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Sp: PMI > 7. Inhalational Induction / Emergence > Flashcards

7. Inhalational Induction / Emergence Flashcards

1
Q

Inspired Concentration
(Fi)

A

concentration of volatile agent in the anesthesia machine/inspiratory tubing of the circuit

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2
Q

Fi monitor observation

A

in SEVO

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3
Q

alveolar concentration
(Fa)

A

concentration of volatile agent in the alveoli

concentration of agent in the expiratory tubing of the circuit

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4
Q

Fa vs Fi relationsip

A

Fa < Fi

body is absorbing some VA

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5
Q

Fa monitor observation

A

end tidal sevo concentration

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6
Q

Fa:Fi ratio

A

how concentrated the alveoli are (Fa) compared to how concentrated the machine is (Fi)

[lungs] < [machine]

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7
Q

Fa:Fi ratio for induction

A

<1

concentration in lungs (Fa) will always be lower than the concentration in machine (Fi) when VA is turned on

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8
Q

When does Fa:Fi approach 1

A

as the blood gets saturated w/agent
diffusion of agent from lung to blood slows
[lung] increases close to [machine]

concentration of VA in lungs builds up over time

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9
Q

inhalational induction mechanism

A
  1. volatile agent turned on
  2. [machine] increases (Fi)
  3. [alveoli] increases (Fa)
  4. agent diffuses from alveoli to blood
  5. agent from blood diffuses into brain (tissues)
  6. [brain] sufficiently high = pt asleep
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10
Q

inhalational induction speed depends on:

A
  1. lung to blood diffusion speed
  2. blood to brain diffusion speed
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11
Q

Faster diffusion of agent into blood

A

faster build up of [lung]
greater [lung]:[blood] gradient
faster diffusion into blood
faster induction

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12
Q

Slower diffusion of agent into blood

A

slower build up of [lung]
smaller [lung]:[blood] gradient
slower diffusion into blood
slower induction

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13
Q

desflurane blood solubility

A

low blood solubility

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14
Q

low blood solubility

A

slow diffusion of agent into blood
faster buildup of [lung]
– high initial [lung]

fast diffusion from blood into brain
– low [blood]

high [lung]: low [blood] = lrg conc gradient
== faster diffusion into blood

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15
Q

low blood solubility summary

A

faster buildup in lungs
greater [lung]:[blood] gradient
faster diffusion into blood
faster diffusion into brain
faster inhalational induction

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16
Q

isoflurane blood solubility

A

high blood solubility

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17
Q

high blood solubility summary

A

slower buildup in lungs
smaller [lung]:[blood] gradient
slower diffusion into blood
slower diffusion into brain
slower inhalational induction

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18
Q

high blood solubility

A

fast initial diffusion into blood
slow buildup in lungs
–low initial [lung]

slow diffusion from blood into brain
– high [blood]

