Maintenence*

Question 1

what’s included in a “balanced anesthetic?”

Answer 1

IV
Inhalation
Narcotics
Muscle Relaxants

Question 2

what are two ways to calculate the O2 maintenance requirement?

Answer 2

VO2 = 10*kg^0.75 = ml/min or 
VO2 = 2.5*kg+67.5 = ml/min

Question 3

numeric values for dead space

Answer 3

Anatomic Dead space = 2 ml/kg

= 140 ml/B *10 = 1400 ml/min

Question 4

Alveolar Oxygen Equation

Answer 4

PAO2 = [(PB-PH2O)(FiO2)]-(PaCO2/R)

Question 5

What is the initial treatment for a patient whose sats begin to drop?

Answer 5

increase FiO2

Question 6

why does a low BP lead to VQ mismatch?

Answer 6

poor perfusion

Question 7

PEEP can be simplified to mean what?

Answer 7

resistance to expiration

Question 8

therapeautic range for PEEP

Answer 8

7.5-10mmHg

Question 9

What is the physiological value for PEEP?

Answer 9

5 mmHg

Question 10

advantages of inhalational agents

Answer 10

Rapid appearance of drug in arterial blood
Efficient to distribute
Easy to deliver - Unique route
Predictable recovery
High safety profile

Question 11

drawbacks of inhalational agents?

Answer 11

No analgesia (N20 exception)
PONV

Question 12

MACBAR =
MACawake =
MACamnestic =

Answer 12

MACBAR = 1.5
MACawake = 0.3-0.5 (10% of MAC)
MACamnestic = 0.25

Question 13

what effects do age, accute intoxication and pregnancy have on MAC?

Answer 13

age = increase/decrease
EtOH = decrease
Pregnancy = decrease

Question 14

rate of rise for the Fa/Fi curves depends on what?

Answer 14

Solubility

Question 15

The more _____ the anesthetic agent, the quicker the pt will go to “sleep”

Answer 15

INsoluble

Question 16

Factors affecting inspiratory concentration (Fi)

Answer 16

Fresh gas flow (increase)
Circuit Volume (decrease)
Any machine/circuit absorption (decrease)

Question 17

In terms of time constants, what percent must change in order for the change to be therapeautic?

Answer 17

95%

Question 18

What pathway does the agent take once in the body?

Answer 18

lung -> blood -> brain

Question 19

Describes relative affinity of anesthetic gas for blood

Answer 19

Blood/gas partition coefficient

Question 20

Increased partition coeff -> _______ solubility -> ________ agent uptake

Answer 20

increased

increased

Question 21

Increased agent uptake -> ______ induction

Answer 21

slower

Question 22

Blood/Gas values for Iso, Des, Sevo

Answer 22

Iso = 1.4
Des = 0.42
Sevo = 0.65

Question 23

Muscle/Blood values for Iso, Des, Sevo.

& why are they important?

Answer 23

Iso = 4.0
Des = 2.0
Sevo = 3.1
Determines speed of wake up

Question 24

What is Cardiac Output?

Answer 24

CO = HR x SV

Question 25

Which agents are most effected by CO?

Answer 25

Highly soluble agents are most effected by CO

Question 26

What are some factors affecting arterial concentration (Fa)?

Answer 26

V/Q mismatch Venous admixture Alveolar dead space Nonuniform alveolar gas distribution

Question 27

What effect does N2O have on MAC?

Answer 27

cuts MAC requirement by 50%

Question 28

N2O advantages

Answer 28

Powerful analgesic properties Decreases MAC of other inhal. Agents Safe in MH patients Rapid induction/recovery

Question 29

N2O disadvantages

Answer 29

Decreases myocardial contractility Increase risk PONV Increase ICP by inc CBF Teratogenicity

Question 30

N2O contraindications

Answer 30

``` Air embolism Pneumothorax (75% 2-3x 10 min) Acute intestinal obstruction Intracranial air (tension pneumocephalus) Pulmonary air cyst Intraoccular air bubbles Tympanic membrane grafting ```

Question 31

What does Sevo smell like?

Answer 31

``` juicy fruit (according to Sam) If you sniff enough, you won't remember it though ```

Question 32

What is a potential risk with Sevo and when is it seen?

Answer 32

Compound A (fluoromethyl-2,2-difluoro-1-(trifluoromethyl)vinyl ether Low gas flows High temperatures Desiccated absorbent

Question 33

Sevo advantages

Answer 33

Non-irritant sweet odor Rapid induction/recovery Does not sensitize myocardium to catecholamine No CO production with Na lime

Question 34

Sevo disadvantages

Answer 34

Less potent Compound A production (2L/min) Contraindicated with Baralyme Post op agitation in children*

Question 35

Which agent is a gas at room temp?

Answer 35

Des

Question 36

Which gas is Capable of increasing HR, documented myocardial ischemia?

Answer 36

Des

Question 37

Des advantages

Answer 37

Rapid onset/recovery | Stable with CO2 absorbers

Question 38

des disadvantages

Answer 38

Requires special vaporizer Low potency Pungency (not good for asthma) Rapid increase >1.25 MAC SNS stimulation

Question 39

which agent can you not use in pt's with renal or hepatic dysfunction?

Answer 39

Iso

Question 40

xenon advantages

Answer 40

``` Inert Min CV effects Low blood solubility Rapid induction/recovery Nonexplosive Environmentally friendly ```

Question 41

xenon disadvantages

Answer 41

High cost Low potency (MAC – 70%) Not readily available

Question 42

Sam's 10 commandments

Answer 42

1. never turn down a break 2. You can always give more 3. Go ahead it is not my MAMA 4. Tank ‘em till they froth, then back off 5. Give them what they need add it up later 6. Straighten out your lines , keep them that way 7. There is always an exception to what you think you know 8. Learn how to disagree without being disagreeable 9. Never say it has not happened to me 10. Never Never use the drugs you give to your patients

Question 43

Sorry if these cards are confusing

Answer 43

Sam's slides are hard to work with