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Spring Anesthesia Pharm > Inhaled Anesthetics - Part 2 > Flashcards

Inhaled Anesthetics - Part 2 Flashcards

(43 cards)

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1
Q

Components of general anesthesia

A

Amnesia, unconscious, imobility, relaxation

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2
Q

What do we want general anesthesia to do?

A
  1. Minimize deleterious direct and indirect effects of agents
  2. Sustain physiologic homeostasis during procedure
  3. improve postop outcomes
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3
Q

What is the drug doing to the body?

A

pharmacodynamics…MAC

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4
Q

1 MAC is ____% of patients have no response to noxious stimulus.

1.3 MAC prevents movement in ___%

A

50%

95%

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5
Q

T/F
MAC allows for comparison of potency and the values are additive.

A

True

0.5 MAC sevo + 0.5 MAC N2O = 1 MAC

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6
Q

By how much does MAC decrease per decade of age?

A

6%

Ex: 2.6% for 1 MAC at 20yo, 2.4% @ 30yo, 2.2% @ 40yo

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7
Q

What is MAC awake?

A

10% of MAC (0.2% for sevo)

End-tidal concentration of an anesthetic agent at which 50% of patients approptriately respond to verbal commands (open your eyes).

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8
Q

What is MAC bar?

A

Concentration required to block autonomic reflexes to nociceptive stimuli

1.3 MAC (if using inhalational agent only…not if using opioids)

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9
Q

If a patient is currently drunk, what affect will it have on MAC? (increase, decrease, stay the same)

A

Decrease MAC requirement

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10
Q

If a patient chronically abuses alcohol, what affect will it have on MAC? (increase, decrease, stay the same)

A

MAC is unchanged

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11
Q

Name three factors that will increase MAC requirements

A
  1. Hyperthermia
  2. Drug-induced increase in catecholamines
  3. Hypernatremia
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12
Q

An older patient who received preop meds and is hypothermic will require more/less/same amount of MAC?

A

Less MAC

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13
Q

History of inhaled anesthetics

A
  • 1840s
    • Nitrous Oxide
    • Ether
    • Chloroform
  • 1951
    • Fluroxene
    • Halothane
  • 1960
    • Methoxyflurane
  • 1973
    • Enflurane
  • 1981
    • Isoflurane
  • 1992
    • Desflurane
  • 1994
    • Sevoflurane
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14
Q

What do inhaled anesthetics do to cerebral blood flow?

Specifically to: Vasodilation, vascular resistance, CBF, and ICP

A

↑ Vasodilation

↓ vascular resistance

↑ CBF and ↑ ICP - can be opposed by hyperventilation (which vasoconstricts)

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15
Q

Compare halothane to isoflurane in the ways the affect CBF

A

Halothane increases CBF so much that it’s not used in neuro surgery

Isoflurane increases CBF the lease, and can be opposed by hyperventilation

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16
Q

How do inhaled anesthetics affect cerebral metabolic rate for oxygen (CMRO2)?

A

decreases CMRO2

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17
Q

Burst supression occurs at what MAC of Iso?

A

1.5 MAC

↓ systemic pressure, can impare cerebral perfusion pressure, sacrifice systolic

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18
Q

Inhaled anestheti effects on CNS physiology

19
Q

Cardiovascular Effects of inhaled anesthetics

on blood pressure

Study These Flashcards
A
  • Halothane and enflurane decrease myocardial contractility
  • Other volatiles derease SVR, thus decrease BP
  • N2O has NO EFFECT, but slight increase
20
Q

Cardiovascular Effects of inhaled anesthetics

on heart rate

Study These Flashcards
A
  • Des tachycardia due to stimulation of SNS (esp with rapid increase in vapor concentration)
  • Increase in HR from other volatiles or N2O usually baroreceptor mediated (halothane is exception) - relex tachycardia due to decrease in BP
21
Q

Cardiovascular Effects of inhaled anesthetics on Cardiac Output

Study These Flashcards
A
  • Halothane and Enflurane decases CO because of decrease in contractility
  • Other volatiles decrease CO but to a lesser degree (almost negligible)
  • N2O is sypathomimetic, thus slight increase in CO (high doses may decrease)
22
Q

Cardiovascular Effects of inhaled anesthetics on SVR (systemic vascular resistance)

Study These Flashcards
A

Iso, Des, and Sevo decrease SVR

23
Q

Cardiovascular Effects of inhaled anesthetics on pulmonary vascular resistance

Study These Flashcards
A
  • All volatiles decrease PVR
  • BLUNT HYPOXIC PULMONARY VASOCONSTRICTION RESPONSE
  • N2O known to increase PVR with patients with pulmonary hypertension
24
Q

Cardiovascular Effects of inhaled anesthetics on coronary blood flow

Study These Flashcards
A
  • Iso is a POTENT vasodilator - can cause coronary steal phenomenon, no increase in ischemia
    • Coronary steal = dilating good areas of heart, not areas of stenosis where already maximally dilated

volatile agents are weak coronary vaasodilators

25
Cardiovascular Effects of inhaled anesthetics on cardiac arrythmias
Halothane is bad Halothane + epi --\> arrythmias
26
Effects of inhaled anesthetics on cardiovascular physiology table
27
What do volatile anesthetics do to Minute Ventilation (RR, Tidal Volume) and PaCO2
↑ RR (dose dependent) ↓ VT This equals a net ↓ in minute ventilation (rapid, shallow breaths) Causes ↑ PaCO2
28
Des and sevo produce apnea at what MAC?
1.5 - 2 MAC (the anesthetics themselves, not including narcotics)
29
True or false Inhaled anesthetics decrease FRC
True
30
T/F All inhaled anesthetics decrease airway resistance
False (kind of) All except Desflurane - do not use in asthmatic pts
31
T/F The drive to breathe for pts with COPD is hypercarbia
False, their drive to breat is hypoxemia
32
Effects of inhaled anesthetics on respiratory physiology
33
Renal effects
Decreases renal blood flow, GFR, urine output - due to the decrease in SVP (sideeffects of side effect, not the drug) Nephrotoxicity
34
Hepatic effect
Decreases hepatic blood flow, and hepatic clearance, hapatic toxicity
35
T/F Volatiles decrease uterine smooth muscle contractility and blood flow
True Usefule in removing retained placenta
36
T/F Inhaled drugs do not cross the placenta
False, they do cross the placenta and can be delivered to the baby. The baby breathes off and therefore no effect on baby.
37
Effects on skeletal muscle
Ether derived drugs (sevo & des) produce muscle relaxation N2O does not produce relaxation (may produce muscle rigidity)
38
Effects on temp
* Volatiles lower the core temp set point at which thermoregulatory vasoconstriction is activated * Vasodilation redistributes blood flow from central to peripheral compartments * Metabolic oxygen consumption is decreased---decreases heat generation
39
What is compound A?
Caused by Sevo Nephrotoxin higher levels in baralyme than sodalime Use higher than 2 L/min flows
40
How many MAC hours are acceptable at low gas flows when using sevo to prevent Compound A?
2 MAC hours of low flows are ok (\< 1MAC sevo for 2 hrs @ low gas flows)
41
T/F Nephrotoxicity was due to an inactive fluoride metabolite
True, and it's not seen much anymore
42
Which agent is most potent when it come to MH? A) Sevo B) Des C) Iso D) Halothane
D) Halothane
43
What is halothane hepatitis?
Two types: 1. Mild, self-limited form (usually in kids) 2. Rare, life-threatening hepatic necrosis (causes death or liver transplant)

Spring Anesthesia Pharm (2 decks)

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