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Des Flashcards

1
Q

Most insoluble volatile anesthetic

A

Desflurane

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2
Q

1 determinant of speed of recovery and onset of anesthetic

A

BGPC

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3
Q

Low BGPC =

A

More insoluble

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4
Q

Lower solubility in blood and tissues accomplished by

A

Halogenation with fluorine

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5
Q

Change in iso to des

A

Chlorine replaced by fluorine on alpha ethyl carbon

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6
Q

The most electronegative element

A

Fluorine

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7
Q

What changes boiling point, vapor pressure and stability of volatile anesthetic

A

Fluoridation

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8
Q

Isoflurane broken down by soda lime at what temp

A

60 degrees celcius

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9
Q

Is desflurane broken down by soda lime at 40-60 degrees Celsius

A

No

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10
Q

Which broken down further by soda lime (sevo, des, iso)

A

Sevoflurane

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11
Q

Resistance to degredation results in ability to use

A

Low flows

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12
Q

Lowest flow can go on des

A

Lowest metabolic oxygen requirements for pt

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13
Q

Desflurane is _______ as potent as isoflurane

A

1/5

MAC of 6% in comparison to 1.17%

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14
Q

Desflurane vapor pressure

A

669

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15
Q

High vapor pressure of desflurane requires

A

Use of a special vaporizer

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16
Q

BGPC of des

A

0.42

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17
Q

Most rapid elimination of volatile anesthetic

A

Desflurane

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18
Q

Which volatile has less shivering and delirium

A

Desflurane

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19
Q

8 carbons on desflurane…how many fluoridated?

A

6

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20
Q

If replace last hydrogen’s with Florine’s you get

A

Immobilizers

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21
Q

Best patient population to use desflurane

A

Bariatric surgery bc better able to maintain airway after case

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22
Q

Differences between concentration of anesthetic delivered from vaporizer and concentration in alveoli- __________ the difference the greater the control

A

Smaller

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23
Q

Vaporizer setting better indicates ______________ with desflurane as opposed to iso or sevo

