chapter 23

Question 1

b. Administration of any drug into the body is balanced by two factors: ___to other areas of the body, and ___(ie. Clearance).

Answer 1

b. Administration of any drug into the body is balanced by two factors: redistribution to other areas of the body, and metabolism (ie. Clearance).

Question 2

1. The concentration of inhalant in the alveoli parallels the concentration of inhalant in the brain, as long as ___ is adequate.

Answer 2

1. The concentration of inhalant in the alveoli parallels the concentration of inhalant in the brain, as long as cardiac output is adequate.

Question 3

iii. At the induction of anesthesia, a relatively high concentration of inhalant is present in the arterial blood, with a relatively low concentration of aneshteic in the _____blood, which reflects uptake of the inhalant by the tissues of the body; exhaled gas after the first breaths will contain little to no anesthetic agent. Once an equilibrium exists between arterial and venous anesthetic concentrations, relatively little additional anesthetic needs to be supplied to the circuit (assuming rebreathing of exhaled gases, which contain an equal percentage of inhalant).

Answer 3

iii. At the induction of anesthesia, a relatively high concentration of inhalant is present in the arterial blood, with a relatively low concentration of aneshteic in the venous blood, which reflects uptake of the inhalant by the tissues of the body; exhaled gas after the first breaths will contain little to no anesthetic agent. Once an equilibrium exists between arterial and venous anesthetic concentrations, relatively little additional anesthetic needs to be supplied to the circuit (assuming rebreathing of exhaled gases, which contain an equal percentage of inhalant).

Question 4

e. OXYGEN requirements – ___ml/kg/min

Answer 4

e. OXYGEN requirements – 5ml/kg/min

Question 5

b. ________vapor pressure – the point when the gas of the anesthetic agent is in dynamic equilibrium with the liquid agent

Answer 5

b. Saturated vapor pressure – the point when the gas of the anesthetic agent is in dynamic equilibrium with the liquid agent

Question 6

___ ____ – splitting the incoming fresh gas flow to direct a cariable portion through the vaporizing chamber and the remainder through a bypass chamber. Most common type of vaporizer used today

Answer 6

variable bypass – splitting the incoming fresh gas flow to direct a cariable portion through the vaporizing chamber and the remainder through a bypass chamber. Most common type of vaporizer used today

Question 7

a. ____-over – the carrier gas passes over a reservoir of inhalant and picks up the anesthetic vapor as it does so. Often wicks are incorporated into the vaporizer to increase surface area for contact between the inhalant and the carrier gas. (most commonly used)
b. _____-through – bubble the carrier gas through the bottom of the reservoir of anesthetic to pick up the vapor.
c. Direct injection – inject an atomized spray of inhalant into the stream of the carrier gas, rapidly vaporizing the inhalant, as is done in desflurane vaporizers.

Answer 7

a. Flow-over – the carrier gas passes over a reservoir of inhalant and picks up the anesthetic vapor as it does so. Often wicks are incorporated into the vaporizer to increase surface area for contact between the inhalant and the carrier gas. (most commonly used)
b. Bubble-through – bubble the carrier gas through the bottom of the reservoir of anesthetic to pick up the vapor.
c. Direct injection – inject an atomized spray of inhalant into the stream of the carrier gas, rapidly vaporizing the inhalant, as is done in desflurane vaporizers.

Question 8

a. ______circuits (circle systems)
i. Uses CO2 absorbent to remove CO2 from the system. Ex. Soda lime
1. CO2 exhaled reacts with the soda lime water to form carbonic acid on the surface of the absorbent granules. Then carbonic acid dissociates to free protons and carbonate. Heat and water are generated by all reactions

Answer 8

a. Rebreathing circuits (circle systems)
i. Uses CO2 absorbent to remove CO2 from the system. Ex. Soda lime
1. CO2 exhaled reacts with the soda lime water to form carbonic acid on the surface of the absorbent granules. Then carbonic acid dissociates to free protons and carbonate. Heat and water are generated by all reactions

Question 9

c. __________systems
i. Prevent rebreathing of CO2 by using high fresh gas flow rates. Upon exhalation, the expired gas passes into a reservoir bag or out of the system via the adjustable pressure-limiting valve.
ii. The fresh gas flow rate is at least 3 times the patient’s respiratory minute volume (MV = respiratory rate x tidal volume; estimated tidal volume = 15ml/kg)
iii. A small amount of expired gas may enter the patient before the incoming fresh gas gets to the patient, particularly if the fresh gas flow rate is too low upon the subsequent inspiration.

