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SRNA4TopicsAnesthesia > 4/10Exam 3 N. Inhaled (7) > Flashcards

4/10Exam 3 N. Inhaled (7) Flashcards

1
Q

Site of action of inhaled anesthetics

A

multiple sites of action and protein targets probably exist;

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2
Q

When does loss of consciousness ensue?

A

Once a critical concentration of drug has entered the brain and spinal cord

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3
Q

VA with a chloride ion

A

Isoflurane

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4
Q

What are The primary factors that influence absorption of the inhalation anesthetics? (VUCSA)

A

Ventilation,
Uptake into the blood
Cardiac output,
Solubility of the anesthetic drug in the blood, and Alveolar-to-venous blood partial pressure difference.

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5
Q

The concentration or partial pressure of anesthetic in the lungs is assumed to be

A

the same as in the brain, because the drugs are highly lipid soluble and diffusible, and they quickly and easily reach equilibrium among the highly perfused body compartments.

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6
Q

Dose of an individual drug is expressed in terms of the

A

minimum alveolar concentration (MAC)

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7
Q

MAC is the

A

Minimum alveolar concentration needed to produce anesthesia (lack of movement) upon surgical stimulation

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8
Q

The faster the lung (and therefore brain) concentration rises, the_______Anesthesia is achieved

A

the faster

anesthesia is achieved.

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9
Q

The faster the lung (brain) concentration falls after discontinuation of the drug, _________the patient emerges

A

the more quickly the patient emerges

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10
Q

What do you do when preparing for a patient who is susceptible to malignant hyperthermia to avoid exposure resulting from residual trace amounts of gases *(TRI) ?

A

Thorough flush of the anesthesia machine with 100% oxygen at 10 L/min for at least 20minutes
Replacement of breathing circuits and the carbon dioxide canister, and draining, Inactivation or removal of vaporizers are
advised

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11
Q

MAC of Sevoflurane

A

2

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12
Q

Blood/Gas partition Coefficient of Sevo

A

0.6

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13
Q

MAC of Isoflurane

A

1.15

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14
Q

MAC of Nitrous oxide

A

105

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15
Q

Blood/Gas partition Coefficient of N2O

A

0.47

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16
Q

Desflurane MAC

A

5.8

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17
Q

Blood/Gas partition Coefficient of N2O

A

0.42

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18
Q

Is an indicator of the speed of uptake and elimination

A

The blood/gas solubility coefficient of an anesthetic

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19
Q

Concentration effect

A

The higher the concentration of anesthetic delivered, the faster anesthesia is achieved; this is also referred to as over-pressuring; as with any drug, the larger the initial dose administered, the faster the onset of action

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20
Q

Oil/gas Solubility coefficient

A

The blood/gas solubility coefficient is the indicator of an anesthetic’s speed of onset and emergence:
the higher the coefficient, the slower the anesthetic; conversely, the lower the coefficient, the faster
the anesthetic

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21
Q

Second-gas effect

A

The second-gas effect is a phenomenon in which two anesthetics of varying onset speeds are administered
together: a high concentration of a fast anesthetic such as nitrous oxide is administered with a slower second anesthetic gas; the slower gas achieves anesthetic levels more quickly than if it had been given alone

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22
Q

Diffusion Hypoxia

A

Diffusion hypoxia occurs when high concentrations of nitrous oxide are administered; at the end of the procedure, when nitrous oxide is discontinued, it leaves the body very rapidly, causing a transient
dilution of the oxygen and carbon dioxide in the lungs; hypocarbia and hypoxia may occur;

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23
Q

How to prevent diffusion hypoxia?

A

administration of 100% oxygen for approximately 3-5 min when nitrous oxide is discontinued alleviates this problem

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24
Q

Allow for an increase in deposition of anesthetics into fat and may prolong
recovery

A

Long procedures and morbid obesity

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25
Q

The MAC or required dose of Anesthetics is

A

higher in infants and children and decreases with increasing age.

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26
Q

Infants MAC vs adult

A

Infants aged 6 months have a MAC 1.5 to 1.8 times higher than
a 40-year-old adult.59

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27
Q

Diffusion of Nitrous Oxide into Closed Spaces

A

Nitrous oxide diffuses into air-containing cavities in the body during an anesthetic procedure.

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28
Q

These air-containing spaces are normally rich in nitrogen, which is_________Soluble than nitrous oxide.

A

34 times less soluble than nitrous

oxide.

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29
Q

NItrous oxide , If the space is expandable

A

it increases in volume.

