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Inhalational Agents Flashcards

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1
Q

First Ether demonstration

A

1846 – William Morton Massachusetts General Hosp.

everyone was exposed to ether lol

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2
Q

Vapor

A

gaseous phase
at a temp where the substance can be either liquid or solid
below its critical temp

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3
Q

Potent inhaled are mostly in the liquid state at which T and atm?

A

room temperature (20 C)
atmospheric pressure (760 mm Hg)

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4
Q

Heat of vaporization

A

calories required: 1 g liquid —> vapor
(w/o changing temperature)

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5
Q

Boiling point

A

temperature at which vapor pressure equals atmospheric pressure (760 mmHg)

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6
Q

Desflurane VP

A

669 mmHg

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7
Q

Variable bypass vaporizer mechanism

A

total gas flow is divided in two streams by a variable resistance proportioning valve

small amount enters a vaporizing chamber, acts as carrier gas

majority travels through a bypass line.

DES DOES NOT USE THIS

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8
Q

Tech 6 Vaporizer (Desflurane)

A

39 C

Raises Vapor Pressure = no need for carrier gas

Dual circuit: fresh/diluted gas separate from vaporizing pressure

Desflurane added directly to fresh gas

vaporizer dial: delivers concentration

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9
Q

T/F
In a Tec 6 Vaporizer, fresh gas mixes with the desflurane.

A

False
Fresh gas and IA mix = variable BP

Tec 6: Des directly added to fresh gas

this is the main difference btwn VB and tec 6

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10
Q

T/F
The Tec 6 does not use a carrier gas mechanism.

A

True
Tec 6 increases the vapor pressure, so that a carrier gas is not needed.

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11
Q

The perfect IA

A

doesn’t exist lol

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12
Q

Ideal IA

A

-non-pungent
-non-flammable
-fast induction
-fast wake-up
-no harmful metabolites

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13
Q

Nociception

A

CNS and PNS processing of noxious stimuli

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14
Q

T/F
Gases can provide muscle relaxation

A

true

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15
Q

most noxious stimulation from anesthesia

A

intubation

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16
Q

General anesthesia

A

reversible state of “loss of sensation”

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17
Q

Which phases are affected by the pharmacodynamics and pharmacokinetics of the inhalational anesthetics?
induction
maintenance
emergence (redistribution)

A

all 3

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18
Q

An Anesthetic state is obtained with a combination of… (3)

A

amnesia, analgesia and lack of response to noxious stimuli

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19
Q

don’t rely on one agent

A

Balanced anesthesia

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20
Q

Myer-Overton Theory

A

(IA)
high lipid solubility = high potency

higher solubility = lower MAC

Mac determines potency

depth of anesthesia is determined by the number of anesthetic molecules that are dissolved in the brain

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21
Q

Unitary Hypothesis

A

All inhalational anesthetics work via a similar mechanism of action but not all the same sites

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22
Q

IA MoA bottom line

A

don’t know for sure where/how they work

Enhancing inhibitory sites/receptors (GABA, Glycine)

Inhibits excitatory channels (Glutamine)

Inhibits calcium channels (Ca2+) & K

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23
Q

Immobility is mediated principally by the effects of inhalationals on the ___.

