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NGR6462 Pharm & Chem Anesthesia I > Inhaled Anesthetics > Flashcards

Inhaled Anesthetics Flashcards

1
Q

Function of the Respiratory System

A
  • Gas exchange
  • Acid-base balance
  • Phonation
  • Pulmonary defense
  • Metabolism
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2
Q

• Upper Airway Function

A

Humidification and filtration of inspired air.

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3
Q

Tracheobronchial tree function

A

conduct gas flow to and from the alveoli

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4
Q

alveoli generations present secondary to dichotomous division

A

23

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5
Q

How many alveoli are present for gas exchange?

A

300 million

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6
Q

Gas exchange begins at generations

A

17-19

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7
Q

Largest alveoli are found where?

A

Apex

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8
Q

Function of the THIN side of alvoli?

A

gas exchange

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9
Q

Function of the thick side of alveoli?

A

Structural support

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10
Q

Supplies circulation to the tracheobronchial tree to the level of the respiratory bronchioles

A

Bronchial circulation

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11
Q

bronchial circulation arrives from the aorta via which vessels

A

2 left arteries & 1 right artery

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12
Q

receives output from the right heart and pulmonary arteries

A

pulmonary circulation

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13
Q

takes part in perfusion tissues taking part in gas exchange

A

Pulmonary circulation

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14
Q

perfusion of tissues that TAKE PART in pulmonary exchange

A

Pulmonary circulation

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15
Q

passes through pulmonary capillaries, O2 is taken up, and CO2 eliminated

A

Deoxygenated

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16
Q

blood returned to the left side of the heart via the pulmonary veins is said to be

A

oxygenated

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17
Q

Combination of what elements decreased flammability?

A

Carbon together with fluorine

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18
Q

Halothane produced what negative side effects when introduced in the 1950’s?

A

Hepatitis and dysthymias

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19
Q

Halothane is a dysrhymogenic worsened by which drug?

A

Epinephrine

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20
Q

Halothane brand name

A

Fluothane

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21
Q

Enflurane brand namE

A

Ethrane

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22
Q

Isoflurane brand name

A

Forane

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23
Q

Desflurane brand name

A

Suprane

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24
Q

Sevoflurane brand name

A

Ultane

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25
Q

all agents are volatile anesthetics except

A

Nitrous oxide

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26
Q

Most beneficial features of IA

A

speed of onset, gaseous state, route of administration.

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27
Q

Features of IA contributing to rapid diffusion.

A

unionization & low molecular weight

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28
Q

How drugs affect the body

A

pharmacodynamics

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29
Q

how the body affects drugs

A

pharmacokinetics

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30
Q

Pharmacokinetic features unique to IA

A

uptake, redistribution, biotransformation, excretion

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31
Q

absorption equates to what for IA

A

uptake

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32
Q

metabolism equates to what for IA

A

biotransformation

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33
Q

distribution equates to what for IA

A

redistribution

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34
Q

elimination equates to what for IA

A

excretion

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35
Q

propels IA across barriers to action sites in the CNS

A

partial pressure gradients

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36
Q

tissue group first reach by blood/anesthetic

A

VRG

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37
Q

VRG includes which organs

A

brain, kidney, heart, liver

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38
Q

second tissue group reached by anesthetic/blood mixture

A

muscle, skin

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39
Q

last tissue group reached by anesthetic/blood mixture

A

fat, connective tissue

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40
Q

VRG AKA tissue of ____ effect

A

desired

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41
Q

muscle and skin AKA the tissue of ____ effect

A

undesired

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42
Q

fat and connective tissue is known as the site of ___.

A

accumulation

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43
Q

At what point does the saturation of fat tissue play a role in emergence?

A

> 4 hour anesthetic time

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44
Q

VRG % body mass

A

10%

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45
Q

Muscle % body mass

A

50%

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46
Q

fat % body mass

A

20%

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47
Q

VRG % cardiac output

A

75%

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48
Q

Muscle % cardiac output

A

19%

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49
Q

Fat % cardiac output

A

6%

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50
Q

VRG perfusion

A

55-500 (ml/min/100g)

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51
Q

muscle perfusion

A

3 (ml/min/100g)

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52
Q

fat perfusion

A

1 (ml/min/100g)

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53
Q

goal of anesthesia

A

establish specific concentrations of anesthetics in the CNS.

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54
Q

Partial pressure in the CNS equates to what other compartments?

