Inhalation Agents

Question 1

Sevoflurane: Class

Answer 1

Inhaled anesthetic : Ether

Question 2

Sevoflurane: Use

Answer 2

Induction and maintenance of General Anesthesia

Question 3

Sevoflurane: Mechanism of Action

Answer 3

Brain:
- Stimulates GABA-a receptor
- Increases Cl influx and hyperpolarizes neurons by increasing the amount of time the channel stays open
- Impairs neurons ability to fire
Spinal Cord:
- Stimulates glycine receptor
- Inhibits NMDA receptor
- Inhibits Na channel

Question 4

Sevoflurane: Dose

Answer 4

MAC: 2.0%

Question 5

Sevoflurane: B:G Solubility

Answer 5

0.65

Question 6

Sevoflurane: Vapor Pressure

Answer 6

157

Question 7

Sevoflurane: Contraindication

Answer 7

Malignant Hyperthermia
Severe liver disease (higher risk of immune mediated hepatitis due to relatively high hepatic metabolism

Question 8

Sevoflurane: Considerations

Answer 8

Compound A (in hydrated or dessicated)
Needs minimum FGF
Good agent for inhalation inductions in Pediatrics
High concentrations can produce seizure activity
Increase risk for PONV

Question 9

Sevoflurane: Metabolism

Answer 9

2-5% in liver

Question 10

Desflurane: Class

Answer 10

Inhaled anesthetic: Ether

Question 11

Desflurane: Use

Answer 11

Induction and Maintenance of General Anesthesia

Question 12

Desflurane: Mechanism of Action

Answer 12

Brain:
- Stimulates GABA-a receptor
- Increases Cl influx and hyperpolarizes neurons by increasing the amount of time the channel stays open
- Impairs neurons ability to fire
Spinal Cord:
- Stimulates glycine receptor
- Inhibits NMDA receptor
- Inhibits Na channel

Question 13

Desflurane: Dose

Answer 13

MAC: 6.6

Question 14

Desflurane: B:G Solubility

Answer 14

0.42

Question 15

Desflurane: Vapor Pressure

Answer 15

669

Question 16

Desflurane: Contraindications

Answer 16

Hx: Malignant Hyperthermia

Question 17

Desflurane: Considerations

Answer 17

Impairs hypoxic drive the least-> Good choice for COPD/OSA
Least soluble -> Stays in alveoli longer, able to blow off faster
Produces Carbon Monoxide in the presence of Soda Lime
Rapid increases cause Tachycardia

Question 18

Isoflurane: Class

Answer 18

Inhaled anesthetic: Halogen
Ether

Question 19

Isoflurane: Use

Answer 19

Induction and maintenance of general anesthesia

Question 20

Isoflurane: Mechanism of Action

Answer 20

Brain:
- Stimulates GABA-a receptor
- Increases Cl influx and hyperpolarizes neurons by increasing the amount of time the channel stays open
- Impairs neurons ability to fire
Spinal Cord:
- Stimulates glycine receptor
- Inhibits NMDA receptor
- Inhibits Na channel

Question 21

Isoflurane: Dose

Answer 21

MAC: 1.2

Question 22

Isoflurane: B:G Solubility

Answer 22

1.46

Question 23

Isoflurane: Vapor Pressure

Answer 23

238

Question 23

Isoflurane: Contraindictions

Answer 23

Hx: Malignant Hyperthermia
Patients with severe CAD

Question 24

Isoflurane: Considerations

Answer 24

Risk for coronary steal Carbon Monoxide is byproduct in dessicated soda lime Most severe drop in BP

Question 25

Nitrous Oxide: Class

Answer 25

Anesthetic Gas

Question 26

Nitrous Oxide: Use

Answer 26

As an adjunct to other inhaled medications or anesthesia medications

Question 27

Nitrous Oxide: Mechanism of Action

Answer 27

Antagonizes NMDA receptor Stimulates potassium 2P channel

Question 28

Nitrous Oxide: Dose

Answer 28

MAC: 104

Question 29

Nitrous Oxide: B:G Solubility

Answer 29

0.46

Question 30

Nitrous Oxide: Vapor Pressure

Answer 30

38,770

Question 31

Nitrous Oxide: Contraindications

Answer 31

Procedures in the middle ear Occular Gas bubble placement Fire Risk Pre-existing vitamin b12 deficiency pregnancy

Question 32

Nitrous Oxide: Considerations

Answer 32

Concentrating Effect (34 x's more soluble than nitrogen in the blood) *fastest FA/FI* Second Gas effect Is NOT metabolized in the body Can be absorbed into anesthesia equipment