A

spinal cord

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24
Q

The ultimate effect of an IA depends on…

A

reaching a therapeutic level in the CNS/Brain/Spinal Cord

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25
Sites of Anesthetic Action Unconsciousness
Reticular activating system (Cortex, thalamus, brainstem)
26
Sites of Anesthetic Action Analgesia
Spinothalamic tract
27
Sites of Anesthetic Action Amnesia
Amygdala, hippocampus
28
Sites of Anesthetic Action Immobility
Ventral horn (immobility: spinal cord mediated)
29
_____ activity causes motor effects.
SPINAL CORD
30
T/F Sevo stinks.
False
31
T/F Des smells good.
False pungent
32
Most polluting IA
Desflurane
33
Most expensive IA
Desflurane
34
Which IA works on one specific site of action?
None currently only act on 1 site
35
T/F Ideally, IAs should not be water-soluble.
True LESS W. SOLUBLE = GOOD we don't want it to stay in the blood; we can use pressure to get it in there
36
N2O has a ___ smell.
sweet
37
SEDLINE monitoring
gives 4 leads of EEG Looks at both frontal lobe hemispheres Lots of blue = asleep
38
Burst suppression
flat EEG; too much anesthetic
39
Amnesia and LOC occur at (lower/higher) levels while immobility occurs at much (lower/higher) levels.
Amnesia & LOC = lower doses Immobility = higherrrr
40
Which route allows us to physically observe all Guedel stages?
IA (IV occurs too quickly)
41
Guedel’s Stage I
I: induction to loss of consciousness
42
Guedel’s Stage II
Delirium + “excitement” period pupils dilated disconjugate gaze increased RR/HR **High risk of laryngospasm/bronchospasm** b/c reflexes come back but cant control Caution when removing airway Minimal extra touching/stimulation
43
Why is Guedel stage II assoc. w/ risk of laryngospasm/bronchospasm?
reflexes come back but cant control
44
Guedel’s Stages III
Surgical plane, fixed gaze, constricted pupils WE LIKE!
45
Guedel’s Stage IV
Overdose absent/shallow/irregular RR -hypoTN/profound CV collapse -dilated/unresponsive pupils almost ded lol
46
T/F Pts pass thru all Guedel stages into anesthesia and on emergence.
True I to IV and back up to I
47
Which Guedel stage is assoc. w/ disconjugate gaze?
II
48
Vital capacity breathing IA
exhale completely and take deepest breath --> speeds induction (VC: the volume of exhaled air after maximal inspiration)
49
Nitrous can help speed induction through.....
the second gas effect
50
Tidal Volume breathing IA
TV: breathing normal tidal volumes Slower than IV **Gradual increase** of a high concentration
51
Humans have a constant gas flow of
2-3 L/min
52
If using TV breathing with IA, how long until total plane of anesthesia?
9 mins
53
Which technique reaches total plane of anesthesia faster? VC TV
VC
54
T/F VC breathing IA is the quickest way to reach total plane of anesthesia.
False IV is quickest however, VC is faster than TV (diff is small)
55
Agents for Inhalational Induction
N2O/O2 (70%:30%) and Sevoflurane (7-8%) until induced
56
⭐️ Can you use Desflurane for a mask induction?
Not reccomended; pungent, coughing
57
T/F Volatile agents can also relax airway smooth muscle and produce bronchodilation
True
58
benefits of not provoking an irritant response
Less: **breath holding** coughing secretions **laryngospasm**
59
T/F IAs can break status asthmaticus.
False cannot drive enough
60
IA advantages
Less traumatic No IV access Short pediatric case Bronchodilator effect
61
IA Disadvantages
Smell/Irritant **Excitatory stage (II)** **Delayed airway** (b/c have to wait until stage II over) Gas bypassing scavenger system
62
⭐️ Minimum Alveolar Concentration (MAC)
inhalational anesthetic/alveolar [ ] at which 50% of the population will not move to painful or noxious stimulus (e.g., surgical incision)
63
⭐️ MAC is a direct measure of...
the potency of the volatile anesthetic
64
⭐️ The IA [ ] in the alveoli is equal to...
The IA [ ] in the brain
65
⭐️ Lower MAC = (more/less) potent
more lower dose necessary to achieve [ ] = more potent
66
⭐️ MAC mirrors ____ partial pressure