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30
Q

Examples of expandable air cavities, include

A 
Air embolism
Pneumothorax
Acute intestinal obtruction
Intraocular air bubles 
Pneumoperitoneum
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31
Q

Avoid nitrous during these procedures

A

tympanomastoid procedures

and intracranial air during diagnostic or surgical intracranial procedures.

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32
Q

Cuff and nitrous

A

endotracheal tube cuff, laryngeal mask airway, and
balloon-tipped pulmonary artery catheters may expand during nitrous oxide anesthesia, and appropriate precautions and adjustments
should be considered

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33
Q

The uptake of anesthetic drugs is faster in which population?

A

children than in adults. In other words, a child goes to sleep faster than an adult patient

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34
Q

Child goes to sleep faster than an adult, whY?

A

Child has higher alveolar ventilation per weight accounts for this effect.

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35
Q

The higher the cardiac output

A

the slower the onset.

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36
Q

Less soluble anesthetic work

A

faster

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37
Q

In general, the longer an anesthetic is administered,

A

the slower the patient emerges.

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38
Q

The least soluble

Exhibits the fastest clinical recovery, Least to fast order

A

desfluranewith sevoflurane and isoflurane following in that order.

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39
Q

Intraocular hexafluoride gas and N2O

A

2-18 mmHg increase in pressure in 20 minutes

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40
Q

Middle ear pressure and N2O

A

Increased 1-7 mmHg in 1 hour

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41
Q

Pneumothorax and Nitrous

A

2-3 times the volume in 5-20

minutes

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42
Q

Intestinal gas and N2O

A

Double in 150 minutes

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43
Q

Air Bubble and N2O

A

Immediate increases in size occur

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44
Q

Least metabolize

A

nitrous

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45
Q

Least metabolize before nitrous

A

Desflurane Less than 0.1

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46
Q

Minimum alveolar concentration—BAR definition

A

block adrenergic responses
(MAC-BAR)The alveolar concentration of anesthetic that blunts the autonomic response to noxious stimuli;
approximately

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47
Q

MAC Bar level

A

1.6-2.0 MAC

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48
Q

The MAC suppressing appropriate response to commands in

A

50% of patients; memory is usually lost at MAC-awake; approximately 0.3-0.5 MAC

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49
Q

The MAC suppressing appropriate response to commands in

A

50% of patients; memory is usually lost at MAC-awake;

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50
Q

MAC awake level is

A

approximately 0.3-0.5 MAC

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51
Q

Are the least metabolized and do not result in metabolism-related toxicity.

A

Nitrous oxide, desflurane, and isoflurane

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52
Q

First, the majority of the blood leaving the lungs with anesthetic is normally distributed to the vital organs

A

Vessel rich group

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53
Q

The longer the anesthetic is given , the

A

Greater the saturation of all the body compartments.

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54
Q

During induction, increases in cardiac output effect on onset?

A

slow onset.

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55
Q

Hyperthermia and MAC

A

Increase

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56
Q

Drug induces increases in CNS and MAC

A

Increase

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57
Q

Hypernatremia and MAC

A

Increases

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58
Q

Chronic Alcohol abuse and MAC

A

Increase

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59
Q

Hypothermia and Increasing age and MAC

A

Decrease

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60
Q

Hyponatremia and MAC

A

Decrease

61
Q

Hypoxia and MAC

A

Decrease MAC

62
Q

Lidocaine and MAC

A

Decrease MAC

63
Q

Lithium and MAC

A

decrease MAC

64
Q

Cardiopulmonary bypass and MAC

A

Decrease

65
Q

Hypotension and MAC

A

Decrease

66
Q

Right to left shunt on induction of anesthesia

A

shunted blood mixed with blood coming from ventilated alveoli which results in reduction of alveolar partial pressure of the anesthetic. SLOW INDUCTION of anesthesia

67
Q

Left to right shunt on induction of anesthesia

A

Left to right shunting causes the anesthetic partial pressure in mixed venous blood to increase more rapidly than it would in the absence of the shunts.

68
Q

Cardiopulmonary bypass , it is necessary to administer a relative

A

Higher concentration of the volatile agent compared to that with normal lung inhalation.

69
Q

The uptake of volatile agents administered by the oxygenator is dependent on 3 factors

A

Blood/gas solubility
tissue/gas solubility
Oxygenator intake

70
Q

Blood gas solubility and temperature

A

Increases as temperature falls

71
Q

Tissue/gas solubility and temperature

A

Increases as temperature falls.

72
Q

Emergence Phase I : Resp

A

Transition from apnea to regular breathing

73
Q

Emergence Phase II: Characteristics

A 
Tearing, salivation
Increase HR and BP
Grimacing
Response to Autonomic responsiveness 
Extubation possible
Swallowing
74
Q

Extubation possible in

A

Phase II and Phase III

75
Q

Emergence Phase III characteristics: REEA

A

Eye opening
Response to oral commons
Awake patterns on EEG
Extubation possible.

