Neurological, Hepatic, Renal Effects of Inhalation Anesthetics

Question 1

all inhalation agents: CBF

Answer 1

all inhalation agents increase CBF by decreasing cerebrovascular resistance which leads to increased ICP
-halothane > enflurane > or = isoflurane = desflurane = sevoflurane

Question 2

all inhalation agents: ICP

Answer 2

increased

Question 3

all inhalation agents: CMRO2

Answer 3

decrease

Question 4

all inhalation agents: SSEP

Answer 4

depress SSEP

-add N2o and get minimal response

Question 5

enflurane neuro effects: O2

Answer 5

relative excess perfusion in relation to oxygen consumption

Question 6

enflurane neuro effects: EEG

Answer 6

no electrical silence on EEG

Question 7

enflurane neuro effects: seizures

Answer 7

cause seizure like activity on EEG at 2 MAC

-epileptiform activity with hyperventilation (hypocapnia) at lower concentration

Question 8

Neuro cases and inhalation agents

Answer 8

use low does inhalation agent with opioid uses (remifentanil)

Question 9

Neuromuscular effects: all inhalation agents with no muscle relaxant on board

Answer 9

-centrally mediated muscle relaxant properties
-when not using muscle relaxants
enflurane =iso=des=sevo>halothane

Question 10

Neuromuscular effects: all inhalation agents with muscle relaxant on board

Answer 10

iso=des=sevo > = enflurane > halothane

Question 11

Malignant Hyperthermia all inhalation agents

Answer 11

Halothane > enflurane = iso=des=sevo

Question 12

reserve muscle relaxant at what number

Answer 12

0.8-0.9

Question 13

all inhalation agents hepatic blood flow

Answer 13

decrease; hal>enflurane>iso>des/sevo

Question 14

inhalation drug metabolism phase 1

Answer 14

CYP 450

Question 15

inhalation drug metabolism phase 2

Answer 15

uridine 5’ diphosphate transferase enzymes

Question 16

metabolism of inhalation agents via hepatic altered by

Answer 16

age, gender, disease, genetics

Question 17

Liver injury caused by metabolism

Answer 17

Iso, des, hal, and enflurane metabolize to a trifluoroacetylated protein that may produce liver injury in susceptible patients

Question 18

N2O metabolism

Answer 18

not metabolized in humans

Question 19

renal and all inhalation agents: blood flow

Answer 19

renal blood flow decreases GFR and urine output

Question 20

all inhalation agents and obstetrical effects: uterine blood flow

Answer 20

decrease uterine blood flow and uterine contractility

-enflurane>hal>iso=des=sevo

Question 21

Compound A formation

Answer 21

in desiccated soda lime