brain
67
⭐️ T/F MAC values are additive
True 0.5 MAC of N2O + 0.5 MAC of Sevoflurane = effect of 1.0 MAC anesthetic
68
T/F MAC Young/healthy pts need lower
False they need more
69
⭐️ MAC-BAR
MAC needed to Block Autonomic Responsiveness to painful stimuli 1.5-2.0 MAC
70
⭐️ Typical MACBAR values
about 1.5-2.0 MAC (varies according to resource)
71
⭐️ MAC-awake
alveolar concentration at which patient opens their eyes 0.4-0.5 = unconsciousness 0.15 = regain
72
⭐️ MAC value of LOC
0.4-0.5 = unconsciousness
73
⭐️ MAC value to regain consciousness
0.15
74
⭐️ MAC value: awareness/recall (Not the same as MAC awake)
0.4-0.5
75
⭐️ MAC value that will prevent movement in 95% of surgical patients
1.2-1.3
76
T/F MAC is the IA/alveolar [ ] that will block autonomic response to pain.
False MAC: 50% won't move to painful/noxious stimulus MACBAR: MAC that Blocks Autonomic Responsiveness to pain
76
⭐️ Know dis
77
IA potency most to least potent
Iso > Sevo > Des > N2O "I'm So Dead Now"
78
Desflurane: potency lipophilicity onset clearance
less potent high lipophilic fast onset fast expiratory clearance
79
T/F higher MAC = higher lipid solubility
False higher MAC = LOWER lipid sol.
80
Des Dial for 1 MAC VP
Dial 6.6 VP 669
81
N2O Dial for 1 MAC VP
Dial 104 VP 38,770
82
Iso Dial for 1 MAC VP
Dial 1.17 VP 240
83
Sevo Dial for 1 MAC VP
Dial 1.8 VP 157
84
No Change in MAC
Duration of anesthesia **Anesthetic metabolism** **Hyperkalemia** **Hyper/Hypocarbia** Gender Thyroid function (not directly) **Metabolic alkalosis**
85
T/F Thyroid fxn directly alters MAC.
False not directly
86
Increases MAC
Hyperthermia Excess catecholamines (MAO inhibitors, cocaine, ephedrine, levodopa, amphetamine abuse) Excess pheomelanin production (true redhead) Hypernatremia Chronic ethanol abuse
87
We would expect a (higher/lower) MAC in a chronic drinker.
higher
88
Hypernatremia (increases/decreases) MAC. Hyponatremia (increases/decreases) MAC.
HyperNa = increase MAC HypoNa = decrease MAC “MAC is high in sodium”
89
Ephedrine (increases/decreases) MAC.
increases
90
Decreases MAC
Hypothermia Benzos > 40Y Pregnancy Alpha agonists (Precedex) Acute alcohol ingestion Hyponatremia Induced hypotension (MAP<50) Lots of drugs (Lidocaine, Lithium, Ketamine, opioids, benzos) Severe anemia/traumatic blood loss
91
We would expect a trauma pt w/ blood loss to have (increased/decreased) MAC.
decreased
92
We would expect a pregnant pt to have (increased/decreased) MAC.
decreased d/t uterine atony & increased Vd
93
Opioids and benzos (increase/decrease) MAC.
decrease
94
HypoTN (increases/decreases) MAC.
decreases MAP <50
95
T/F All IAs are rapid acting.
True
96
Only true gas
N2O; rest are mixed
97
Potent inhaled anesthetics are vapors of
volatile liquids
98
Why do IAs diffuse rapidly?
nonionized low molecular weights
99
Major advantage of IAs
delivered to the bloodstream via the lungs
100
Know dis too
ugh
101
T/F IAs are heavily metabolized by the body.
False
102
Which IA is metabolized by the body the most?
Sevo
103
Inhaled gases quickly transfer bidirectionally (when dial is at ___) via...
dial = 0 lungs <--->bloodstream <---> CNS
104
⭐️ Gases are delivered and removed by...
ventilation thru the lung
105
T/F Plasma and tissues have a high capacity to absorb the anesthetic
False low capacity
106
bidirectional flow
high vaporizer [ ] = into lungs low vaporizer [ ]= exhausted out of pt as they expire
107
When does PCNS = PBlood = PAlveolar ?
at equilibrium EtCO2 constant
108
Constant rate of EtCO2 = reached equilibrium (assuming no changes in ____)
delivery
109
Expired [ ] is measured from...
venous blood returning to alevolus
110
increases the speed of onset of inhaled anesthetics
High inspired concentration (FI) High alveolar minute ventilation Low blood solubility High MAC
111
Higher gas delivery = (higher/lower) FI
higher
112
Why do we want low blood solubility for faster IA onset?
Low blood solubility: will not sit in blood; will cross into brain rapidly higher blood solubility = will sit in blood; requires saturating systemic circulation (wait longer)
