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General Principles > Exam 2- Inhalational Agents > Flashcards

Exam 2- Inhalational Agents Flashcards

1
Q

potent inhaled anesthetics are mostly in what state?

A

liquid state at normal room temperature

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2
Q

what is vapor?

A

gaseous phase of a substance at a temperature which the substance can exist in either a liquid or a solid state below a critical temperature for that substance

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3
Q

what is a variable bypass vaproizer?

A

one in which the total gas glow is divided in two streams by a variable resistance proportioning valve

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4
Q

where does the majority of a volatile agent flow through?

A

the bypass line

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5
Q

what does the Tech 6 vaporizer do?

A

contains an electrical filament that heats the desflurane to 39º C

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6
Q

what what does the Tech 6 vaporizer do to the saturated vapor pressure?

A

raises it

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7
Q

what does a higher pressure do to Desflurane?

A

removes the need for a pressurized carrier gas

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8
Q

what would make an ideal agent?

A

non-pungent, non-flammable, fast induction, fast wake-up, no harmful metabolites

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9
Q

3 main phases of anesthesia?

A

induction, maintenance, emergence

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10
Q

how is an anesthetic state obtained?

A

combination of amnesia, analgesia, and lack of response to noxious stimuli

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11
Q

what does the myer-overton theory state?

A

the lipid solubility is directly proportional to the potency of an inhaled anesthetic

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12
Q

the ultimate effect of inhaled anesthetics depends on

A

reaching a therapeutic level in the CNS/brain/spinal cord

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13
Q

unconsciousness is based on effects of what system?

A

the reticular activating system

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14
Q

analgesia effect is based on what part of the body?

A

the spinothalamic tract

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15
Q

amnesia affects what parts of the brain?

A

the amygdala and hippocampus

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16
Q

immobility affects of anesthesia affect what part of the body?

A

the ventral horn of the spinal cord

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17
Q

what are ideal characteristics of inhaled gases

A

pleasant to inhale, smooth induction and emergence

low solubility

easy to administer and analyze

stable in CO2 absorbers, inflammable, not metabolized

specific site of action

No CV or Resp side effects, non toxic, pain control, muscle relaxation

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18
Q

amnesia and loss of conscious occur when?

A

at lower levels of anesthesia

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19
Q

immobility occurs at what level of anesthesia?

A

higher levels than amnesia and loss of consciousness

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20
Q

stage I

A

induction to loss of consciousness

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21
Q

state II

A

delirium w a period of excitement

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22
Q

pupils during stage II

A

dilated

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23
Q

gaze during stage II

A

disconjugate

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24
Q

in which stage will patient have an increase HR and RR

A

stage II

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25
Q

in which stage is the patient at highest risk for laryngospasm or bronchospasm?

A

stage II

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26
Q

stage III

A

surgical plane, fixed gaze, constricted pupils

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27
Q

stage IV

A

overdose

shallow/irregular RR

hypotension/profound CV collapse

dilated/unresponsive pupils

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28
Q

when is inhalational induction commonly seen?

A

pediatrics

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29
Q

vital capacity breath

A

prime entire circuit with the gas, quicker than tidal volume breathing

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30
Q

N2O/O2 induction

A

70% : 30% until induced

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31
Q

sevoflurane induction

A

7-8% until induced

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32
Q

can you use desflurane for mask induction?

A

yes? but it is pungent. patients may cough.

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33
Q

volatile agents effect on airway?

A

can relax airway smooth muscle and produce bronchodilation

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34
Q

what stages of anesthesia do patients undergoing inhaled induction experience?

A

stage I, II, and III

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35
Q

what stage of anesthesia do patients undergoing inhalational induction especially experience?

A

excitatory

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36
Q

which kind of induction bypasses the second stage?

A

IV induction

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37
Q

what are advantages of inhalation induction?

A

less trauma, no IV access, short pediatric cases, bronchodilator effect

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38
Q

what are disadvantages to inhalation induction?

A

smell
excitatory stage
delayed airway
gas bypassing scavenger system

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39
Q

what gas smells the best?

A

sevo

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40
Q

MAC

A

the inhalational anesthetic concentration at which 50% of the population will not move to painful or noxious stimuli

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41
Q

MAC is a direct measure of

A

the potency of the volatile anesthetic

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42
Q

how much does MAC vary among individuals

A

10-15%

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43
Q

how does MAC relate to brain partial pressure?

A

MAC mirrors brain pressure

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44
Q

potency is directly related to

A

solubility

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45
Q

are MAC anesthesia values additive?

