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23 spring anesthesia > Test 1: 12 + 13: inhalant agents > Flashcards

Test 1: 12 + 13: inhalant agents Flashcards

(50 cards)

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1
Q

vapor pressure of isoflurane

A

240

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2
Q

vapor pressure of sevoflurane

A

160

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3
Q

vapor pressure of desflurane

A

664- very close to sea level pressure

means boiling point very close to room temp, need to be stored at high pressure to keep in liquid form

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4
Q

which inhaled anesthetics have the highest blood gas ratio and what does this mean

A

isoflurane has the highest

takes a longer time to cause change in the body when you change the amount of drug given

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5
Q

what does oil gas ratio mean

A

amount of drug disolved into the lipid/brain= more potent

iso: 91
servoflurane: 50
desflurane: 18
N2O: 1.4

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6
Q

how does generic variable bypass vaporizer work

A

used for iso and sevoflurane

made of bronze- keeps temp constant and therefore vaporization of drug constant

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7
Q

how does desflurane vaporizers work

A

desflurane boils at close to room temp 23.5°C

the vaporizer keeps drug at 39°C and at specific pressure= this allows for rate of vaporization to be constant

injects desflurane vapor into fresh gas stream

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8
Q

inhalant anesthetics cause what in the CNS

A

spinal cord and brain
inhibit sensory processing, nocicpetive signaling and motor response to pain

Brain
hypnosis and amnesia
loss of consciousness
analgesia

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9
Q

how do inhalant drugs work

A

↓ excitatory receptors: inhibit central ACh receptors and NMDA receptors in the brain

stops receptors from opening and sending AP

↑ function of inhibitory receptors: GABA A receptor, glycine, serotonin

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10
Q

MAC

A

minimum alveolar concentration

The anesthetic concentration preventing motor response to a supramaximal noxious stimulus in 50 % of subjects.

Correlates inversely with O/G part. coeff: the more lipophilic the drug the less drug you need to give to cause sedation

agent and species specific

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11
Q

— will decrease MAC valves

A

Increasing age (calmer when older)
Pregnancy (endogenous opioid release)
Hypothermia
Hypotension (MAP< 40 mmHg)
Hypoxemia (PaO2< 38 mmHg)
Hyponatremia
CNS depressant drugs/analgesics

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12
Q

— will increase MAC valve

A
  • Hyperthermia
  • Hypernatremia
  • CNS stimulants
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13
Q

non-anesthetic cerebral effects of iso

A
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14
Q

non-anesthetic cerebral effects of sevoflurane

A
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15
Q

non-anesthetic cerebral effects of desflurane

A
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16
Q

adverse effects of inhaled anesthetics on respiratory system

A

central respiratory depression

↓ tidal volume (iso > sevo, des)
↓RR ( ↑ up to 1 MAC)
↑ PaCO2 Des>Iso = sevo

bronchodilation (iso= sevo>des)

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17
Q

adverse effect of iso on CV system

A
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18
Q

adverse effect of sevoflurane on CV system

A
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19
Q

adverse effect of desflurane on CV system

A

↓CO by ↓Ca into cell

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20
Q

Adverse effect of inhalants on kidney

A

↓ renal blood flow
↓ urine output

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21
Q

adverse effects of inhalants on liver

Study These Flashcards
A

↓ blood flow to liver → ↓ drug metabolism by 50-70%

need to give lower doses of meds

22
Q

adverse effects of inhalants on skeletal muscle

Study These Flashcards
A

↓ muscle tone from ↓ Ca into the cell

Augmentation of neuromuscular
blockade by Non-Depolarizing
Neuromuscular Blockers
(NDNMB)

23
Q

adverse effects of inhalants on fetus

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A

↓ blood flow to fetus

24
Q

why use sevoflurane over iso

Study These Flashcards
A

faster induction and faster recovery
no pungent odor
can change depth of med faster
less ↓BP
less respiratory depressant