113
Lower blood solubility is preferred with IAs. How do we get into into circulation to reach the brain?
drive across capillary membrane with high alveolar [ ]
114
T/F The high water solubility of IA's allow them to act quickly.
False Their low blood solubility allows fast onset IA's do not sit in blood and cross into brain quickly
115
FGF
fresh gas flow flowmeter settings & vaporizer [ ]
116
FI definition depends on...
inspired gas concentration FGF, breathing circuit volume & circuit absorption
117
The common gas outlet sensor senses the: FGF FI FA Fa
FI inspired gas concentration
118
T/F FA can be measured directly.
False End tidal detection of returning volatile thru expiratory limb
119
FA definition depends on...
alveolar gas uptake, ventilation, the concentration effect & second gas effect
120
Fa definition depends on...
arterial gas affected by ventilation-perfusion mismatch
121
We want our Et [ ] to equal ___ for that particular agent.
1 MAC
122
FA (alveolar gas) reflects [ ] in ....
brain and spinal cord not to be confused with Fa (arterial gas)
123
T/F FA (alv. gas) is always less than the vaporizer [ ].
True ~0.4-0.6 less adjust vaporizer [ ] so that Et correlates with 1.0 MAC
124
Gives info on MAC FA or Fa
FA (alveolar gas)
125
T/F Fa tells us how much gas is being absorbed.
False FA (alveolar gas) does
126
arterial gas [ ] in blood/cap bed on the other side of avleolus that's picking up the gas
Fa
127
Goal of Inhalational Anesthesia
anesthetic state in the CNS/Brain optimal and constant partial pressure of anesthetic in the brain (Pbr)
128
Increased Induction or Fast Recovery
High fresh gas flow Small breathing circuit Less absorption
129
Organ of uptake for inhalation agents is the
LUNGS
130
Target Organs
Brain and spinal cord
131
⭐️ Solubility in the ___ determines speed of onset
blood (not lipid solubility!)
132
When we talk about solubility with IAs, we are referring to (blood/lipid) solubility.
blood (water) insoluble= faster; crosses into brain soluble= slower; stays in blood
133
Faster induction is achieved with an (insoluble/soluble) IA.
insoluble taken up much slower by the blood faster induction does not want to enter/stay in blood
134
Solubility of an anesthetic is expressed as
Partition Coefficients
135
Partition Coefficients
ratio IA [ ] in blood phase : gas phase (at equilibrium between the two phases)
136
Higher blood : gas coefficient means
highly blood soluble
137
Most to least blood soluble
Halo > Iso > Sevo > N2O > Des "Hate Ice So No 2 Drinking"
138
Overpressure technique
speeds induction for blood soluble agent increase inhaled [ ] speeds up equilibrium
139
Which has faster induction/wakeup? Iso or Des
Desflurane 0.42 (Poor bld Solubility) Rapid induction/wakeup
140
⭐️ T/F Insoluble IAs have faster onset.
True insoluble IA = not water soluble will not sit in blood crosses into brain
141
Parallels anesthetic requirements
Oil:Gas Partition Coefficients B/c brain & SC = lots of lipids
142
⭐️ Potency of volatile agents correlates w/
physical property of lipid solubility **potency = lipid sol. onset = w. sol
143
⭐️ T/F higher MAC = higher B:G coefficient
False higher MAC = lower B:G coefficient
144
Decrease in potency is associated with
a decrease in the oil:gas partition coefficient
145
How does increased CO affect IA uptake?
higher CO = higher lung blood flow more rapid uptake more removed from alveolar [ ] constantly have to refresh [ ]
146
Increased CO = (shorter/longer) induction time
longer induction time **longer time for IA to reach equilibrium (alveoli & brain)
147
(high/low) solubility agents are more effected by changes in CO.
High
148
(high/low) solubility agents are rapid onset regardless of CO changes.
low
149
Decreased CO = ___ PA (Alveolar blood flow)
Slow flow = pick up more
150
A-vD
tissue uptake of inhaled anesthetics never will be 1:1 d/t tissue extraction!
151
Transfer of anesthetic from blood to tissue is determined by:
