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AP Exam 2 > General Anesthesia > Flashcards

General Anesthesia Flashcards

1
Q

Maintaining O2 requirement is accomplished by the ______ ______.

The formula for VO2 is:

A

Brody equation

10 * kg3/4 = ml/min

or 2.5 * kg + 67.5

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2
Q

For maintaining oxygenation/ventilation O2 saturation > _____ %

A

97%

Clinically treat if you see >3% change

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3
Q

Normal ParterioleCO2 = _______mmHg

PA-aCO2 = _______ mmHg

EtCO2 is _____%

A

40 mmHg

5 mmHg

35

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4
Q

Normal PA-a CO2 = _____ mmHg

A

5

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5
Q

EtCO2 = _____ mmHg

A

35 mmHg

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6
Q

VAlveolarCO2 = ________

A

8 * kg3/4

about = 200 ml/min

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7
Q

VaCO2 = __________ (equation)

A

VCO2 / % CO2 in lungs (5%)

= 200/0.05 = 4000 ml CO2/min

not enough ventilation because of dead space

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8
Q

Anatomic dead space = (formula?)

A

2 ml/kg *kg

140 ml/Breath * 10 breaths/min =

1400 ml/min

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9
Q

VACO2 = _____ ml/min

A

5400 ml/min

or 540 ml/Breath

4000 + 1400 dead space

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10
Q

Alveolar Gas Equation

PAO2 =

A

PAO2 =

FiO2 (PB - PH2O) - (PaCO2/R)

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11
Q

If O2 saturation begins dropping, what is the first treatment?

A

increase FiO2

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12
Q

Normal AaO2 equation:

Normal is:

A

PAO2 = PAO2 - PaO2

Normal is < 10mmHg

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13
Q

Abnormal PA-aO2 gradients caused by:

A

anatomic shunting like pulmonary AVM, thebesian minute vessels in heart

diffusion impairment: thickened capillary membrane

low V/Q areas intrapulmonary shunt

high V/Q areas: alveolar dead space

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14
Q

Increase FiO2 by: (3)

A
  • increasing TV
  • increase PEEP
  • change position
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15
Q

Benefits of improved oxygenation by adding PEEP: (3)

A
  • increase FRC (recruitment)
  • improve lung compliance
  • VQ corrections
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16
Q

Advantages of inhalation agents:

A
  • rapid appearance of drug in arterial blood
  • efficient to distribute
  • easy to deliver
  • predictable recovery
  • high safety profile
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17
Q

Drawbacks to inhalation agents (2)

A
  • no analgesia (N2O is exception)
  • PONV
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18
Q

Effectiveness of inhalation agent is measured by: (2)

A
  • ET% agent
  • established MAC
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19
Q

MAC is an average, NOT a predictor

MAC amnestic is _____.

A

0.25

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19
Q

MAC awake is ______

A

0.3-0.5

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20
Q

MACBAR = ______

BAR means:

A

1.5

blocking adregernic receptor

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21
Q

Factors that affect MAC: (3)

A
  • extremes in age (up or down)
  • chronic alcohol abuse (increase MAC)
  • pregnancy (decrease MAC)
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22
Q

Desflurane FA/Fi is ______.

A

0.8

It is the least soluble and works the fastest.

23
Q

The FA/Fi of sevoflurane is: ______

24
Factors affecting inspiratory concentration (Fi): (3)
* increase fresh gas flow * decrease circuit volume * decrease any machine/circuit absorption
25
Time constant is :
volume / flow Volume of circuit / FGF
26
How many liters in circuit of anesthesia machine? This includes bag, piping, CO2 canister.
6L
27
To increase FA/Fi equilibrium (2)
* decrease FRC * increase VA (minute ventilation)
28
Most important factor in the rate of FA/Fi is \_\_\_\_\_\_\_.
uptake
29
Increase uptake _____ rise of FA/Fi
decreases
30
If uptake = 0, then FA = Fi, uptake influencing factors include (3)
solubility (partition coefficient) blood flow (CO) concentration
31
What coefficient is "blood solubility" based upon?
blood/gas partition coefficient
32
Blood/gas partition coefficients:
describes relative affinity of anesthetic gas for blood increased partition coeff --\> increased solubility --\> increased agent uptake
33
The more soluble agent, larger capacity blood, longer to take to saturate. True or false?
true
34
Blood/gas coefficient of isoflurane
1.4
35
Desflurane blood/gas coefficient is:
0.42
36
Sevoflurane blood/gas coefficient is
0.6
37
Overcome uptake of anesthetic gas by changing ventilation:
* hyperventilate * large FRC causes dilution and thus slower rate of rise of FA/Fi
38
How to increase CO?
* increase Q * flow * CO = SV \* HR * so increase HR
39
Factors affecting FA/Fi
* uptake * blood/gas coefficient * cardiac output * hyperventilation * anesthetic overpressurizing
40
Factors affecting arterial concentration:
* V/Q mismatch * venous admixture * alveolar dead space * nonuniform alveolar gas distribution
41
Nitrous oxide advantages:
* powerful analgesic * decreases MAC of other inh. agents * safe in MH patients * rapid induction/recovery
42
Nitrous disadvantages:
* decreases myocardial contractility * increase PONV * increase ICP by increase CBF * teratogenicity
43
Contraindications of N2O
* air embolism * pneumothorax * acute intestinal obstruction * pneumocephalus * pulmonary air cyst * intraocular air bubbles * tympanic membrane grafting
44
Sevoflurane advantages:
non-irritant sweet odor rapid does not sensitize mycardium No CO production with NA lime
45
Sevo disadvantages:
* Less potent * compound A production (contraindicated with baralyme) * post op agitation in children
46
Which agent is a vapor at RT
desflurane
47
What agent is capable of increasing HR and documented myocardial ischemia?
desflurane
48
Disadvantages of desflurane:
* special vaporizers * low potency * pungency * rapid increase \> 1.25 MAC SNS stimulation
49
What agent is good for renal/hepatic dysfunction?
isoflurane
50
Eucapnic ventilation = ____ ml/min
5400 ml/min
51
R = respiratory quotient =
1.2
52
Abnormal PA-aO2 gradient (should be
Anatomic shunting: R-L thebesian, bronchiole, pulmonary AVM diffusion impairment: thickened capillary membrane Low V/Q areas due to position (supine, to lateral)
53
Lung volume recruitment calculation: Compliance = ►V / ►P If compliance = 50 PEEP = 5 cmH20, then...
Lung volume : 250 ml
54
Adverse effects of PEEP: (2)
barotrauma/pneumothorax decreased VR/CO

AP Exam 2 (5 decks)

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