Answer 9

c. Nonrebreathing systems
i. Prevent rebreathing of CO2 by using high fresh gas flow rates. Upon exhalation, the expired gas passes into a reservoir bag or out of the system via the adjustable pressure-limiting valve.
ii. The fresh gas flow rate is at least 3 times the patient’s respiratory minute volume (MV = respiratory rate x tidal volume; estimated tidal volume = 15ml/kg)
iii. A small amount of expired gas may enter the patient before the incoming fresh gas gets to the patient, particularly if the fresh gas flow rate is too low upon the subsequent inspiration.

Question 10

c. ___eye – separate opening at the end of an endotracheal tube that prevents airway obstruction from occurring secondary to obstruction of the endotracheal tip.

Answer 10

c. Murphy eye – separate opening at the end of an endotracheal tube that prevents airway obstruction from occurring secondary to obstruction of the endotracheal tip.

Question 11

a. In a patient breathing room air, hypoxemia will develop within 30 seconds of apnea or airway obstruction, whereas a patient previously breathing 100% oxygen (for ___minutes) may not become hypoxemic for upward of ___minutes after onset of apnea.

Answer 11

a. In a patient breathing room air, hypoxemia will develop within 30 seconds of apnea or airway obstruction, whereas a patient previously breathing 100% oxygen (for 3 minutes) may not become hypoxemic for upward of 5 minutes after onset of apnea.

Question 12

iii. The oxygen flush valve delivers oxygen, which bypasses the flowmeter and vaporizer and is consequently delivered at high pressure (__-__L/min) which can result in significant barotrauma.

Answer 12

iii. The oxygen flush valve delivers oxygen, which bypasses the flowmeter and vaporizer and is consequently delivered at high pressure (30-50 L/min) which can result in significant barotrauma.

Question 13

d. Anesthesia ventilators
i. Manual or mechanical ventilator to provide intermittent positive pressure ventilation (IPPV)
ii. Default inspiratory to expiratory ration of :
iii. Tidal volume can be estimated as _-_ml/kg for each breath

Answer 13

d. Anesthesia ventilators
i. Manual or mechanical ventilator to provide intermittent positive pressure ventilation (IPPV)
ii. Default inspiratory to expiratory ration of 1:2
iii. Tidal volume can be estimated as 10-15ml/kg for each breath

Question 14

a. Eye positioning (light ____moderate __ deep ____)

Answer 14

a. Eye positioning (light – deep; central, ventromedial, center)

Question 15

4. When mean arterial pressure is less than ____, perfusion and oxygen delivery to the kidney and brain are likely insufficient to meet the requirements for aerobic metabolism.
5. A diastolic pressure less than ____indicates poor coronary artery perfusion and possible cardiac ischemia

Answer 15

4. When mean arterial pressure is less than 60mmHg, perfusion and oxygen delivery to the kidney and brain are likely insufficient to meet the requirements for aerobic metabolism.
5. A diastolic pressure less than 40mmHg indicates poor coronary artery perfusion and possible cardiac ischemia

Question 16

1. The Doppler method (____blood pressure)of indirect blood pressure measurement relies on the recognition of a change in sound produced as blood passes under the Doppler crystal. The crystal emits a sound wave and, as that wave is reflected by the blood, receives the change in signal created by the velocity of the flowing blood.
   a. Most commonly used areteries: radial artery, plantar metatarsal artery, and coccygeal artery of the tail
   b. The width of the cuff should be equal to __-__% of the circumference of the limb or tail.
   i. Larger cuffs will result in an artificially low value
   ii. Smaller cuffs will result in an artificially high value
   iii. In cats, the Doppler tends to underestimate the systolic arterial pressure by __
   iv. Doppler sound pulse is not affected by tachyarrhythmias, bradyarrhythmias, or irregular heartbeats