Tissue solubility Tissue blood flow (perfusion) Arterial blood/tissue partial pressure difference
152
The brain and spinal cord are vessel (rich/poor)
Rich
153
(VRG/VPG) gets IA first
VRG
154
Inhalational agents are very (blood/lipid) soluble
lipid
155
Greater affect on emergence than induction d/t...
Diffusing out of tissues (reservoir for drug)
156
(Fat/blood) equilibrates slower due to ___.
Fat perfusion (fat is vessel poor)
157
What do this graph tell us?
Gas builds in alveoli the fastest When gas is turned off: -[ ] drops rapidly in alveoli and VRG -[ ] in muscle and fat are now higher **shows why effects of gases are still evident on emergence**
158
FA/FI
Ratio alveolar [ ] anesthetic/inspired anesthetic over time
159
⭐️ alveolar fraction is directly proportional to...
the partial pressure of the anesthetic in the brain (CNS)
160
3 time constants = __% of max theoretical value of anesthetic
95
161
Anesthetic [ ] in gas circuit follows which order of kinetics?
first
162
How to lower number of time constant
higher gas flow decrease FRC (supine) low dead space
163
How can we increase the FI?
Increase the fresh gas flow Increase the ventilation Decrease the Functional Residual Capacity (FRC)
164
T/F Supine pts will experience Equilibrium of FA/FI faster.
True Supine = decreases FRC decreased FRC = increased FI
165
Uptake (increases/declines) as the tissues become saturated
declines
166
Augmented gas flow
absorbed gas replaced by FGF (new gas) we refresh by giving FGF plus IA
167
⭐️ achieves a faster rate of rise of FA/FI
N2O Desflurane is less soluble in blood, but the volume of Nitrous compensates for the minimal difference in solubility
168
Second Gas Effect
Uptake large volume of first/primary gas (ie: Nitrous) from alveoli sharper increase in PA of second gas
169
Factors that are responsible for the concentration effect also control
the second gas effect
170
Factors responsible for the [ ] effect & control the second gas effect
Increasing ventilation Concentrating the IA
171
Second Gas Effect is associated with which law?
Fick's Law of Diffusion all about [ ] gradients
172
V/Q mismatch may occur in
R mainstem bronch intubation
173
T/F Ventilation/Perfusion mismatch can affect the uptake and distribution of the inhaled anesthetics
True
174
Longest recovery time (gas)
Iso "Iso slow"
175
⭐️ Concentration of Inhaled anesthetics in the tissues at the end of anesthetic depends on...
the solubility of the agent and time of administration
176
⭐️ Exhaled gases from the patient containing anesthetic will be rebreathed unless
fresh gas low rates are >5L/min
177
T/F Return of spont. breathing can cause increase in expired IA
True spont breathing has greater lung recruitment
178
T/F During emergence, can permissively let CO2 climb to trigger brainstem breathing reflexes
True esp sleep apnea
179
T/F Recovery is exact mirror of induction
True
180
T/F Long induction = long recovery
True
181
Primary factor in recovery/exhalation
Anesthetic solubility others: circuit volume increased CBF CO increase ventil8n & FGF
182
non-pungent
Sevoflurane, Halothane, and Nitrous "Smells Hella Nice"
183
pungent
Isoflurane Desflurane "I'm Dead"
184
⭐️ dose dependent IA changes in resp parameters
Increase: RR, PaCO2 Decrease: TV, MV
185
IAs (increase/decrease) MV.
decrease gradually
186
How IA affects respiratory parameters
increased: RR PaCO2 Decrease: TV MV
187
How do IAs increase PaCO2?
Dose dependent depression of the ventilatory response to hypercarbia
188
⭐️ T/F all IA's cause bronchodilation
true
189
Which IA should we not give to a smoker?
Des airway irritant
190
Inhalationals (except N2O) CV effects
reduce MAP, CO, and CIndex in (dose-dependent) Reduce BP --> decrease in SVR (relaxes vascular smooth muscle)
191
N2O hemodynamic effects
Activates SNS increases SVR, CVP & art.pressures
192
Nitrous + inhalationals CV effects
increase SVR help support BP balance each other out: N20 inc HR but temper with IA
193
can increase HR and BP due to the sympathetic stimulation
!!! Desflurane Isoflurane
194