A

yes

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46
Q

MAC-BAR

A

MAC needed to block autonomic responsiveness to painful stimuli

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47
Q

MAC-BAR values

A

1.5-2.0 MAC

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48
Q

MAC-awake

A

alveolar concentration at which patients open their eyes

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49
Q

MAC-awake values

A

0.4-0.5 to lose consciousness and 0.15 to regain it

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50
Q

awareness and recall are usually thought to be prevented at what MAC?

A

0..4-0.5 MAC

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51
Q

what MAC will prevent movement in 95% of surgical patients?

A

1.2-1.3

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52
Q

nitrous oxide MAC and vapor pressure

A

MAC- 104
vapor pressure- 38,770

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53
Q

halothane MAC and vapor pressure

A

MAC- 0.75
vapor pressure- 244

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54
Q

isoflurane MAC and vapor pressure

A

MAC- 1.17
vapor pressure- 240

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55
Q

sevoflurane MAC and vapor pressure

A

MAC- 1.8
vapor pressure- 157

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56
Q

desflurane MAC and vapor pressure

A

MAC- 6.6
vapor pressure- 660

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57
Q

does duration of anesthesia change MAC?

A

no

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58
Q

does anesthetic metabolism change MAC

A

no

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59
Q

does hyperkalemia change MAC

A

no

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60
Q

does hyper or hypo carbia change MAC

A

no

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61
Q

does gender change MAC

A

no

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62
Q

does thyroid function change MAC

A

no

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63
Q

does metabolic alkalosis change MAC

A

no

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64
Q

which population requires a higher MAC requirement?

A

young, healthy patients

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65
Q

what factors may increase MAC

A

hyperthermia, drugs, natural red hair, hypernatremia, chronic alcohol abuse

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66
Q

what drugs might increase mac

A

drugs that increase CNS catecholamine levels
- MAOI
-cocaine
-ephedrine
-levodopa
-amphetamine abuse

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67
Q

what factors may decrease MAC

A

hypothermia, Benzos, older age, pregnancy, alpha agonists (precedex), acute alcohol ingestion, hyponatremia, hypotension, drugs, severe anemia, low MAP <50mmHg

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68
Q

what is the only true gas?

A

N2O

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69
Q

inhaled anesthetic properties

A

nonionized, low molecular weights, rapid diffusion

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70
Q

sevoflurane boiling point

A

59º C

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71
Q

sevoflurane vapor pressure at 20º C

A

157 mmHg

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72
Q

sevoflurane blood: gas partition coefficient

A

0.65

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73
Q

sevoflurane oil: gas partition coefficient

A

47

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74
Q

sevoflurane MAC

A

1.8

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75
Q

sevoflurane % metabolized in the body

A

2-5%

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76
Q

desflurane boiling point

A

24º C

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77
Q

desflurane vapor pressure

A

669 mmHg

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78
Q

desflurane blood:gas partition coefficient

A

0.43

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79
Q

desflurane oil:gas partition coefficient

A

19

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80
Q

desflurane MAC

A

6.6

81
Q

desflurane % metabolized in the body

A

0.02%

82
Q

isoflurane boiling point

A

49º C

83
Q

isoflurane vapor pressure

A

238 mmHg

84
Q

isoflurane blood:gas partition coefficient

A

1.46

85
Q

isoflurane oil:gas partition coefficient

A

91

86
Q

isoflurane MAC

A

1.17

87
Q

isoflurane % metabolized in the body

A

0.2%

88
Q

nitrous oxide boiling point

A

-88ºC

89
Q

nitrous oxide vapor pressure

A

38,770 mmHg

90
Q

nitrous oxide blood:gas partition coefficient

A

0.46

91
Q

nitrous oxide oil: gas partition coefficient

A

1.4

92
Q

nitrous oxide MAC

A

104

93
Q

nitrous oxide % metabolized in the body

A

0%

94
Q

can plasma and tissues absorb the anesthetic well?

A

no.

95
Q

at equilibrium, CNS partial pressure equals

A

blood partial pressure which equals alveolar partial pressure

96
Q

which factors increase the speed of onset of inhaled anesthetics?

A

high inspired concentration

high alveolar minute ventilation

low blood solubility

high MAC

97
Q

FGF

A

fresh gas flow; determined by flowmeter settings and vaporizer

98
Q

FI

A

inspired gas concentration, determined by fresh gas flow, breathing circuit volume, and circuit absorption

99
Q

FA

A

alveolar gas; determined by uptake, ventilation, the concentration effect and second gas effect

100
Q

Fa

A

arterial gas, affected by ventilation perfusion mismatch

101
Q

Goal of inhalational anesthesia

A

anesthetic state in the CNS/brain

to achieve optimal and constant partial pressure of anesthetic in the brain

102
Q

inspired gas concentration depends on

A

Fresh gas flow and rate
Breathing system volume
Absorption of machine circuit

103
Q

what determines the speed of onset for inhalation agents?