low [lung] : high[blood] = sm conc gradient
== slower diffusion into blood

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19
Q

low cardiac output inhalational induction speed

A

[lung] rises more quickly
[blood] rises more quickly

faster diffusion into blood and brain

faster inhalational induction

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20
Q

high cardiac output inhalational induction speed

A

[lung] rises slowly
[blood] rises slowly

slower diffusion into blood and brain

slower inhalational induction

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21
Q

low cardiac output induction

A

inhalational: fast
IV: slow

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22
Q

high cardiac output induction

A

inhalation: slow
IV: fast

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23
Q

minute ventilation and inhalational induction

A

increase MV
increase inhalational induction speed

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24
Q

minute ventilation

A

RR X TV

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25
increase TV
more surface area for gas exchange increase MV increase inhalational induction
26
increase RR
constantly replenish alveoli w/more volatile agent increase inhalational induction
27
FRC
volume of air in the lungs at end of normal expiration
28
low FRC (inhalational induction)
less space in alveoli higher volatile agent [lung] faster inhalational induction
29
pediatric inhalational induction speed
faster due to low FRC
30
high FRC (inhalational induction)
more space in alveoli lower volatile agent [lung] slower inhalational induction
31
factors that cause Fa (agent [lung]) to build up quickly (4)
low blood solubility of agent low cardiac output high minute ventilation low FRC
32
Fa:Fi curve
depicts how fast the Fa:Fi ratio approaches 1
33
Fa:Fi curve steep slope
agent builds up quickly in lungs lower blood solubility = faster induction
34
Fa:Fi curve gradual slope
agent builds up more slowly in lungs higher blood solubility = slower induction
35
why is N2O curve steeper than Des?
N2O is given in much higher concentrations (25-75%) compared to Des at 6-8% higher concentrations lead to faster buildup in lungs (Fa)
36
Ways to speed up inhalational induction (4)
1. higher percentage of agent 2. higher fresh gas flow (FGF) 3. choose agent w/lowest blood solubility 4. decreased circuit volume
37
FGF affect on induction speed
increasing FGF allows machine dead space to fill more quickly
38
Factors for Faster Inhalational induction (8)
1. faster buildup in alveoli 2. lower blood solubility of agent 3. higher % on vaporizer 4. higher FGF 5. smaller anesthesia circuit volume 6. lower cardiac output 7. higher minute ventilation 8. low FRC (including peds)
39
Factors for slower inhalational induction
1. slower buildup of agent in alveoli 2. higher blood solubility of agent 3. lower % on vaporizer 4. lower FGF 5. large circuit volue 6. higher cardiac output 7. lower minute ventilation 8. higher FRC
40
O2 consumption of awake normothermic 70kg male
250 mL/min
41
how much is O2 consumption reduced under GA in most pts?
15-20%
42
minimum FGF for adults
0.5L/min ensures circuit has adequate pressure
43
low FGF advantages
1. cost effective (preserves agent) 2. preserves trachea heat/moisture 3. preserves CO2 bsorber 4. preserves pt body temo
44
low FGF disadvantages
1. slower inhalational induction 2. slower emergence
45
high FGF advantages
1. faster inhalational induction 2. faster emergence
46
high FGF disadvantages
1. expensive (agent wasted) 2. dries out pt airway (moisture/heat loss) 3. accelerates drying out of CO2 absorber
47
low flow wizard
tells how much flow is req to get job done - TV, RR, uptake, leaks saves $$ preserves pt temp helps detect leaks in system
48
wakeup aka
recovery emergence
49
groups of tissues that the volatile agents impact
vessel rich muscle fat
50
vessel rich group
75% of CO brain heart liver kidney endocrine quick on quick off
51
muscle rich group
20% CO skin muscle
52
fat group
5% CO slow on slow off
53
which tissues are volatile agents most soluble in?
fat
54
wakeup mechanism
1. vaporizer off (FGF up) 2. agent [machine] and [lungs] decr 3. agent diffuses from blood to lungs 4. agent [blood] decreases 5. agent diffuses from tissues to blood 6. when agent [fat] low enough, [blood] and [brain] will be low enough for wakeup
55
to decrease the agent concentration in machine and lungs faster, what can you do?
increase FGF rate
56
low blood solubility: emergence
faster agent wants to get out of blood diffuses more quickly into lungs
57
high blood solubility: emergence
slower agent wants to stay in blood diffuses slower into lungs
58
factors that cause slower wakeup (13)
1. older age 2. obesity (more agent in fat) 3. long sx times (more agent in fat) 4. sx w/higher [agent] (more agent in fat) 5. high blood solubility volatile agent 6. higher dose narcotics 7. lower FGF (emergence) 8. lower minute ventilation (emergence) 9. closed APL valve (emergence) 10. higher FRC 11. lung disease 12. low CO 13. hypothermia
59
low FGF rate
1-2 L/min
60
high FGF rate
10-15 L/min
61
how does a closed APL valve slow down emergence?
more rebreathing of agent
62
pediatrics emergence
faster than adults peds have higher % blood flow to vessel rich group lower % blood flow going to fat faster on faster off
63
factors in pediatric faster emergence
1. higher minute ventilation (faster RR) 2. lower FRC 3. higher % BF to vessel rich (less to fat)

Sp: PMI (18 decks)

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