has an irritant effect (gas)
Des "Stop it, Des irritating me"
195
minimal effect on HR (inhaled agent)
Sevoflurane "Sevo the heart saver"
196
Use ___ to blunt tachycardic effects of some IAs
opioids
197
T/F IAs lower the CO.
False Cardiac Output is well preserved with minimal effect
198
T/F IAs decrease SVR, leading to hypoTN.
True
199
T/F IAs are coronary vasodilators.
True
200
T/F IAs cause myocardial depression.
True
201
⭐️ Coronary Steal
Diversion of blood from a myocardial bed with limited or inadequate perfusion to a bed with more perfusion (Dilation pulls blood away from areas that usually lack oxygenation) currently debated
202
T/F All inhalationals increase Cardiac Blood Flow less than the myocardial oxygen demand
False increase blood flow more than O2 demand
203
IA CNS effects
increases: CBF (vasodilation cerebral BVs) ICP (N2O) decreased: Cereb. metab rate
204
How to attenuate increased ICP from IAs.
Hyperventilation
205
T/F All volatiles cause dose-dependent: increase in latency decrease amplitude in all cortical SEPs
True "I'm late b/c my cortical sep isn't working"
206
IA OB effects
Mag + too much IA = uterine atony and bleeding! dose-dependent decreases in uterine smooth muscle contractility and blood flow
207
⭐️ OB IAs cause undesired effects for uterus at which flows?
(risk uterine atony from too much relax8n) Modest: 0.5 MAC substantial: >1 MAC
208
OB We want to keep volatile dosing as low as possible. What can we do to reduce it?
Nitrous can decrease the need for volatile anesthetics
209
____ degradation with the older carbon dioxide absorbents = compound A
Sevo
210
Renal concerns with Compound A
nephrotoxic in rats
211
IAs are most commonly biodegraded by...
hepatic metabolism cytochrome P-450 oxidation **Keep in mind: minimal liver metabolism
212
Depolarizing and nondepolarizing muscle relaxants have an additive effect/potentiates IA's; except for ____
Suxx gone too quick
213
How do IAs relax skeletal muscle?
Reduced CNS neural activity Prominent postsynaptic effect at NMJ
214
Inhalationals ____ recovery from nondepolarizing muscle relaxants
delay synergsitic effect
215
Which pt population is prone to emergence delirium with IAs?
Children Put back to sleep re-emerge usually w/o stage II
216
Emergence delirium duration how to treat
10-15 minutes propofol, midazolam, **clonidine**, dexmedetomidine, ketamine, opioids
217
T/F Emergence Delirium can resolve spontaneously
true
218
Emergence Delirium is more common with ___ and ___ compared to Iso & TIVA.
Des Sevo "they be on some **D**umb **S**hit"
219
Compound A
Degradation of Sevoflurane by strong bases (soda lime) in the CO2 absorbers
220
increases chances of compound A
low flow rates closed circuit warm/dry CO2 absorbents
221
Induced Nephrotoxicity risk factors
Sevo: >2 MAC hours FGF <2 L/min
222
degradation product of volatile agents(especially Desflurane) due to dry/desiccated CO2 absorbents
C. Monox
223
Monday morning phenomena contributes to ___ production
CO
224
Dry CO2 absorbers produce ___.
CO
225
Optimal CO2 absorbent size
2.5 mm 4-8 mesh
226
CO2 absorber channeling
loose packing allowing exhaled gases to bypass absorber granules in the canister
227
⭐️ Final Products of CO2 Neutralization
Ca carbonates, water and heat
228
T/F Ideal CO2 absorbents have high resistance to gas flow.
False low resistance
229
Turns sodalime purple
ethyl violet
230
T/F Current CO2 absorbers use NaOH or KOH.
False contain Calcium or lithium hydroxides strong bases + sevo = compound A
231
what kind of compound is Compound A?
vinyl ether
232
⭐️ Other than turning purple, what indicates our CO2 abs. is exhausted?
rising ETCO2 waveform on capnograph
233
Why does des need diff vaporizer?
Vapor pressure close to atm
234
Vapor Pressure
The pressure exerted by a vapor in equilibrium with its liquid or solid phase inside of a closed container
235
Vapor pressure is ____ proportional to temperature
directly
236
T/F All anesthestic gases used today are based off ethers.
False N2O is not an ether
237
⭐️ Who dis