Answer 16

1. The Doppler method (systolic blood pressure)of indirect blood pressure measurement relies on the recognition of a change in sound produced as blood passes under the Doppler crystal. The crystal emits a sound wave and, as that wave is reflected by the blood, receives the change in signal created by the velocity of the flowing blood.
   a. Most commonly used areteries: radial artery, plantar metatarsal artery, and coccygeal artery of the tail
   b. The width of the cuff should be equal to 40-60% of the circumference of the limb or tail.
   i. Larger cuffs will result in an artificially low value
   ii. Smaller cuffs will result in an artificially high value
   iii. In cats, the Doppler tends to underestimate the systolic arterial pressure by 25mmHG
   iv. Doppler sound pulse is not affected by tachyarrhythmias, bradyarrhythmias, or irregular heartbeats

Question 17

___________________often occurs during cardiac arrest and cardiopulmonary cerebral resuscitation and shows a plausible ECG tract that is not correlated with any muscular contraction

Answer 17

Electromechanical dissociation (pulseless electrical activity) often occurs during cardiac arrest and cardiopulmonary cerebral resuscitation and shows a plausible ECG tract that is not correlated with any muscular contraction

Question 18

capnograph

d. Phase 0 – inspiration where there is 0mmHg CO2 passing the sensor
e. Phase 1 – elevation of the waveform during expiration
f. Phase ____ – peak at the end of expiration
g. Phase 4 – before the next inspiration as the levels approach 0 again

Answer 18

d. Phase 0 – inspiration where there is 0mmHg CO2 passing the sensor
e. Phase 1 – elevation of the waveform during expiration
f. Phase 3 – peak at the end of expiration
g. Phase 4 – before the next inspiration as the levels approach 0 again

Question 19

. The pulse oximeter estimates the percent of ____that is saturated in oxygen. Hemoglobin can exist as oxyhemoglobin or deoxyhemoglobin, depending on the presence of oxygen on the hemoglobin molecule. Each type absorbs infrared light at a different frequeny.

Answer 19

. The pulse oximeter estimates the percent of hemoglobin that is saturated in oxygen. Hemoglobin can exist as oxyhemoglobin or deoxyhemoglobin, depending on the presence of oxygen on the hemoglobin molecule. Each type absorbs infrared light at a different frequeny.

Question 20

1. The pulse oximeter alone is not a valuable tool for determining perfusion, blood pressure, or cardiac output. Only for determining ____delivery to tissues.

Answer 20

1. The pulse oximeter alone is not a valuable tool for determining perfusion, blood pressure, or cardiac output. Only for determining oxygen delivery to tissues.

Question 21

ii. CVP is measured with a catheter placed into the central circulation, usually the cranial vena cava via the jugular vein. The tip of the CVP catheter should be located within the thorax, just outside of the right atrium. The CVP catheter may be connected to a water manometer and a sterile saline bag via a three-way stopcock, or it may be connected to a multiparameter monitor using the same type of transducer used for direct arterial pressure monitoring. The zero point should be placed level to the patient’s right atrium.
iii. CVP normal: ___-___cmH20 or __-__mmHg

Answer 21

ii. CVP is measured with a catheter placed into the central circulation, usually the cranial vena cava via the jugular vein. The tip of the CVP catheter should be located within the thorax, just outside of the right atrium. The CVP catheter may be connected to a water manometer and a sterile saline bag via a three-way stopcock, or it may be connected to a multiparameter monitor using the same type of transducer used for direct arterial pressure monitoring. The zero point should be placed level to the patient’s right atrium.
iii. CVP normal: 0-8cmH20 or 0-5mmHg