A

blood and alveoli

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55
Q

Sevo Vapor pressure

A

157

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56
Q

Des vapor pressure

A

669

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57
Q

Iso vapor pressure

A

238

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58
Q

Enflurane vapor pressure

A

172

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59
Q

Halothane vapor pressure

A

243

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60
Q

Sevo B/G coefficient

A

0.65

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61
Q

Des BG coefficient

A

0.42

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62
Q

Iso BG coefficient

A

1.46

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63
Q

Enflurane BG coefficient

A

1.9

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64
Q

Halothane BG coefficient

A

2.5

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65
Q

Nitrous oxide BG coefficient

A

0.46

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66
Q

Nitrous oxide vapor pressure

A

38,770

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66
Q

Nitrous oxide vapor pressure

A

38,770

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67
Q

Sevo MAC

A

1.8%

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68
Q

Des MAC

A

6.6%

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69
Q

Iso MAC

A

1.17%

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70
Q

Enflurane MAC

A

1.63%

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71
Q

Halothane MAC

A

0.75%

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72
Q

Nitrous oxide MAC

A

104%

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73
Q

IA that are unstable in MOIST CO2 absorber?

A

Sevo & Halothane

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74
Q

vapor pressure

A

pressure exerted by a vapor in a closed container when at equilibrium with its liquid and gas phase.

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75
Q

vapor pressure increases as ____ increases.

A

temperature

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76
Q

boiling point

A

temp at which a liquid’s vapor exceeds atmospheric pressure in an open container.

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77
Q

1 atmosphere = _____ mmHg

A

760

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78
Q

Partial pressure

A

fractional amount of pressure a single gas exerts within a gas mixture.

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79
Q

Dalton’s law of partial pressures

A

the total gas pressure in a container is equal to the sum of the partial pressures exerted by each individual gas.

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80
Q

solubility

A

the tendency of a gas to equilibrate with a solution, determines concentration.

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81
Q

Gases are more soluble in liquid when temperature ____.

A

decreases

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82
Q

uptake looks at the concentration of

A

alvolar / inspired

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83
Q

Fi (fraction inspired) represents

A

concentration of anesthetic leaving the circuit

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84
Q

factors increasing Fi

A

increased FGF, increased Fd (delivered) from FGO, decrease volume of breathing system (dead space)

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85
Q

factors that decreasing Fi

A

decreased FGF, increased volume of breathing system (dead space), absorption by anesthesia machine parts, CO2 absorbent decomposition.

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86
Q

Faster Fa relative to Fi results in

A

faster induction

87
Q

Factors that speed induction of insoluble agents

A

increased MV, decreased FRC

88
Q

What happens to anesthetic uptake as CO increases

A

minimal effect on insoluble agents. soluble agents however will take longer to achieve adequate alveolar concentration, thus slowing induction.

89
Q

What happens to anesthetics with deceased CO

A

decreased CO results in an increased concentration of anesthetic in the alveoli which could lead to overdose and subsequent lower CO/myocardial depression.

90
Q

What determines clinical effect of anesthetics?

A

concentration of anesthetics in the CNS and brain tissue.

91
Q

Factors affecting anesthetic uptake

A

blood solubility, alveolar blood flow, partial pressure gradient between alveolar and venous blood

92
Q

agents are taken by blood less readily, results in higher alveolar concentration

A

insoluble

93
Q

relative solubilities of anesthetics

A

partition coefficients

94
Q

higher partition coefficients results in _____ uptake.

A

greater

95
Q

which factors have a greater impact on changing concentrations of soluble agents

A

MV and CO

96
Q

How much of a role does metabolism play in delaying induction

A

little

97
Q

overpressurization

A

delivering a higher partial pressure of anesthetic than the desired alveolar concentration of that agent to achieve a quicker desired effect.

98
Q

Concentration effect

A

Increasing the inspired concentration of an IA

99
Q

N2O has the greatest concentrating effect at what concentration?

A

50%-70%

100
Q

Augmented gas inflow

A

high partial pressure of N2O causes the quick influx of N2O into the blood, this causes an increase in the concentration of agent within the alveoli.

101
Q

second gas effect

A

N2O augments the effects of a VA due to its higher partial pressure

102
Q

Concentration/second gas effect is less augmented with ____ agents.

A

soluble

103
Q

increasing MV for insoluble agents has what effect

A

minimal changes

104
Q

What is the rate limiting step during hyperventilation and increased alveolar concentration.

A

Spontaneous ventilation. This will eventually provide a negative feedback loop, decreasing alveolar concentration and effects.

105
Q

right to left VQ mismatch leads to

A

dilution and slowed induction

106
Q

Left to right VQ mismatch lead to

A

may (but likely wont) speed induction

107
Q

washout

A

alveolar concentration v. expired concentration at time zero.

108
Q

all IA have the same rate of elimination until __%

A

50%

109
Q

emergence doesnt occur until ____% of anesthetics have been eliminated.

