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inhaled 3 Flashcards

1
Q

when des/sevo/iso increase, MAP

A

decreases

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2
Q

decrease in MAP reflects a decrease in

A

SVR (dilation)

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3
Q

halothane decreases MAP by

A

decreasing CO

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4
Q

N20 causes ___ MAP

A

unchanged or mildly increased d/t activation of sympathetic nervous system

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5
Q

the substitution of nitrous for a portion of iso produces (cardiac)

A

less decrease in BP

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6
Q

increase gas concentration, HR will

A

increase

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7
Q

increase in HR during induction is seen with which gas

A

des .. (and iso?)

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8
Q

linear, dose dependent inc in HR is seen with iso starting at __ MAC

A

.25

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9
Q

linear, dose dependent inc in HR is seen with des at __ MAC

A

> 1

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10
Q

inc in HR is seen with sevo at ___ MAC

A

> 1.5 MAC

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11
Q

minimal increase in HR with des at concentrations __ MAC

A

<1 MAC

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12
Q

which gas effects EF

A

des- minor increase

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13
Q

do inhaled agents predispose the heart to PVC’s?

A

No, except halo

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14
Q

avoid ___ in patients with known long Qt syndrome

A

sevo

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15
Q

coronary steal

A

iso’s ability to dilate small-diameter coronary arteries might cause a susceptible patient to develop regional myocardial ischemia as a result of coronary vasodilation. not found valid

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16
Q

ischemic preconditioning

A

protective against myocardial ischemia in setting of compromised regional perfusion

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17
Q

first period of ischemic preconditioning

A

1-2 hours after the conditioning episode

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18
Q

second period of ischemic preconditioning

A

benefit reappears 24h later and can last as long as 3 days

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19
Q

as anesthetic increases, patients will breathe

A

faster and shallower (increased rate, decreased volumes)

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20
Q

anesthetic effect on minute ventilation

A

relatively preserved but the decreased TV leads to greater dead space ventilation relative to alveolar ventilation

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21
Q

gas exchange becomes ___ efficient as anesthetic depth increases

A

less

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22
Q

PaCO2 ___ proportionate to anesthetic depth

A

increases

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23
Q

anesthetic response to resp response to increased CO2 and arterial hypoxemia

A

blunted

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24
Q

anesthetic gases ___ FRC

A

decrease

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25
which gases are non-pungent
sevo, halo, n2O
26
which gases are pungent
des and iso. avoid with asthmatics and smokers
27
inhalation agents ___ CMRO2 (cerebral oxygen demand)
decrease
28
Do anesthetic gases have an effect on cerebral vascular response to changes in PACO2? yes/no
no
29
in normocapnic patients, cerebral vasodilation occurs at concentrations above __ MAC
0.6 (think about half) | but this effect is offset by decrease in CMRO2= no net change in CBF
30
at higher concentrations, >1 MAC, cerebral blood flow ___
increases, esp if systemic BP is maintained at awake values (be careful with neuro pt!)
31
n20 ___ CMRO2
increases
32
n20 causes cerebral ___
vasodilaton
33
***ICP increases with all volatile anesthetics at doses***
>1 MAC
34
auto regulation is impaired at concentrations
< 1 MAC
35
autoregulation maintains
MAP
36
evoked potentials may be abolished at
1 MAC
37
N20 and __ MAC inhalation abolish EP
0.5
38
isoelectric occurs at __ MAC
1.5-2
39
increased depth of anesthesia is characterized by___ amplitude and ___ synchrony on EEG
increased amplitude and synchrony on the EEG
40
which gas is associated with epileptiform activity on the EEG (can cause seizures)
sevo
41
neuromuscular effect of gases
dose dependent skeletal muscle relaxation and enhance the activity of neuromuscular blocking drugs
42
causative agent of hepatic damage
trifluoroacetate metabolite
43
compound A comes from the breakdown of
sevo and halo
44
compound A is toxic to the
kidneys
45
keep flows at at least ___ to prevent nephrotoxicity r/t compound A
2L/min
46
n20 is contraindicated for people with pre-existing vitamin __ deficiency
B12
47
nitrous inactivates methionine synthase.... affect on heart
its the enzyme that regulates vitamin b12 and folate metabolism. homocysteine levels also elevated, resulting in increased risk of adverse coronary events
48
preferential transfer of N20 causes the volume/pressure of air-filled cavities to ___
increase . compliant wall it will increase volume, non compliant wall it will increase pressure.
49
the blood gas coefficient for nitrous is ___ times greater than nitogen
34
50
high fresh gas flow rates ___ the desiccation of CO2 absorbents
accelerate
51
degradation is an ___ process, which may cause extremely high ___, esp with ___
exothermic , temps, sevo
52
iso and des produce ___ when exposed to ___ absorbent
carbon monoxide , desiccated
53
if you see an increase in inspiratory CO2, suspect
rebreathing - desiccated absorbent
54
which agents do we use variable bypass vaporizers
iso and sevo
55
variable-bypass is temperature ___
compensated
56
des vapor pressure
700mmHg at 20degrees C
57
heated vaporizer tec 6 heats des to ___ atm of pressure
2
58
tec 6 and altitude
does not altitude adjust - you have to!
59
___ causes bradycardia <1 mac *
sevo
60
whats the physio behind ischemic preconditioning?
opening of mitochondrial adenosine triphosphate (ATP)-sensitive potassium channels
61
how does the chest wall change
cephalad displacement of the diaphragm and inward displacement of the rib cage occur from enhanced expiratory muscle activity. this results in a reduction in FRC.
62
atelectasis...
occurs in dependent areas of the lung and to a greater extent when spot vent is permitted
63
at .5MAC, what happens to cerebral blood flow
the decrease in CMRO2 offsets the vasodilation such that cerebral blood flow does not change significantly
64
low concentrations 0.2-0.3 MAC decrease the reliability of ____evoked potentials
motor
65
which gas has lowest boiling point
des
66
reduce compound A risk by
low sevo,. high flow, use soda lime
67
inhaled moves CO2 response
down to the R
68
sevo is broken down to
inorganic fluoride
69
des and iso is broken down to
inorganic fluoride ions
70
principal catalyst for CO2 absorption in soda lime and baralyme is
sodium hydroxide
71
n20 ___ PVR
increases
72
CO production highest in
des > nef > iso
73
n20 __ CMRO2 and CBF
increases
74
volatile anesthetics produce a dose dependent ___ in cbf
increase
75
when vascular resistance is decreased, CBF, CBV, and CSFP ___
increase
76
at high altitudes, partial pressure of des will be ___, so you will ___ someone If no adjustments are made.
lower, under dose.

Pharmacology (10 decks)

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