A

Alveolar concentration

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24
Q

Larger the difference in vaporizer setting and alveolar concentration reflects

A

Higher BGPC

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25
Insolubility advantages (3)
1. Rapid induction 2. Precise control of anesthetic 3. Prompt recovery independent of length of anesthesia
26
If go up on vaporizer with desflurane too rapidly results in
Airway irritation and HTN, tachycardia
27
Can you do an inhaled induction with desflurane?
No
28
Disadvantages of desflurane (4)
- airway irritation - SNS stimulation - CO production - new vaporizer technology
29
Regardless of tissue type, which volatile anesthetic has lowest tissue:blood partition coefficient
Desflurane
30
More insoluble the anesthetic, over time the more ________
Rapid equilibration of | FA/FI at 1
31
Desflurane and mental function
No impairment
32
Desflurane and retrograde amnesia
Does not produce
33
Desflurane effect on - CMRO2 - cerebral activity - cerebral blood flow
- decreased CMRO2 - decreased cerebral activity - increased cerebral blood flow
34
Desflurane electrical silence around what MAC
1.5-2 MAC
35
At what MAC has Desflurane maximally reduced CMRO2?
2 MAC- bc electrical silence on EEG
36
Desflurane and evoked potential monitoring
0.5MAC don’t exceed 1
37
Desflurane increase in CBF last up to
4 hours
38
Desflurane < CMRO2 less than ________ but comparable to ______
Less than Isoflurane but comparable to Sevoflurane
39
Desflurane and ICP
Increases especially with space occupying lesions
40
How to decrease elevation in ICP with des
Hyperventilate to ETCO2 on 30
41
Dose required to increase ICP with des lies bw
0.8-1.1 MAC
42
Circulatory effects of des most closely resemble
Iso
43
Desflurane changes on - BP - HR - SVR
Decreased BP Increased HR Decreased SVR
44
Biggest effect of des to decrease BP found where
Skeletal muscular vascular bed vasodilation
45
To decrease magnitude of BP drop with des
Substitute nitrous for equal MAC portion of des
46
Increase HR with desflurane blunted by
Opioids and beta blockers
47
HR increase with des seen less in
Elderly
48
Desflurane and dysrhythmia
Does not cause dysrhythmia
49
Desflurane, isoflurane, and sevoflurane decrease LV SV by _______ - effect dissipates within how long of des anethesia
15-30% - 5 hours
50
Decrease in SV is offset by
Increase in HR
51
Desflurane and RAP
Raises sim to iso and sevo
52
Desflurane and PVR
Does not alter
53
What inhaled anesthetic does increase PVR
Nitrous
54
Abrupt increase in Desflurane cause transient increase in HR and BP r/t
SNS and RAA activity increased
55
Site mediating increase in HR and BP with des - abated by what
Upper airway Lungs -fentanyl and beta blockers
56
HR and SNS responses less than _____ MAC
1
57
HR increase with desflurane not dependent on
Rate of increase or desflurane concentration
58
Desflurane and myocardium
Myocardial depressant effects
59
Des and coronary steal
Redistributes blood from ischemic to non-ischemic areas
60
Apnea with desflurane
1.5-2 MAC
61
Net effect on MC and PaCO2
Decreased MV | Increased PACO2
62
Desflurane increases PaCO2 more with what pt
Pt with lung disease
63
Overall breathing pattern of pt spontaneously breathing Desflurane
increased RR decreased TV
64
Increase in PaCO2 with desflurane begins to decrease
After 5 hours of spontaneously breathing des
65
Best way to balance elevated CO2 with desflurane
Mechanical ventilation
66
Is assistive ventilation effective to decrease PACO2 with pt spontaneously breathing des
No. Do not assist, control ventilation
67
Desflurane and bronchoconstriction
May induce bronchoconstriction in smokers
68
Is des pungent
Yes
69
Volatile agent easiest to spontaneously breath with
Sevolfurane
70
In children des associated with
Oxyhemoglobin desaturation
71
Desflurane and LFT’s
Transient increase in LFTs following Desflurane administration
72
Desflurane and liver
Post op liver dysfunction | -worse with hepatocyte hypoxemia, preexisting liver disease
73
Desflurane is metabolized by ___________ to _____
Cytochrome P-450 to form acetylated liver protein adduct Results in antibody-antigen ____
74
Desflurane and renal fx
Dose dependent decrease in - renal blood flow - GFR - UOP Rt < SVR
75
To counterbalance des effect on kidneys
Pre-op hydration
76
Desflurane and NMB
Dose dependent enhancement of NMBs
77
Desflurane and OB
Dose dependent decrease in uterine smooth muscle contractility and uterine blood flow
78
OB changes with des are modest at ______ MAC and significant at _______ MAC
0.5 MAC | Significant at 1 MAC
79
Desflurane and total body oxygen requirements
Reduced
80
Organ with largest O2 requirement decrease with desflurane
Heart
81
How does des decrease total body O2 requirements
- metabolic depressant effect | - decreased functional needs
82
Greater metabolism of desflurane seen with
Increased MACs
83
______ of desflurane undergoes metabolism
0.02%
84
Results of Desflurane metabolism
- inorganic fluorides - trifluroacetic acid - CO2 - water
85
CO production of volatile anesthetic comparison
Desflurane > Isoflurane > Sevoflurane
86
Metabolism order of magnitude of volatile anesthetic
Sevoflurane > Isoflurane > Desflurane
87
Completely dry soda lime produces more CO than absorbent with _________
1.4% water content
88
Soda lime containing > _______ water generates no CO
4.8%
89
Standard soda lime contains what percent water
15% water
90
Baralyme with _________ water produces high CO concentrations
<1.6%
91
Baralyme containing >_______water produces no CO
9.7%
92
Which absorbent produces more carbon monoxide
Baralyme more than soda lime
93
Temperature effect on CO production
Increased temp increases CO production
94
More carbon monoxide produced from _______ concentrations
Higher concentrations
95
Carbon monoxide generation can be avoided by (3)
- soda lime with > 4.8% water - Baralyme with > 9.7% water - FGF < 2-3 L/min to ensure absorbent doesn’t dry out
96
Desflurane MAC
6%

Pharmacology (6 decks)

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