Isoflurane 5 fluorine atoms and 1 chlorine atom
238
⭐️ Who dis
N2O
239
Who is she?
Sevoflurane 7 fluorine atoms (sevo=seven)
240
New phone, who dis?
Desflurane 6 fluorine atoms
241
⭐️ Which IA is not chiral?
Sevo "Sevo's So different"
242
Isoflurane (Forane)
**Halogenated methyl ethyl ether** **Coronary Steal** **Low flow OK, resistant to degradation** B:G Coeff 1.46 (soluble) Vapor Pressure 238 Decrease MAP (d/t dec. SVR) Increase CBF most potent pungent
243
Sevoflurane (Ultane)
**Fluorinated methyl isopropyl ether** bronchodilator Minimal sympathetic activation **Compound A** B:G coefficient of 0.65 VP 157
244
Desflurane (Suprane)
**Fluorinated methyl ethyl ether** **Carbon Monoxide if dry absorber** Insoluble (faster sleep & wake) **potential irritant** over 1 MAC B:G 0.42 VP 669 **SNS stimulation** (Increased HR and BP)
245
T/F You cannot fill the Tec 6 vaporizer while its in use.
False Can fill the vaporizer during use
246
⭐️ T/F volatiles decrease incidence of PONV.
FALSE all volatile agents increase PONV
247
T/F N2O is a triggering agent for MH.
False It is not
248
T/F N2O does not offer muscle/uterine relaxation, as opposed to other IAs.
True
249
⭐️ N2O diffusion & solubility
Diffusion into closed spaces INSOLUBLE Nitrous is 34x more soluble than N2, both are insoluble (increase in volume and pressure with the closed space)
250
When to avoid N2O
bowel cases pneumothorax/blebs venous air emboli middle ear surgery some eye surgeries
251
T/F N2O is an analgesic.
True
252
⭐️ N2O inactivates ________, a key enzyme in folate metabolism. This affects vitamin ____.
methionine synthetase B12 pic: "inactivation of vitamin B12 by nitrous oxide"
253
N2O can cause ____ in a noncomplicant airspace, esp it pf does not have a chest tube.
tension pneumothorax
254
In a fixed/noncompliant airspace, N2O will increase ____.
pressure
255
In a compliant airspace, N2O will increase ____.
volume
256
______ effects responsible for PONV
Middle ear
257
⭐️ best approach to prevent operating room pollution with anesthetic gases and reduce wastage
Shut off FGF (not vaporizer) during intubation or airway instrumentation
258
⭐️ Diffusion Hypoxia is SPECIFIC TO
N2O
259
Diffusion Hypoxia
1. nitrous stopped abruptly 2. reverses prtl pressure gradients 3. nitrous: blood --> alveoli washout of high N2O [ ] lowers alveolar [ ] of oxygen and carbon dioxide
260
How to avoid diffusion hypoxia
Stop nitrous early initiate recovery from N2O anesthesia with 100% oxygen rather than less concentrated O2/air mixtures.
261
how does diffusion hypoxia affect respiratory drive?
decreases (Diluted PACO2)
262
MAC of ____ will decrease potential for intraop awareness
0.4 - 0.5
263
Malignant Hyperthermia
massive release of Ca from sarcoplasmic reticulum Ryanodyne receptor (RYR1) Induced by inhalational agents and succinylcholine
264
T/F O2 will displace N2O
False N2O displaces O2
265
T/F Early signs of MH include increased temperature.
False this is a late sign
266
First sign of MH
unexplained rising EtCO2
267
Determines bill for gases
FGF
268
(low/high) solubility needs less FGF.
low solubility = less FGF
269
T/F All volatiles are greenhouse gases.
True
270
How long does Des last in atmosphere?
14 Yrs
271
chlorofluorocarbon that directly contributes to the destruction of the ozone layer
N2O
272
atmospheric lifetime of 114 years
N2O
273
Minimizing IA pollution
✅sevoflurane & isoflurane ❌desflurane & nitrous oxide Total intravenous anesthesia (TIVA)
274
Which takes priority when choosing anesthetic? Environmental effect Patient Safety
Patient Safety Earth can't sue me, but the patient/family sure can
275
Henry's Law
More Dissolved gas = higher partial pressure
276
Graham's Law
277
Ideal Gas Law
volume of a gas is directly proportional to mass entire mixture behaves just as if it were a single gas
278
LeChatelier's Law
279
Fick's Law of Diffusion
gas: high [ ] area --> low [ ] area proportional to the concentration gradient

Gen Exam 2 (7 decks)

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