A

solubility in the blood

104
Q

more insoluble inhaled agents

A

are taken up much slower by the blood SO INDUCTION IS FASTER

105
Q

how is the solubility of an anesthetic expressed?

A

partition coefficients

106
Q

does isoflurane have a high blood : gas coefficient

A

yes, 1.4

it is soluble; slower induction/wakeup

107
Q

which inhaled anesthetic has a low blood : gas coefficient

A

desflurane (0.42)

poor solubility

rapid induction/wake up

108
Q

what parallels anesthetic requirements

A

oil:gas partition coefficient

109
Q

higher MAC level

A

lower B:G coefficient

110
Q

decrease in potency

A

associated with a decrease in the oil:gas partition coefficient

111
Q

as cardiac output increases what happens to anesthetic uptake?

A

it increases

112
Q

what % cardiac output does the vessel rich group recieve?

A

75%

113
Q

what % cardiac output does the muscle recieve?

A

19%

114
Q

what % cardiac output does fat recieve?

A

6%

115
Q

how much blood flow does the vessel poor group recieve?

A

less than 1%

116
Q

are inhalational agents lipid soluble?

A

yes, very

117
Q

ways to speed up the equilibrium of FA/FI

A

increase minute ventilation

decrease FRC

for mask inductions: breathe deeply before applying the mask, breathe deeply and quickly after applying the mask

118
Q

describe the second gas effect

A

Uptake of a large volume of a first or primary gas (usually Nitrous) from alveoli accelerates the rate of increase of the PA of a co-administered second gas

119
Q

concentration of inhaled anesthetics in the tissues at the end of anesthetic depends on

A

solubility of the agent and time of administration

120
Q

exhaled gases from the patient will be rebreathed uneless

A

fresh gas flow rates are >5L/min

121
Q

which anesthetics are non-pungent?

A

sevoflurane, halothane, and nitrous

122
Q

which anesthetic agents are pungent?

A

desflurane and isoflurane

123
Q

why might PaCO2 increasee?

A

dose dependent depression of the ventilatory response to hypercarbia

124
Q

which anesthetic agent might be irritating to smokers?

A

desflurane

125
Q

inhalational agent cardiovascular effects

A

reduce MAP, CO, and Cl in dose dependent ways

myocardial depression

decreased SVR –> hypotension from vasodilation

reduce BP via relaxation of vascular smooth muscle causing a decrease in SVR

126
Q

which agent activates the sympathetic nervous system and increases SVR?

A

N2O

127
Q

which inhalation agent can lead to increases in CVP and arterial pressures?

A

N2O

128
Q

which inhalation agents can increase HR and BP due to sympathetic stimulation?

A

isoflurane and desflurane

129
Q

which inhalation agent demonstrates initial tachycardia?

A

desflurane

130
Q

what do inhalational agents do to the CNS?

A

dose dependent increases in cerebral blood flow by direct vasodilation

increased ICP

131
Q

how is increased ICP from inhalational agents attenuated?

A

hyperventilation

132
Q

inhalational agent obstetric effects?

A

dose-dependent decreases in uterine smooth muscle contractility and blood flow

133
Q

what MAC are obstetric effects seen at?

A

> 1 MAC

134
Q

inhalational agent effect on kidneys?

A

decreased GFR

135
Q

do inhaled anesthetics undergo liver metabolism?

A

minimally

136
Q

how are inhaled anesthetics most commonly biodegraded?

A

CYP450 oxidation

137
Q

inhalational anesthetic neuromuscular system effects

A

dose dependent skeletal muscle relaxation

138
Q

what can inhalational agents do to recovery from nondepolarizing muscle relaxants?

A

delay recovery because of synergistic effects

139
Q

when is post-op cognitive dysfunction an increased concern?

A

elderly and pediatric patients

140
Q

what is emergence delirium

A

acute state of confusion/agitation after anesthesia

141
Q

when is emergence delirium more commonly seen?

A

20-80% in pediatrics in both sexed 2-6 yrs old

142
Q

what inhalational agents more commonly have emergence delirium effects?

A

sevoflurane and desflurane

143
Q

how long does emergence delirium last and how does it end?

A

10-15 mins; terminated spontaneously or after IV dose of propofol, midazolam, clonidine, precedex, ketamine, opioids, etc

144
Q

when is there a higher probability of Compound A production?

A

low flow rates

closed circuit breathing systems

warm/dry CO2 absorbers

Sevoflurane use

144
Q

how much CO2 can soda lime absorb

A

23 L of CO2 per 100g of absorbent

144
Q

what are the final products of CO2 neutralization

A

carbonates, heat, water

145
Q

what type of capnography would you see in a patient when the CO2 absorbent is exhausted?