76
Q

General Anesthesia

A

Arousal not possible, unresponsive, eyes closed, reactive pupils

77
Q

What is the Meyer-Overton rule

A

The more lipid soluble the anesthetic, the higher the potency.

78
Q

What favors the genesis of cardiac dysrhythmias?

A

Increasing the number of halogen atoms.

79
Q

2 Key players in the mechanism of anesthesia

A

Neurotransmitter gated-ion channels

2 pore K+ channels

80
Q

The lipid solubility is

A

Directly proportional to potency

81
Q

Gender on MAC

A

No effect

82
Q

Metabolic alkalosis on MAC

A

No effect

83
Q

VA causes immune suppresion

A

Nitrous oxide

84
Q

Triggers for malignant Hyperthermia

A

Iso, des, sevo

85
Q

Support combustion: VA

A

Nitrous

86
Q

Gas likely to evaporate when left in an open container in the OR?

A

Desflurane

87
Q

VP of desflurane

A

669 mmHg

88
Q

VP of enflurane

A

172 mmHg

89
Q

VP of Halothane

A

243 mmHg

90
Q

VP of isoflurane

A

238 mmHg

91
Q

VP of sevo

A

157 mmHg

92
Q

Boiling point of Desflurane

A

22.8

93
Q

Boiling point of Isoflurane

A

48.5

94
Q

Boiling point of Sevoflurane

A

58.5

95
Q

Which of the following physical properties best correlates with VA potency?

A

Lipid solubility

96
Q

Nitrous can also inhibit this receptor

A

NDMA ; they are excitatory receptors, and their inhibition leads to decrease neuronal activity/

97
Q

What is the boiling point of a liquid?

A

It is the temperature at which VP equals atmospheric pressure.

98
Q

What VP and boiling point favors evaporation of the liquid phase into a vapor phase?

A

HIgh VP and low boiling point.

99
Q

VA effects on the neuro physiology and metabolism

A

Increase CBF, decrease in CMRO2./

100
Q

Nitrous on CMRO2

A

Increases CMRO2, CBF, and ICP

101
Q

Gas most likely to produce seizure like activity on the EEG

A

Enflurane.

102
Q

Causes a reflex increase in HR (gas favor)

A

Isoflurane

103
Q

Nitrous oxide has a direct

A

negative inotropic effect despite this, it has the lest effect on the CV

104
Q

NITROUS and SNS

A

Sympathetic stimulator, and increases level of catecholamines, present during nitrous anesthesia produces a slight compensatory increase in arterial BP and HR so that CO remains same.

105
Q

Sevoflurane, Desflurane and isoflurane are all

A

Vasodilators and decrease the SVR.

106
Q

Sensitize the myocardium

A

Halothane.

107
Q

C1H2CIF5O.

A

Isoflurane

108
Q

C3H2F6O

A

Desflurane

109
Q

Desflurane and sevoflurane are halogenated exclusively with

A

fluorine

110
Q

Halogenated exclusively with fluorine are

A

less soluble in blood.

111
Q

Halogenated exclusively with fluorine are

A

less soluble in blood.

112
Q

Which modern volatile agent differs from isoflurane only in the replacement of the chlorine with fluorine?

A

Desflurane differs from isoflurane only by the substitution of a fluorine
atom for the chlorine atom. This one change increases the vapor pressure
dramatically

113
Q

Methyl ethyl ethers.

A

Enflurane, isoflurane, and desflurane

114
Q

Fluorinated methyl isopropyl ether.

A

Sevoflurane

115
Q

Is the only brominated modern volatile anesthetic agent

A

Halothane

116
Q

4 contraindications to the use of N2O

A

Closed pneumothorax
Tympanoplasty or middle ear surgery
Pneumocephalus
Venous Air embolism

117
Q

May promote aplastic anemia

A

Nitrous oxide

118
Q

N20 can cause a decrease in blood pressure and cardiac output when added to high dose of what intravenous anesthetics?

A

Opioids

119
Q

Does ETC02 increase, decrease, or remain unchanged when N 10 is turned off? Why? What law applies?

A

ETC02 decreases. When N2O is discontinued, N20 rushes into the alveoli from the blood. The alveoli enlarge and gases that are present, including
C02, are diluted. Fick’s law of diffusion applies.

120
Q

Does nitrous oxide administered alone increase cerebral blood flow and intracranial pressure?