A

80%-90%

110
Q

Factors slowing elimination

A

high tissue solubility, longer anesthetic times (>4 hours), low FGF

111
Q

diffusion hypoxia

A

rapid elimination of O2 and CO2 when N2O is discontinued.

112
Q

treatment for diffusion hypoxia

A

100% oxygen for 5-10min after discontinuation of N20.

113
Q

characteristics of an ideal anesthetic

A

quick onset/recovery, easy to administer, clear indication of anesthetic depth, inexpensive, wide safety margin, minimal effects on organs

114
Q

Most metabolized IA

A

Halothane, second is Sevo

115
Q

Most physically stable VA

A

Iso

116
Q

VA not used for mask induction

A

Des & Iso

117
Q

VA with risk of coronary steal

A

Iso

118
Q

VA with lowest BF solubility, quick recovery

A

Des

119
Q

MOST pungent VA

A

Des

120
Q

requires a heated/pressurized vaporizer

A

Des

121
Q

may see an increase in BP and HR if opioids not provided with this VA

A

Des

122
Q

high or rapid increases in concentration of this VA may cause myocardial ischemia.

A

Des

123
Q

VA with least airway irritation and most bronchodilation

A

Sevo

124
Q

Agents producing carbon monoxide (most to least)

A

Des, Iso, Sevo

125
Q

risk of fire due to exothermic reaction

A

Sevo

126
Q

Compound A

A

nephrotoxic in rats

127
Q

Produces compound A

A

Sevo

128
Q

May explode

A

N2O

129
Q

analgesic effects

A

Nitrous oxide, Xenon

130
Q

IA not metabolized by the body

A

N2o

131
Q

not a trigger for MH

A

N2O & Xenon

132
Q

risk of PONV

A

N2o

133
Q

inactivates b12

A

N2O

134
Q

absorbs into gas containing spaces

A

N2O

135
Q

May cause myocardial ischemia in hypovolemic patients or those with CAD.

A

N2O

136
Q

Sympathetic stimulation. Depresses the myocardium but stimulates catecholamine release

A

N2O

137
Q

chemically inert

A

Xenon

138
Q

Xenon MAC

A

71%

139
Q

disadvantage of Xenon

A

high cost & scarcity

140
Q

MAC

A

Concentration of IA at 1atm preventing skeletal muscle movement with surgical stimulation in 50% of patients.

141
Q

how do MAC and potency correlate

A

Increased MAC = low potency

142
Q

Immobility with MAC occurs primarily in the

A

spinal cord

143
Q

MAC Bar

A

MAC X 1.5

144
Q

MAC Awake

A

Follows commands

MAC X 0.5

145
Q

MAC Memory

A

Associated with amnesia in 50% of patients

146
Q

MAC is _____ but the effects may not be the same

A

additive

147
Q

MAC was established with what age group

A

33-55 year olds

148
Q

MAC decreases by ____% after ___ years of age.

A

6% after 40 years of age

149
Q

MAC is highest at what age?

A

6 months

150
Q

Factors that reduce MAC

A

hypothermia, sedatives, other anesthetics, hypoxemia, hyponatremia, anemia, hypotension, pregnancy, lithium, alpha2 agonist, opioids.

151
Q

Factors increase MAC

A

Young age, hyperthermia, hypernatremia, CNS stimulants, red hair in females, chronic alcohol abuse, hyperthyroidism

152
Q

factors that do not affect MAC

A

duration of anesthesia, gender, hypo/hypercapnia, metabolic alkalosis, hypertension, hyper/hypokalemia

153
Q

VA cause isoelectric EEG at clinical doses

A

des, iso, sevo

154
Q

VA isoelectric EEG changes may revert to continuous despite no changes do dose.

A

Des

155
Q

Sevo at MAC __to ___ combined with ________ can decrease CBF and trigger EEG abnormalities and increase ______.

A

1.5-2, hyperventilation, heart rate

156
Q

Iso, Des, Sevo have minimal changes to CBF at ___ MAC.

A

Less than 1

157
Q

All VA increase CBF , which VA increases CBF the most

A

Halothane

158
Q

Uncoupling

A

increase in CBF despite decrease in CMRO2

159
Q

Sevo preserves autoregulation up to ____ MAC.

A

1

160
Q

which agent preserves autoregulation best at 1.5 MAC

A

Sevo

161
Q

Physiological process can diminish/prevent elevated ICP

A

hyperventilation/hypocapnia

162
Q

At ____MAC will des, iso, and sevo increase CBF.

A

1

163
Q

Which agent increases ICP the most

A

Des

164
Q

Which VA may lessen the risk of increased ICP, why?

A

Sevo. Decreased pungency/airway irritation lessens coughing/bucking.

165
Q

VA increases PO2 and maintain PO2 better than thiopental during cerebral artery occlusion surgery.

