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NUNA 681(pharm) > Inhalation Agents: MAC > Flashcards

Inhalation Agents: MAC Flashcards

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1
Q

the ideal inhaled anesthetic

A
  1. nonflammable
  2. easily vaporized at ambient temperature
  3. potent
  4. low blood solubility to assure rapid induction and recovery from anesthesia
  5. minimal metabolism
  6. compatible with epinephrine
  7. skeletal muscle relaxation
  8. suppresses excessive sympathetic nervous system activity
  9. not irritating to airways
  10. bronchodilation
  11. absence of excessive myocardial depression
  12. absence of cerebral vasodilation
  13. absence of hepatic and renal toxicity
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2
Q

effects of increased fluorination

A
  1. nonflammable
  2. decreased solubility ***
  3. decreased potency
  4. less toxic due to resistance to degradation
  5. decreased percentage metabolized
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3
Q

MAC is

A

minimum alveolar concentration (partial pressure) of an inhaled agent at 1 atmosphere that prevents skeletal muscle movement in response to a noxious stimulus in 50 percent of patients (ED50, potency)

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4
Q

____ greater concentration than MAC produces immobility in ___ of patients

A

10-30%

90-95%

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5
Q

what portion of the central nervous system determines MAC

A

spinal cord

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6
Q

____ is decreased resulting in immobility

A

spinal cord

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7
Q

perfusion of the brain alone with ordinary concentration does not produce ____

A

immobility (took up to 3-6X MAC)

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8
Q

use minimal alveolar concentration because alveolar reflects

A

the concentration at the cord or the brain most accurately

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9
Q

with alveolar concentration you must allow

A

for equilibration (generally about 10-15 min)

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10
Q

alveolar concentration is dependent on

A

agent (3-4 time constants)

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11
Q

as age increase, MAC

A

decreases 6% per decade

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12
Q

___ decreases MAC in all ages, but more so in the elderly

A

nitrous oxide

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13
Q

MAC is greatest in patients

A

less than a year of age

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14
Q

MAC decreases in nearly

A

50% in the elderly years

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15
Q

MAC from greatest to least

A

infants > children > neonates > adults

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16
Q

60% nitrous oxide causes about a ____ reduction in MAC normally

A

60%

more so in elderly

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17
Q

____ reduction causes MAC reduction

A

body temperature

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18
Q

MAC of desflurane is decreased almost in half by

A

a 10 degree C decrease in temp

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19
Q

MAC of ___ is not affected by body temperature

A

nitrous oxide

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20
Q

pregnancy decrease MAC due to

A

increased concentrations of progesterone

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21
Q

MAC decreases ___ through early postpartum and normalizes within ___

A

30%

12-72 hours

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22
Q

decreased CNS ___ decreases MAC

23
Q

possible causes of decreased CNS Na leading to decreased MAC

Study These Flashcards
A

dehydration, absorption of irrigant

24
Q

drugs that decrease MAC

Study These Flashcards
A
  1. opioids
  2. benzodiazepines
  3. barbiturates and propofol
  4. acute ETOH injection
  5. local anesthetics
  6. nitrous oxide
  7. clonidine and dexmedatomidine
  8. some beta-blockers
  9. some calcium-channel blockers
  10. adenosine
25
opioids have a ___ effect on MAC
ceiling
26
benzodiazepine decrease in MAC is
dose-dependent
27
the local anesthetic ___ IV decreases MAC
lidocaine
28
nitrous oxide effects on MAC
0.5 MAC of N2O plus 0.5 MAC of isoflurane are additive to 1 MAC of either drug alone
29
clonidine and dexmedetomidine decrease MAC by
decreasing central nervous system catecholamines and by hyperpolarization of CNS cell membranes
30
factors that decrease MAC
1. neuraxial opioids 2. PaO2 < 38 mmHg 3. BP < 40 mmHg 4. cardiopulmonary bypass
31
factors that increase MAC
1. red hair 2. drug induced increases in CNS catecholamine levels 3. hyperthermia 4. hypernatremia
32
red hair increased MAC due to
excess pheomelanin production (19%)
33
drugs that increase MAC
1. cocaine 2. ketamine 3. amphetamines
34
factors that do not alter MAC
1. gender 2. duration of anesthesia (isoflurane decreases) 3. body mass 4. arterial PaO2 > 50 mmHg 5. atrial PaCO2 < 80 mmHg 6. Hct > 10% 7. BP > 40 mmHg
35
MACawake is
the average of the concentrations immediately above and below those permitting voluntary response to command
36
MAC__ usually exceeds MAC___
awake amnesia
37
MACawake is affected by
age (decreases) and inhalation agent
38
the ratio of MACawake/MAC is not affected by
age as both decrease
39
for desflurane, isoflurane, and sevoflurane, MACawake is
about 1/3 of MAC
40
for halothane, MACawake is
more than 50% of MAC
41
for nitrous oxide, MACawkae is
more than 60% of MAC
42
the higher the MACawake/MAC ration, the __ the recovery
faster
43
the higher the MACawake/MAC ration, the poorer the
amnestic value
44
___ minimally affect MACawake
low dose opioids
45
low dose opioids ___ the MACawake/MAC ratio so, __
increases awakening should be more quickly
46
MACawake does not ensure return of
esophageal sphincter tone or return of pharyngeal function
47
concentration of inhaled agent may require levels of __ for patient safety
less than 0.1 MAC
48
MAC TE
MAC to allow tracheal stimulation (intubation)
49
to allow tracheal stimulation there needs to be:
1. no coughing or bucking during suctioning of pharynx 2. no movement or coughing within 1 min of extubation 3. no breath holding or larygnospasm after extubation
50
MAC TE is __ or __ MAC
equal to or exceeds MAC
51
MAC bar
minimum alveolar concentration that blocks autonomic response to surgical stimulus
52
MAC bar with 60% nitrous oxide for deflurane
1.3 MAC (1.9 MAC total)
53
MAC bar with 60% nitrous oxide for isoflurane
1.3 MAC (1.9 MAC total)
54
MAC bar with 60% nitrous oxide for sevoflurane
2.2 MAC

NUNA 681(pharm) (12 decks)

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