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Introduction to Anesthesia - Coggle Diagram
Introduction to Anesthesia
Types of Anesthesia
General - drug induced LOC
Regional - neuraxial or peripheral nerve block
Monitored Anesthesia Care (MAC) - sedation not necessary
Components of Anesthesia
Unconsciousness
Arousal
Awareness
Amnesia
Analgesia
Immobility
Attenuation of Autonomic Responses
Lipid Theory
First: Meyer-Overton Rule
Potency of anesthetic agent is related to lipid solubility
Second: Unitary Theory of Anesthesia
Anesthetics dissolve in lipid bilayer and change membrane structure to produce anesthesia
Issues
Cutoff Effect
Anesthetic potency increases with increasing chain length to a certain point
If TOO long, no longer produced anesthesia
Enantiomers
Same octanol and water partition coefficient does NOT have same anesthesia potency
Protein Theory
Anesthetics bind to specific lipophilic amino acids
Why Exceptions to Lipid Theory
Work in Protein Theory
Structure is too large to fit in binding site
Different shape of enantiomer does not fit into binding site
Same binding site = No or different effect
Receptor Effects
GABA
Inhibitory Ion Channels in CNS
Increase affinity in presence anesthesia
Hyperpolarization
Glycine
Inhibitory Ion Channels in Spinal Cord
Glutamate
Excitatory
NMDA, AMPA, Kainate
Components of General Anesthesia
Preoperative anxiolysis
Oxygen
Induction
Neuromuscular Blockade
Airway Management
Maintenance
Reversal / Postoperative
Opioids
NMB Reversal
Benzodiazepines
TIVA
ETT, LMA, Facemask
Intravenous
Inhaled