Inhalation anesthesia 3

Question 1

T/F: MAP decreases as concentration of desflurane, sevoflurane, and isoflurane increases, in a dose dependent manner.

Answer 1

True

Question 2

T/F: Increase in MAP reflects a decrease in systemic vascular resistance (SVR).

Answer 2

False

Question 3

T/F: Desflurane decreases MAP by decreasing CO/ direct myocardial depression.

Answer 3

False (Halothane)

Question 4

____ activates the sympathetic nervous system and increases SVR, which can lead to an increase in CVP and arterial pressure.

Answer 4

N2O

Question 5

Alterations in HR from inhaled anesthetic gases are a result of several variable. What are they?

Answer 5

Antagonism of SA node automaticity
Modulation of baroreceptor reflex activity
Sympathetic nervous system activation via tracheopulmonary and systemic receptors.

Question 6

T/F: Incremental increases in delivered concentrations of inhaled agents increase heart rates in patients.

Answer 6

True

Question 7

T/F: Responses in heath rate occurs at unique concentration for each agent.

Answer 7

True

Question 8

What is the heart rate response of Forane?

Answer 8

Starting at concentrations 0.25 MAC, a linear, dose dependent increase in HR is observed

Question 9

What is the heart rate response of Desflurane?

Answer 9

Minimal increase in HR at concentrations < 1 MAC

At concentrations ≥ 1 MAC , a linear, dose dependent increase in HR is observed

Question 10

What is the heart rate response of Sevoflurane?

Answer 10

HR does not increase until concentrations >1.5 MAC

Question 11

T/F: Cardiac index is minimally influenced by inhalation agents.

Answer 11

True

Question 12

T/F: TEE demonstrates that desflurane produces minor increase in EF compared with awake measurements.

Answer 12

True

Question 13

What gas would you avoid if pt. is known to have congenital long QT syndrome.

Answer 13

Sevoflurane (Safe if on B-blocker therapy)

Question 14

T/F: No data effectively demonstrates a difference in outcomes between inhalation and IV opioid anesthesia.

Answer 14

True

Question 15

What is coronary steal?

Answer 15

a reduction in perfusion of ischemic myocardium with simultaneous improvement of blood flow to nonischemic tissue.

Question 16

What might forane do to the heart vessels?

Answer 16

dilate small-diameter coronary arteries might cause a susceptible patient to develop regional myocardial ischemia as a result of coronary vasodilatation…. Questionable validity.

Question 17

What is ischemic preconditioning?

Answer 17

Protective benefits of volatile anesthetics against myocardial ischemia in setting of compromised regional perfusion.
Not related to alteration of myocardial oxygen supply-demand ratio.

Question 18

Ischemic preconditioning has two periods. What are they?

Answer 18

First period
1-2 hours after the conditioning episode.
Second period
Benefit reappears 24° later and can last as long as 3 days.

Question 19

What confers the protective activity to ischemic preconditioning?

Answer 19

Opening of mitochondrial adenosine triphosphate (ATP)-sensitive potassium channels (KATP) is the crucial event that confers the protective activity.

Question 20

T/F: Patients given a general anesthetic and who are on amiodarone can have significant dysrhythmias intraoperatively or postoperatively

Answer 20

True

Question 21

What do you do if atropine is not working for bradycardia?

Answer 21

Isoproterenol infusion

AV sequential pacing

Question 22

How long can Amiodarone and its major metabolites be detectable in plasma.

Answer 22

9 months.

Question 23

_________ respiratory rate and _______ tidal volume as anesthetic concentration ______.

Answer 23

Increased, decreased, increases

Question 24

Minute ventilation is relatively preserved, but the decreased TV leads to greater ______ space ventilation relative to alveolar ventilation.

Answer 24

dead

Question 25

T/F: Gas exchange becomes more efficient as anesthetic depth increases.

Answer 25

False (less)

Question 26

T/F:PaCO2 increases proportionate to anesthetic depth.

Answer 26

True

Question 27

Ventilatory stimulation response evoked by arterial hypoxemia is ________ by volatile anesthetics.

Answer 27

blunted

Question 28

Dose related blunting of the respiratory response to _________ CO2.

Answer 28

increased

Question 29

Cephalad _________ of the diaphragm and inward displacement of the rib cage occur from enhanced expiratory muscle activity. This results in a ________ in FRC.

Answer 29

displacement, reduction

Question 30

T/F:Atelectasis occurs in dependent areas of the lung and to a greater extent when spontaneous ventilation is permitted.