25
disadvantages of sevo vs iso
metabolized in the liver into inorganic fluoride ions could be **cause renal and liver damage in rats**: not seen in man, dog or monkey
26
pros and cons of using desflurane
* Requires special vaporizer * Irritating to airways * Rapid induction & recovery (B/G 0.42; Low Tissue/Blood part. coeff.) * Pharmacodynamic profile similar to isoflurane but less cardiac output depressant * Basically no metabolism
27
why use nitrous oxide
analgesic properties
28
recumbency + inhalant anesthetics cause
increased PaCO2 → **resp. acidosis and acidemia** **hypoxemia** **hypotension**: tissue hypoperfusion, cardiac arrhythmias, muscle weakness
29
inhalant anesthetics cause vaso----, inhibition of the --- nervous system and --- stress hormone release
vasodilation ANS: negative-inotropic effect, ↓ of autonomic CV reflexes increased ## Footnote even though negative inotrope, CO stays similar cause vasodilation balances it out, when at normal levels
30
why use PIVA for anesthesia
use combo of injectable and inhalants with analgesics or NM blockers * can reduce dose needed for each drug * decrease adverse effects * more rapid recovery
31
the use of balanced anesthesia will do what to PaCO2 and MAP
will decrease PaCO2= better respiratory function will increase MAP= better perfusion
32
reduction in MAC is cause
* reduced stress response * inhibition of intraoperative nocicpetion: improved analgesia and recovers faster * improved overal perianesthetic outcome
33
how to monitor balanced anesthesia
* Palpebral reflexes less suppressed * Hemodynamic parameters (esp. arterial blood pressures (ABP)) often closer to physiological values * Plane of anesthesia appears often light despite no response to surgical stimulation Indicators of light anesthesia in case of ketamine CRI * Rapid nystagmus * Sudden rises in HR, ABP, RR, skeletal muscle tone
34
factors that affect uptake, distribution and elimination of inhaled anesthetics
**physical properties**: gradient of anesthetic partial pressures **chemical properties**: solubility in blood vs tissues **Physiological factors**: RR and CO
35
distribution into muscle of IA will determine ---.
how long stays in system, when pt will wake up Desflurane faster then ISO and Sevo
36
change in the amount of IA med that machine is turned to →brain
37
Every change in concentration of IA in the CNS follows changes in the PP in the ---
alveolar gas mixture and arterial blood (brain follows changes in dose of inhaled anesthetic)
38
factors affecting inspired gas concentration
**fresh gas flow rate** (↑FGF = ↑rate of induction) **volume of breathing circuit** (dead space) **absorption** (tubing of machine can absorb some of the med
39
factors affecting alveolar concentration of IA
**Delivery via circuit** machine setting **alveolar ventilation** (↑ ventilation= ↑ delivery) **pulmonary uptake: blood/gas solubility coefficient (B/G)** ↑ solubility= ↓ rate of induction blood and tissue act as sponge **pulmonary blood flow** (↑ the blood flow the slower the induction) not relavant anymore **tissue uptake** tissue solubility, blood flow and partial pressure difference between arterial blood and tissue
40
how does pulmonary uptake affect alveolar concentration of IA
**pulmonary uptake: blood/gas solubility coefficient (B/G)** ↑ solubility= ↓ rate of induction blood and tissue act as sponge **pulmonary blood flow** (↑ the blood flow the slower the induction) not relavant anymore **tissue uptake** tissue solubility, blood flow and partial pressure difference between arterial blood and tissue
41
if the blood gas solubility coefficient is high what happens to rate of induction
lowers blood and tissue act like a sponge
42
the higher the pulmonary blood flow the --- the rate of induction of anesthesia
slower with modern IA drugs almost irrelevant
43
the higher the tissue uptake the --- the rate of induction
slower (a) Tissue **solubility** of anesthetic agent (b) Tissue **blood flow** (c) **Partial pressure difference** between arterial blood and tissues
44
factors affecting arterial concentration of IA gas
VQ mixmatch deadspace intrapulmonary shunting
45
alveolar gas delivery is dependent on
* concentration and partial pressure * ventilation rate
46
IA alveolar gas uptake is due to
blood gas solubility pulmonary (alveolar) blood flow tissue uptake
47
IA inspired gas is based on
FGF rate absorption by breathing circuit volume of breathing circuit
48
arterial concentration of IA is dependent on
V/Q mixmatch
49
how to cause rapid induction of IA
give higher dose 1-4 MAC depending on the med
50
which IA has the longest recovery time and why
sevoflurane (has higher amount that dissolves into muscle) sevo ≃iso > des > nitro

23 spring anesthesia (40 decks)

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