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Flashcards in Maintenence* Deck (43):
1

what's included in a "balanced anesthetic?"

IV
Inhalation
Narcotics
Muscle Relaxants

2

what are two ways to calculate the O2 maintenance requirement?

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

3

numeric values for dead space

Anatomic Dead space = 2 ml/kg
= 140 ml/B *10 = 1400 ml/min

4

Alveolar Oxygen Equation

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

5

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

increase FiO2

6

why does a low BP lead to VQ mismatch?

poor perfusion

7

PEEP can be simplified to mean what?

resistance to expiration

8

therapeautic range for PEEP

7.5-10mmHg

9

What is the physiological value for PEEP?

5 mmHg

10

advantages of inhalational agents

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

11

drawbacks of inhalational agents?

No analgesia (N20 exception)
PONV

12

MACBAR =
MACawake =
MACamnestic =

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

13

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

age = increase/decrease
EtOH = decrease
Pregnancy = decrease

14

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

Solubility

15

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

INsoluble

16

Factors affecting inspiratory concentration (Fi)

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

17

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

95%

18

What pathway does the agent take once in the body?

lung -> blood -> brain

19

Describes relative affinity of anesthetic gas for blood

Blood/gas partition coefficient

20

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

increased
increased

21

Increased agent uptake -> ______ induction

slower

22

Blood/Gas values for Iso, Des, Sevo

Iso = 1.4
Des = 0.42
Sevo = 0.65

23

Muscle/Blood values for Iso, Des, Sevo.
& why are they important?

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

24

What is Cardiac Output?

CO = HR x SV

25

Which agents are most effected by CO?

Highly soluble agents are most effected by CO

26

What are some factors affecting arterial concentration (Fa)?

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

27

What effect does N2O have on MAC?

cuts MAC requirement by 50%

28

N2O advantages

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

29

N2O disadvantages

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

30

N2O contraindications

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

31

What does Sevo smell like?

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

32

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

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

33

Sevo advantages

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

34

Sevo disadvantages

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

35

Which agent is a gas at room temp?

Des

36

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

Des

37

Des advantages

Rapid onset/recovery
Stable with CO2 absorbers

38

des disadvantages

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

39

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

Iso

40

xenon advantages

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

41

xenon disadvantages

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

42

Sam's 10 commandments

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

43

Sorry if these cards are confusing

Sam's slides are hard to work with