Answer 30

True

Question 31

T/F:Inhalation agents have major effect on the principle of “hypoxic pulmonary vasoconstriction”.

Answer 31

False (Limited)

Question 32

T/F: In the absence of bronchoconstriction, bronchodilating properties of inhalation agents are limited.

Answer 32

True

Question 33

What are the non-pungent inhalation gases?

Answer 33

Sevoflurane, halothane, and nitrous oxide

Question 34

What are the pungent inhalation gases?

Answer 34

Desflurane (>6% for mask induction) and forane

Question 35

T/F: Volatile agents decrease cerebral metabolic rate of O2 consumption in a dose dependent manner with N20 being the exception ~ increase CMRO2

Answer 35

True

Question 36

Nitrous oxide has what effect on the CNS?

Answer 36

Causes cerebral vasodilation Increases CMRO2 Coadministration of opioids, barbiturates, or propofol (not ketamine) counteract these effects.

Question 37

What occurs to the ICP after a MAC of greater than 1 with colatile anesthetics.

Answer 37

Increases

Question 38

T/F: Autoregulation is impaired at concentrations < 1 MAC.

Answer 38

True

Question 39

What is the most sensitive evoked potential of the CNS when using volatile agents?

Answer 39

Visual

Question 40

What is the most resistant evoked potential of the CNS when using volatile agents?

Answer 40

brainstem

Question 41

Evoked potentials may be abolished at ___ MAC.

Answer 41

1

Question 42

N20 and 0.5 MAC inhalation also abolish _______ potential.

Answer 42

evoked

Question 43

T/F: Low concentrations 0.2-0.3 MAC decrease the reliability of motor evoked potentials.

Answer 43

True

Question 44

What level must MAC get to for isoelectric pattern to predominate?

Answer 44

1.5-2

Question 45

Sevoflurane and ethrane may be associated with _________ activity on the EEG, especially at high concentrations.

Answer 45

epleptiform

Question 46

T/F: Inhalation agents produce a dose dependent skeletal muscle relaxation and enhance the activity of neuromuscular blocking drugs.

Answer 46

True

Question 47

What least to greatest what is the likely hood that a inhalation agent will trigger MH.

Answer 47

Desflurane

Question 48

T/F: Immune mediated liver injury can occure with all inhalation agents?

Answer 48

True

Question 49

What is the causative agent thought to cause liver damage with inhalation agents?

Answer 49

trifluoroacetate metabolite

Question 50

What inhalation agent show to increase or maintain hepatic blood flow?

Answer 50

Iso, des, sevo

Question 51

What will methoxyflurane produce and what does it cause?

Answer 51

inorganic fluoride, and nephrotoxicity

Question 52

Sevoflurane should only have how many hours of low fresh gas (<2 L/min)?

Answer 52

2 hours of MAC

Question 53

What does Nirtrous Oxide do and what does it cause?

Answer 53

inactivates methionine synthase, enzyme that regulate vitamin b12 and folate metabolism

Question 54

When is N2O contraindicated?

Answer 54

Preexisting vitamin B12 deficiency or underlying critical illness

Question 55

T/F: Full desiccation of conventional carbon dioxide absorbents containing sodium and potassium hydroxide causes degradation and carbon monoxide production from all volatile anesthetic agents regardless of temperature.

Answer 55

True

Question 56

T/F: Low fresh gas flow rates (exceeding normal minute ventilation) accelerate the desiccation of CO2 absorbents, and thus accelerated degradation of inhaled agents.

Answer 56

False (High)

Question 57

What determines the concentration of the anesthetic gas leaving the vaporizer?

Answer 57

Relative flow togas through the reservoir channel versus the bypass channel

Question 58

How is each inhalation gas container unique?

Answer 58

Temperature compensated Calibrated for individual anesthetic d/t differing vapor pressures Tilting or overfilling may lead to overdose if liquid anesthetic gets into bypass channel

Question 59

Vapor pressure of desflurane at sea level is ___mm Hg at __°C

Answer 59

700, 20

Question 60

T/F: A variable bypass vaporizer is used for desflorane.

Answer 60

False (Heated Vaporizer Tec 6)

Question 61

What is another name for desflorane?

Answer 61

Suprane

Question 62

T/F: At high altitudes, the partial pressure of desflurane will be lower at a give Tec 6 vaporizer setting and output concentration will be lower, leading to underdosing if no adjustments are made to account for higher altitude.

Answer 62

True