A

rising ETCO2 waveform

146
Q

isoflurane chemical makeup

A

5 fluorine atoms and 1 chlorine atom

147
Q

desflurane chemical makeup

A

6 fluorine atoms

148
Q

sevoflurane chemical makeup

A

7 fluorine atoms

149
Q

which inhaled agents are chiral?

A

desflurane and isoflurane

150
Q

which inhaled agent has no chiral carbon?

A

sevoflurane

151
Q

what is a coronary steal

A

diversion of blood from a myocardial bed with limited or inadequate perfusion to a bed with more perfusion

152
Q

which inhalation agent is associated with a coronary steal?

A

isoflurane

153
Q

which inhalation agent is associated with a dose dependent decrease in mean arterial pressure?

A

isoflurane

154
Q

which inhalation agent is associated with a dose dependent increase in cerebral blood flow?

A

isoflurane

155
Q

which inhalation agent is associated with a resistance to degradation?

A

isoflurane

156
Q

which inhalation agent is non-pungent

A

sevoflurane

157
Q

which inhalation agent is associated with minimal sympathetic activation?

A

sevoflurane

158
Q

which inhalation agent is insoluble in blood

A

desfluranew

159
Q

which inhalation agent is associated with faster to sleep and wake up times

A

desflurane

160
Q

which inhalation agent is a potential airway irritant?

A

desflurane

161
Q

TEC6 vaporizer

A

dual-circuit, NOT variable bypass

162
Q

what temperature is the TEC6 vaporizer heated to?

A

39º C

163
Q

can you fill the TEC6 vaporizer during use?

A

yes

164
Q

inhalation agents should be avoided in what population?

A

patients w a high risk of PONV

165
Q

characteristics of N2O

A

Colorless, non-pungent, non-explosive, non-flammable

166
Q

which inhalation agent has minimal CV effects but can increase bp?

A

nitrous oxide

167
Q

which inhalation agent can increase RR and decrease TV?

A

nitrous oxide

168
Q

does N2O trigger MH?

A

no

169
Q

nitrous oxide musculoskeletal effects

A

no muscle relaxation or uterine relaxation

170
Q

when is N2O use contraindicated?

A

bowel cases, pneumothorax/blebs, venous air emboli, middle ear surgery, some eye surgeries

171
Q

is N2O a good analgesic?

A

yes

172
Q

what inactivates methionine synthease?

A

N2O

173
Q

what is the best approach to prevent OR pollution with anesthetic gases and reduce waste?

A

shutting off the fresh gas flows

174
Q

when does diffusion hypoxia occur?

A

when nitrous is discontinued abruptly, usually occurs in the first 5 min after stopping nitrous

175
Q

when should nitrous be discontinued during an anesthesia case

A

early to filly the lungs with oxygen and decrease the chance of arterial hypoxemia

176
Q

risk factors for intraoperative awareness?

A

age, gender, substance use, paralytic use, type of surgery,

177
Q

what MAC will decrease potential for intra-op awareness?

A

0.4-0.5 MAC of gas

178
Q

malignant hyperthermia

A

profound uncontrolled release of Ca from the sarcoplasmic reticulum

179
Q

what induces MH?

A

succinylcholine and inhalational agents

180
Q

what does MH do to capnography?

A

unexplained increase in ETCO2

181
Q

what is a late sign of MH?

A

increased temp

182
Q

what kind of gas needs less fresh gas flow?

A

low solubility anesthetics

183
Q

what volatile agent is the most destructive to climate change?

A

desflurane

184
Q

how long can desflurane last in the atmosphere?

A

up to 14 years

185
Q

how long can isoflurane and sevoflurane last in the atmosphere?

A

3.2 years for isoflurane and 1.1 year for sevoflurane

186
Q

what gas directly relates to destruction of the O-zone

A

nitrous oxide

187
Q

MAC decreases at what rate

A

approx. 6% per decade

188
Q

what is a potential risk with high, long-lasting concentrations of secoflurane

A

can trigger EEG abnormalities …unsure

189
Q

is N2O associated with POCD and delirium?

A

yes

190
Q

is N2o meant to be a complete anesthetic itself?

A

no, it is a co-anesthetic used to supplement

191
Q

by what % does O2 consumption decrease during general anesthesia?

A

10-15%

192
Q

what happens to FRC during general anesthesia?

A

it is decreased

193
Q

what do volatile anesthetics and N2O do to ciliary movement?

A

they reduce it, and alter the characteristics of mucus

194
Q

where are inhaled anesthetics primarily excreted?

A

the lungs

195
Q

NIOSH exposure limits

A

25 ppm for N2O and 2 ppm for volatile anesthetics

196
Q

what can halothane cause

A

hepatotoxicity

197
Q
A

General Principles (6 decks)

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