A

Des

166
Q

postoperative cognitive dysfunction

A

impairment to the mental processes of perception, memory, and information processing.

167
Q

POCD is associated with increased _____ & _____ in the first year following surgery.

A

Morbidity and Mortality

168
Q

all IA are associated with POCD, which the most

A

Iso

169
Q

N2O is associated with POCD and _____ and high doses interfere with many _________ functions.

A

delirium , cognitive

170
Q

all agents at _____ MAC and N20 at ______% can increase EEG frequencies.

A

> 1MAC, 30%-70%

171
Q

VA MAC of 1-2 ____frequencies and ______ amplitude of EEG.

A

decrease, increase

172
Q

MAC >2 leads to _______ _______

A

burst suppression

173
Q

What may be some other causes of EEG changes during administration of anesthesia?

A

hypoxia, hypercarbia, hypothermia

174
Q

EVP monitoring results in an _____ in amplitude and ______ in latency.

A

decrease, increase

175
Q

_____ EPs are sensitive while _____ EPs are more resistent

A

visual, brainstem

176
Q

VA should be avoided in which evoked potential monitoring

A

MEPs

177
Q

Sudden MAC increase of ____ can result in sudden EP monitoring changes.

A

> 0.5 MAC

178
Q

N2O has what effect on CBF and CMRO2

A

increases

179
Q

Addition of N2O to 1MAC of Iso has what effect on CMRO2 and CBF.

A

No change in CMRO2 but increases CBF

180
Q

N2O _______ ICP, this can be decreased by ______.

A

increases, hypocapnia

181
Q

Avoidance of which IA in cases with likelihood of elevated ICP.

A

N2O

182
Q

What intervention can negate the increase in CMRO2 and CBF seen with N2O?

A

Barbs and narcotics

183
Q

VA ____ blood pressure.

A

decrease

184
Q

VA _______SVR.

A

Decrease

185
Q

VA _____CO.

A

minimal to none

186
Q

Sevo MAC of ___ does not change HR.

A

1

187
Q

VA result in 5-10% increase in baseline HR.

A

des and iso

188
Q

transient increase in HR during rapid increase in concentration of which VAs? Which the most?

A

des and iso . Des the most.

189
Q

transient increases in HR seen with des and iso can be minimized by administering which agents?

A

alpha 2 agonists and opioids

190
Q

N2O increases _____ _____ ______ activity and _____ ______ in concentrations of 40% and higher.

A

sympathetic nervous system, vascular resistance

191
Q

N2O + VA = ____ SVR and BP than VA alone.

A

higher

192
Q

CO is _________ to brain, muscle, skin with IA administration.

A

increased.

193
Q

CO is ______ to the liver, kidney, and gut with IA admin.

A

decreased

194
Q

VA decrease HR by

A

decrease SA node discharge, decrease conduction in His-Purkinje/vascular conduction pathways.

195
Q

VA _______ QT intervals. Which agent the most?

A

prolong, des the most

196
Q

preconditioning protection of myocardium occurs at Sevo MAC dose of ___ and full efficacy at MAC of ___.

A

1 , 1.5

197
Q

drugs that can abolish preconditioning of myocardium

A

Sulfonylureas (Glipizide)

198
Q

all IA _____ TV and _____ RR

A

decrease , increase

199
Q

which agent no longer increases RR above 1 MAC

A

ISO

200
Q

IA cause ____ in FRC

A

Decrease

201
Q

IA cause what changes in the diaphragm

A

none

202
Q

IA cause _______ in intercostal muscle strength.

A

decrease

203
Q

all IA cause ______ response to increased CO2

A

decreased

204
Q

______ drives ventilation

A

PaCO2

205
Q

Apneic threshold

A

CO2 threshold where respiratory drive stops. 4-5mmHg below resting Pa CO2 in a SV patient.

206
Q

IA ______ ventilatory response to hypoxia.

A

decrease

207
Q

IA best for chronic respiratory pt

A

Des and Sevo

208
Q

all VA relax airway smooth muscle, which is best?

A

Sevo

209
Q

IA _____ ciliary movement and _____mucus

A

impair, change

210
Q

mechanical vent ____ ciliary movement, _____ airways, and _____ mucus.

A

impairs, dries, thickens

211
Q

VA effect on PVR

A

none

212
Q

N2O can _____ PVR.

A

increase

213
Q

VA metabolized to Trifluroacetatic acid (TFA)

A

Des & Iso

214
Q

VA _______ effects of NMBs.

A

Increase

215
Q

Neuromuscular relaxation with VA is the most at ____MAC.

A

> 1 MAC.

216
Q

IA does not affect skeletal muscle relaxation

A

N2O

NGR6462 Pharm & Chem Anesthesia I (4 decks)

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