Quiz 6

Question 1

How do Volatile agents typically decrease MAP? What exceptions?

Answer 1

SVR is decreased

• Halothane decreases MAP by decreased CO
• N2O no change to slight increase in MAP

Question 2

Starting at concentrations 0.25 MAC, a linear, dose dependent increase in HR is observed - What agent?

Answer 2

Isoflurane or “Forane”

Question 3

At concentrations ≥ 1 MAC , a linear, dose dependent increase in HR is observed - What agent?

Answer 3

Desflurane

Question 4

HR does not increase until concentrations >1.5 MAC - what agent?

Answer 4

Sevoflurane

Question 5

Abrupt increases of _______ and ______ > 1 MAC cause transient circulatory stimulation in the absence of anesthetic adjuncts

Answer 5

Desflurane and Isoflurane

Question 6

Inhaled anesthetics prolong the QT interval on the electrocardiogram. which specifically? but safe if?

Answer 6

Sevoflurane

on B-Blockers

Question 7

coronary steal seen more in which agent?

Answer 7

Isoflurane

Question 8

two distinct periods of protection in Ischemic preconditioning?

Answer 8

• 1-2 hours after the conditioning episode

- 24° later and can last as long as 3 days

Question 9

Opening of mitochondrial _______-sensitive ________ channels (KATP) is the crucial event that confers the protective activity in Ischemic preconditioning

Answer 9

adenosine triphosphate (ATP)

potassium

Question 10

_______ increases proportionate to anesthetic depth

Answer 10

PaCO2

Question 11

Dose related _______ of the respiratory response to increased CO2

Answer 11

blunting

so co2 may have to climb higher than normal to stimulate breathing

Question 12

______ stimulation to breath comes on sooner, but _______ is a stronger response

Answer 12

Co2

hypoxia

Question 13

________ displacement of the diaphragm and ________ displacement of the rib cage occur from enhanced expiratory muscle activity. This results in a ________ in FRC

Answer 13

Cephalad

inward

reduction

Question 14

Most pungent agent?

Answer 14

Desflurane

Question 15

Least pungent agent?

Answer 15

Sevoflurane

Question 16

how does the pungency of an agent effect the patient?

Answer 16

• Coughing
• Breath-holding
• Laryngospasm
• Arterial oxygen desaturation
• Asthmatics, smokers, ppl sensitive tosmells

Question 17

cerebral vasodilatation occurs at concentrations above ____ MAC. Who is this good and not good for?

Answer 17

0.6

good for ischemic pts

not good for ^ICP pts

Question 18

At concentrations ≥ ___ MAC, __________ effects predominate and cerebral blood flow _________, especially if systemic blood pressure is maintained at awake values.

Answer 18

1

vasodilating

increases

Question 19

How does N2O differ from others? What to avoid? give what to counter effects?

Answer 19

^CMRO2 (cerebral oxygen consumption)

avoid in cranial injuries

opioids, barbiturates, or propofol

Question 20

ICP increases with all volatile anesthetics at doses ____ MAC

Answer 20

> 1

Question 21

Autoregulation is impaired at concentrations ______ MAC

Answer 21

< 1

Question 22

Volatile anesthetics and nitrous oxide ______ the amplitude and ______ the latency of SSEP in a dose-dependent manner

Answer 22

depress

increase

Question 23

concentrations of _____ MAC decrease the reliability of motor evoked potentials

Answer 23

0.2-0.3

Question 24

Avoid in epileptic or hx seizure pts

Answer 24

sevoflurane

Question 25

which gas has most potentiation of NMBs

Answer 25

Desflurane

Question 26

causitive agent of hepatic effects?

Answer 26

trifluoroacetate metabolite

Question 27

________ (trifluoroethyl vinyl ether) is produced from the breakdown of _______ and ________. In animal studies, Compound A is nephrotoxic after prolonged exposure.

Answer 27

Compound A sevoflurane halothane

Question 28

In humans, Compound A exposure significant to cause? Prevention?

Answer 28

transient proteinuria, enzymuria, and glycosuria occurs after prolonged sevoflurane at low fresh gas flows (1L/min). Keep Sevo to at least 2L of flow or more

Question 29

N2O administration contraindicated in patients with?

Answer 29

preexisting vitamin B12 deficiency

Question 30

N2O other risk?

Answer 30

Gas transfer to closed spaces aka Pneumothorax, pneumoperotoneum, pneumocephalus, air emboli, bowel air, eye bubble procedures, inner ear procedures, avoid in craniotomies as well

Question 31

Gas with highest risk of fire in dessicated CO2 absorber?

Answer 31

Sevoflurane

Question 32

Which gases produce Carbon monoxide when exposed to dessicated absorbant?

Answer 32

Iso and Des

Question 33

________ are tempurature compensated vaporizors

Answer 33

Variable bypass

Question 34

another name for desflurane

Answer 34

suprane

Question 35

Required vaporizer setting for higher altitude equation =

Answer 35

(desired vaporizer setting at sea level × 760mm Hg)/local barometric pressure (in mm Hg.)