Inhalation Pt 2 Desflurane

Question 1

Desflurane is a ____ methyl ethyl ether

Answer 1

Fluorinated

Question 2

Which inhalation agent is the gold standard?

Answer 2

Isoflurane

Question 3

Fluorination is responsible for ___

Answer 3

The loss of anesthetic potency and decreased flammability

Question 4

What is the only difference between Desflurane and Isoflurane?

Answer 4

Substitution of a fluorine atom for Isoflurane’s chlorine atom (just one atom)

Question 5

Iso and sevo are liquids/gases

Answer 5

Liquids

Question 6

Desflurane is liquid, but is packaged in ____ because ____

Answer 6

Special bottle
Boiling point is at 23.5 degrees celsius (can boil at room temp)

Question 7

Desflurane’s B/G λ

Answer 7

0.42

Question 8

Which agent is the least soluble of all potent inhalations agents?

Answer 8

Desflurane

Question 9

Desflurane’s molecular weight:

Answer 9

168

Question 10

Desflurane’s vapor pressure:

Answer 10

Highest vapor pressure of all inhalation agents…. 669 mmHg at 20 degrees C

Question 11

At high altitudes… you must dial a ____ concentration to get same effect with ____

Answer 11

Higher
Desflurane

Question 12

Desflurane MAC

Answer 12

6.0

Question 13

Desflurane’s % required in inhaled mixture:

Answer 13

4-11%

Question 14

Is Desflurane a good mask induction agent? Why?

Answer 14

No
Bad odor, larynx irritation, increased salivation, cough, breath holding, laryngospasms

Question 15

Airway resistance is most common in ____ with what drug?

Answer 15

Children with reactive airways
Desflurane

Question 16

Desflurane maintenance dose in adults and maintenance dose in children

Answer 16

Adults: 2.5-8.5%
Children: 5.2-8.5%

Question 17

Desflurane’s respiratory decreases (3)

Answer 17

Dose dependent decrease in TV
Minute ventilation slight decrease
Decreased ventilatory response to PaCO2

Question 18

Which inhalation agent is the most pungent?

Answer 18

Desflurane

Question 19

Desflurane’s respiratory increases (1)

Answer 19

Rate

Question 20

Desflurane is poor for mask induction, but a good ____

Answer 20

Bronchodilator

Question 21

Desflurane’s concentration > 1 MAC may increase…

Answer 21

Heart rate

Question 22

What measurement is the best guide to anesthetic depth?

Answer 22

BP (see a dose dependent decrease in BP because of vasodilation)

Question 23

Rapid increase in Desflurane concentrations lead to ____

Answer 23

Transient increase in HR, BP, and catecholamine levels (des > iso)

Question 24

Which agent should not be used as a sole induction agent where increased BP or HR would be undesirable (ex CAD)?

Answer 24

Desflurane

Question 25

Does Desflurane increase coronary artery blood flow?

Answer 25

NO, it does not increase coronary artery blood flow. There is NO CORONARY ARTERY STEAL

Question 26

ALL volatile agents increase ____ in patients with space occupying lesions

Answer 26

ICP

Question 27

Desflurane's CNS effects: Increases (2)

Answer 27

ICP CBF

Question 28

Desflurane's CNS effects: Decreases (1)

Answer 28

CMRO2

Question 29

Desflurane is not indicated in what kind of surgery?

Answer 29

Neuro

Question 30

What is an easy way to decrease ICP?

Answer 30

Hyperventilate patient

Question 31

Desflurane ____ both depolarizing and nondepolarizing neuromuscular blocking agents

Answer 31

Potentiate

Question 32

Desflurane + depolarizers... you should decrease maintenance by ***Not induction

Answer 32

30%

Question 33

Desflurane + nondepolarizers... you should decrease maintenance by ***Not induction

Answer 33

50%

Question 34

Desflurane is a trigger for ____

Answer 34

Malignant hyperthermia

Question 35

Do isoflurane and sevoflurane trigger MH?

Answer 35

Yes

Question 36

Fat/blood λ of Sevoflurane

Answer 36

47

Question 37

Fat/blood λ of Isoflurane

Answer 37

45

Question 38

Fat/blood λ of Desflurane

Answer 38

27

Question 39

Which agent is preferred for bariatric surgeries?

Answer 39

Desflurane

Question 40

Desflurane rapid induction and rapid recovery produces...

Answer 40

Greater nausea/vomiting than seen with Propofol

Question 41

Desflurane's biotransformation:

Answer 41

<0.1% Very minimal, the LEAST of all volatile agents

Question 42

Desflurane degradates to ___

Answer 42

Carbon monoxide when exposed to dry CO2 absorbents

Question 43

Desflurane biotransformation most to least carbon monoxide production:

Answer 43

Desflurane ----> Isoflurane

Question 44

Desflurane's advantages:

Answer 44

Control over depth of anesthesia Hemodynamic stability Rapid recovery and early neuro assessment Advantages in elderly and obese Renal advantage

Question 45

Desflurane's disadvantages:

Answer 45

Cerebral vasodilation and increased ICP Atmospheric pollution ***CAN TRIGGER MH***