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Volatile Anesthetics - Quiz 3 Flashcards

1
Q

Equipotent concentrations of inhaled anesthetics have similar circulatory effects.. What does this mean?

A

Does matter the agent, 1 MAC of Iso or 1 MAC of Des will have similar effects.

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2
Q

with increases in concentration of desflurane, sevoflurane, and isoflurane in a dose dependent manner, what happens to MAP?

A

MAP decreases

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3
Q

A decrease in MAP reflects a decrease in

A

SVR

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4
Q

How does Halothan decrease MAP?

A

By decreasing the CO

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5
Q

What does NO do to MAP?

A

unchanged or mildly increases MAP

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6
Q

If you have a hypotensive patient, what combination of gas could you use?

A

Put at half MAC of gas and add nitrous

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7
Q

Incremental ______ in delivered concentrations of inhaled agents increase heart rates in patients

A

increases

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8
Q

Forane or Isoflurane increases heart rate at what MAC?

A

Starting at concentrations of 0.25 MAC

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9
Q

Desflurane increases heart rate at what MAC?

A

minimal to no increases in HR at <1 MAC

> or equal to 1 MAC has dose dependent linear increase in HR

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10
Q

Sevoflurane increases heart rate at what MAC?

A

HR does not increase until a MAC >1.5

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11
Q

Clinically, what happens why you try to wash in Des quickly?

A

tachycardia

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12
Q

If % dialed concentration multiplied by gas flow is greater than 24, what will you see?

A

tachycardia

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13
Q

How is cardiac index influenced by inhaled anesthetics?

A

Minimally

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14
Q

TEE demonstrates that _______ produces minor increase in EF compared with awake measurements.

A

desflurane

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15
Q

When you have surges in sympathetic nerves system activity from abruptly increasing an inhaled anesthetic, what is increased?

A

Plasma concentrations of epic and norepinephrine

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16
Q

Circulatory stimulation is not observed with abrupt increases in ______, _______, or _______ up to 2 MAC

A

Sevo, Halothan, or Ethrane

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17
Q

True or False: Inhaled agents do not predispose the heart to premature ventricular contractions

A

True ~ prolong refractory period (QTC)

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18
Q

What agent sensitizes the heart to PVCs?

A

Halothane

From:
Catecholamines
Hypercarbia

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19
Q

Since inhaled anesthetics prolong the QTC, which drug should you definitely avoid in pts with congenital long QT syndrome?

A

Sevo

but SAFE to give if on beta-blocker therapy

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20
Q

What is coronary steal?

A

Iso’s ability to dilate small-diameter coronary arteries might cause a susceptible patient to develop regional myocardial ischemia as a result of coronary vasodilatation

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21
Q

Volatile anesthetics exert a ______ _______ on the heart, limiting the area of myocardial injury and preserving function after exposure to ischemic insult.

A

protective effect

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22
Q

What is ischemic preconditioning?

A

Protective benefits of volatile anesthetics against myocardial ischemia in setting of compromised regional perfusion.

Exposure to a single or multiple brief episodes of ischemia can confer a protective effect on the myocardium against reversible or irreversible injury with subsequent prolonged ischemic insult.

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23
Q

True or False: Ischemic preconditioning is a protective mechanism present in all tissues, in all species.

A

True

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24
Q

Ischemic preconditioning offers 2 distinct phases, what are they?

