorly soluble in blood, allowing it to move very rapidly in and out of
        the body.
        
        Does not depress respiration
        
        not produce muscle relaxation.
        
        اهمممممم شي
        
        least
        hepatotoxic.(**safest inhalational anesthetic)**
  - - - Isoflurane
        
        cardiac arrhythmias.
        
        pungent odor and stimulates respiratory reflexes
        
        (so not used for inhalation induction
        
        little metabolism
      - Desflurane
        
        Low volatility (need a special heated vaporizer)
        
        (low blood solubility)
        
        Very rapid onset and recovery
        
        It is irritating to the airway and can cause laryngospasm,
        coughing, and excessive secretions (Not used for induction)
        
        Tissue toxicity is rare
      - Sevoflurane
        
        low pungency
        
        allowing rapid induction in pediatric
        patients.
        
         Has rapid onset and recovery (due to low blood solubility)
        
         Metabolized by the liver
        
        compounds formed in the
        anesthesia circuit may be nephrotoxic.
  - - - replaced thiopental as the first choice
        for induction
      - produces an euphoric feeling
      - not cause postanesthetic nausea and
        vomiting
      - Transient pain at the injection site is common and bactirial infection
      - lower doses to provide sedation
      - excitatory phenomena
      - Decreases blood pressure (without depressing myocardium)
      - highly lipophilic
    - - Water-soluble
      - Fospropofol is metabolized to propofol
    - - potent anesthetic but a weak analgesic
      - ultrashort-acting
        
        high lipid solubility
        
        long time in the body
        
        redistribution
      - Thiopental has minor effects on the cardiovascular system, (but severe hypotension in patients with hypovolemia or shock).
      - Can cause apnea, coughing, chest wall spasm,
        laryngospasm, and bronchospasm
      - Contraindicated in patients with porphyria
    - - fentanyl and sufentanil and
        remifentanil,
        
        Opioid effects can be antagonized by naloxone
    - - hypnotic agent (lacks analgesic activity)
      - (little to no effect
        on the heart and circulation
      - adverse effects include a decrease in plasma cortisol and
        aldosterone levels (due to inhibition of 11-β-hydroxylase)
    - - dissociative anesthesia
        
        amnesia
        
        immobility
        
        sedation
      - It interacts with the N-methyl-D-aspartate receptor.
      - stimulates central sympathetic outflow
        
        Therefore, it is beneficial in patients with hypovolemic
        or cardiogenic shock and in asthmatics.
        
        Conversely, it is contraindicated in hypertensive or stroke patients.
      - because it increases cerebral blood flow
        and induces postoperative hallucinations.
    - - sedative used in intensive care settings and surgery.
        
        without
        respiratory depression
      - α2
        
        receptor agonist (like clonidine)