A

Yes

121
Q 
Which inhaled agent is most associated
with postoperative nausea and vomiting
(PONY). Rank the inhaled agents, from
greatest to least. with respect causing
PONY.
A

Nitrous oxide has the greatest capacity to cause postoperative nausea and vomiting (PONY). From greatest to least, the likelihood of an inhaled agent •
causing PONV is: nitrous oxide > desflurane;; isoflurane = sevoflurane.

122
Q

Nitrous oxide is turned on and held at the same concentration for 6 hours. At 6 hours, is the uptake of nitrous oxide increasing, decreasing, or remaining
unchanged?

A

Nitrous oxide equilibrates with all tissues within 6 hours, so uptake of nitrous oxide remains unchanged at this time; the amount of nitrous oxide inhaled essentially equals the amount of nitrous oxide exhaled

123
Q

In general, how much does N20 reduce

the MAC of a volatile agent?

A

There is approximately a I% reduction in MAC for every 1% of nitrous oxide delivery.

124
Q

Which two volatile anesthetics most decrease systemic vascular resistance (SVR)?

A

Isoflurane and desflurane.

125
Q

By what mechanism does isoflurane cause hypothermia?

A

Depresses the temperature regulating centers of the hypothalamus, there is heat loss, because no shivering occurs.

126
Q

How may an increase in ICP with isoflurane can be prevented?

A

Hyperventilate the patient during isoflurane administration

127
Q

Which volatile agent is LEAST likely to produce potentially dangerous increases in intracranial pressure if modest hypocapnian is present?

A

lsoflurane.

128
Q

These agents have similar effects on cerebral blood flow.

A

Iso, sevo, enflurane and desflurane

129
Q

How do VA alter the ventilatory response to CO2? to hypoxia>

A

Dose dependent decrease in ventilatory response to CO2/

130
Q

What MAC completely blocked at low concentration of volatile agent?

A

0.1 MAC

131
Q

Have volatile inhalational agents been shown to inhibit hypoxic pulmonary vasoconstriction (HPV) in patients?

A

HPV is inhibited by a high concentration of a volatile agent, possibly at 1.0-1.5 MAC, or higher.

132
Q

You are providing LMA anesthetic delivery during maintenance anesthesia and the patient begins to cough. What volatile agent has the highest incidence
of causing the patient to cough?

A

Isojlurane has a slightly higher incidence of causing cough during anesthetic delivery through LMA

133
Q

Several minutes after induction, during mechanical ventilation, the vaporizer is delivering 2% isoflurane but the gas analyzer is only reading end-tidal concentration
at 0.5%. Why

A

the alveolar uptake of isoflurane is relatively slow because of its reasonably high blood solubility. This argument holds for enflurane and halothane as well. The greater the blood solubility of an inhalational agent, the slower the increase in partial pressure in the
alveoli

134
Q

Which volatile agents most depress ventilation?

Least depress ventilation?

A

Desflurane and enflurane most depress ventilation. Halothane least depresses ventilation

135
Q

Which volatile agents most depress the baroreceptor reflex, and which least depress it?

A

Halothane and sevoflurane most depress the baroreceptor reflex(there are no increases in heart rate despite decreases in blood pressure with these
agents).

136
Q

Which volatile agents least depress the baroreceptor reflex,

A

Heart rate tends to increase reflexly with the decreases

in blood pressure produced by these agents

137
Q

Which volatile agent is most degraded

by soda lime? Which is least degraded?

A

Sevoflurane is most degraded by soda lime and desflurane least.

138
Q

What volatile inhalational agent least potentiates muscle relaxants?

A

All, but halothane does it the least.

139
Q

What volatile agent produces the greatest

increase in cerebral blood flow

A

Halothane

140
Q

What effect does acute alcohol intoxication

have on MAC

A

MAC is decreased in the patient who is acutely intoxicated

141
Q

Which inhalational agent has no halogen

A

N2O

142
Q

Clinically, what is the most important Fluoride ions. Inorganic fluoride ions cause nephrotoxicity? Why?

A

Fluoride ions. Inorganic fluoride ions cause nephrotoxicity

143
Q

Are isoflurane, enflurane, sevoflurane and desflurane metabolized by oxidative or reductive processes

A

Oxidative.

144
Q

The modern inhaled anesthetics are primarily excreted via the

A

lungs

145
Q

The minimal amount of biotransformation ( 0.02% to 5%) of modern volatile anesthetics takes place in the liver by the

A

cytochrome P450 enzyme system

146
Q

Desflurane how many atoms

A

6 fluorine atoms

147
Q

Sevoflurane how many atoms

A

7 fluorine atoms

148
Q

Vapor pressure is directly proportional to

A

Temperature

SRNA4TopicsAnesthesia (47 decks)

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