A

First Period - 1-2 hours after conditioning episode

Second Period - Benefit appears 24 hours later and can last as long a 3 days

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25
What confers the protective activity in ischemic preconditioning?
opening of mitochondrial ATP sensitive K channels (K-ATP)
26
As anesthetic concentration increase, what is the pulmonary effect?
Increased respiratory rate and decreased tidal volume
27
is minute ventilation preserved with inhaled anesthetics?
Yes
28
What does decreased TV lead to?
greater dead space ventilation
29
Gas exchange becomes more or less efficient as anesthetic depth increases.
less
30
______ increases proportionate to anesthetic depth.
PaCO2
31
Dose dependent – the more gas would mean _____ RR and ______ TVs
HIGHER LOWER
32
Dose related blunting of the respiratory response to increased
CO2
33
Ventilatory stimulation response evoked by arterial hypoxemia is _____ by volatile anesthetics.
blunted
34
_______ displacement of the diaphragm and inward displacement of the rib cage occur from enhanced expiratory muscle activity. This results in a reduction in _____.
Cephalad FRC
35
During anesthesia, ________ occurs in dependent areas of the lung and to a greater extent when ________ ventilation is permitted.
Atelectasis spontanous
36
Inhalation agents have limited effect on the principle of “_______ _________ vasoconstriction”.
Hypoxic pulmonary
37
In the absence of bronchoconstriction, __________ properties of inhalation agents are limited.
bronchodilating
38
Inhaled anesthetics differ in “pungency” or capacity to irritate airways. What are some ways this is shown
Coughing Breath-holding Laryngospasm Arterial oxygen desaturation
39
What 3 inhaled agents are non pungent
Sevoflurane, halothane, and nitrous oxide
40
When inhaled agants are pungent
Des and Iso ** Des is the worst
41
Which inhaled anesthetic is the "nicest" to breath
Sevo
42
Which inhaled agent should you avoid in asthmatics, smokers or reactive airway disease?
Des
43
Inhalation agents ______ CMRO2
Decrease Decreased CMRO2 is good – tells brain we don’t need as much O2 right now
44
In normocephalic patients, cerebral vasodilation occurs at concentrations about _____ MAC
0.6 MAC
45
At ____ MAC, the decrease in CRMO2 offsets vasodilation such that cerebral blood flow ______ change significantly.
0.5 does not
46
At concentration _____ MAC, vasodilating effects predominate and CBF ______
>1 increases
47
When is cerebral vasodilation good?
ischemic cases (we want to get blood to them)
48
When is cerebral vasodilation bad?
high ICP – would lead to more volume
49
in the CNS, what does nitrous oxide cause?
Causes cerebral vasodilation | Increases CMRO2
50
How can you offset the effects of nitrous oxide?
Coadministration of opioids, barbiturates, or propofol (not ketamine
51
ICP increases with all volatile anesthetics at doses ____ MAC
>1
52
Autoregulation is impaired at concentrations ______ MAC
<1
53
Volatile anesthetics and nitrous oxide _____ the amplitude and _______ the latency of SSEP in a dose-dependent manner.
Depress increase
54
When can evoked potentials be abolished?
1 MAC
55
If adding NO, what MAC can abolish evoked potentials
0.5 MAC
56
Low concentrations ______ MAC decrease the reliability of motor evoked potentials.
0.2-0.3
57
on an EGG- Increased depth of anesthesia is characterized by _______ amplitude and ______ on the EEG.
increased synchrony
58
What occurs with greater frequency as depth of anesthesia increases?
Burst supression
59
If a doctors does says you can't uses any more inhalation agent causes it is decreasing evoked potentials, what can you use?
TIVA
60
This isoelectric pattern predominates at _____ MAC.
1.5-2.0
61
Which inhaled anesthetic may be associated with epileptiform activity on the EEG, especially at high concentrations.
Sevo
62
Inhalation agents produce a dose dependent skeletal muscle relaxation and enhance the activity of _______ _______ _______.
neuromuscular blocking drugs
63
Elimination of volatile anesthetic agent enhances OR reduces recovery from neuromuscular blockade
enhances
64
Which inhalation agent triggers MH?
ALL potent inhalation agents trigger MH
65
Will nitrous oxide trigger MH?
no
66
What is thought to be the immune mediated cause of liver injury?
trifluoroacetate metabolite.
67
Halothane and Sevo more likely to cause liver injury because more of the agent is metabolized by the liver. What 2 compounds can they make?
``` Trifluoroacetic Acid (TFA) Inorganic Fluoride Ions ```
68
What can halothane cause?
Halothane hepatitis
69
Are volatile agents are harmful to patients with preexisting liver disease unrelated to anesthesia?
probably not
70
Breakdown of Sevo and halothane cause what?
Compound A - can be nephrotoxic
71
What can compound A exposure cause?
proteinuria, enzymuria and glycosuria
72
What should the fresh gas flow rate be on Sevo and how long should Sevo be ran?
FGF of > or = 2L Ran < 2 hours
73
NO inactivates methionine synthase, the enzyme that regulates
vitamin B12 and folate metabolism.
74
N2O administration contraindicated in patients with preexisting __________ or _______________
preexisting vitamin B12 deficiency or underlying critical illness
75
What is the blood:gass coefficient of NO
0.47
76
NO is 34X greater than
nitrogen (0.014)
77
Give nitric oxide in a Compliant wall - noncompliant wall -
Compliant wall - increases volume | noncompliant wall - increases pressure
78
When would we not want to give NO? why?
pneumothorax, pneumoperotoneum, pneumocephalus, crani never want to give when worried about air being trapped
79
Desiccated CO2 absorbants cause
carbon monoxide production from all volatile anesthetic agents regardless of temperature.
80
What acceleratse the desiccation of CO2 absorbents
High fresh gas flow rates (exceeding normal minute ventilation)
81
What type of process is degradation?
exothermic
82
Which inhaled anesthetic is most likely to cause an increase in temperature and may lead to explosion and fire
Sevo
83
____ produces Compound A when exposed to soda lime.
Sevo
84
_______ produce Carbon Monoxide when exposed to desiccated absorbent
Iso and Des
85
New absorbents with decreased or absent monovalent bases do not result in extensive degradation on exposure to volatile agents regardless of their hydration status. What is in them?
Sodium hydroxide | Potassium hydroxide
86
which inhaled anesthetics use the variable bypass?
Isoflurane, sevoflurane, halothane
87
What does tipping or overfilling of a variable bypass channel do?
may lead to overdose if liquid anesthetic gets into bypass channel
88
What is des heated to?
2 atmospheres (1400)
89
At high altitudes, the partial pressure of desflurane will be _____ at a given Tec 6 vaporizer setting and output concentration will be ______, leading to _________ if no adjustments are made to account for higher altitude.
Lower (less ATM pressure pushing down) lower underusing
90
Does temperature effect gas concentration in the vaporizer?
No
91
how do patients wake up with Iso and Des?
smooth continual wake up
92
how do patients wake up with Sevo?
noting nothing nothing then very awake and pulling at ETT

Pharmacology (8 decks)

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