GenAne(Inhale)-Specifics

Question 1

What is the effect of most inhaled anesthetics on cardiac contractility? MAP?

Answer 1

Decreases both

Question 2

Which two inhaled anesthetics reduce MAP mainly by myocardial depression with little effect on peripheral vascular resistance?

Answer 2

Halothane and enflurane

Question 3

Which three inhalational anesthetics produce vasodilation and have little effect on cardiac output?

Answer 3

Isoflurane desflurane and sevoflurane

Question 4

Which inhalational anesthetics would you give to someone with impaired myocardial function? Why?

Answer 4

Isoflurane desflurane and sevoflurane

Mainly act as vasodilators and don’t depress myocardial contractility

Question 5

Which inhaled anesthetic lowers BP the least?

Answer 5

Nitrous oxide

Question 6

Which inhaled anesthetic sensitizes myocardium to circulating catecholamines and can lead to ventricular arrthymias?

Answer 6

Halothane

Question 7

Which two inhalational anesthetics should be avoided in patients with bronchospasm?

Answer 7

Isoflurane and desflurane

Question 8

Which two inhaled anesthetics are the MOST respiratory depressant?

Answer 8

Isoflurane and enflurane

Question 9

Which inhaled anesthetic is the LEAST respiratory depressant?

Answer 9

Nitrous oxide

Question 10

Which inhaled anesthetic should be used in patients with increased ICP? Why?

Answer 10

Nitrous oxide
All inhaled anesthetics raise ICP,
nitrous does it the least

Question 11

Which inhaled anesthetics can cause tonic-clonic movements at high concentrations?

Answer 11

Enflurane (rarely and only at high conc)

Question 12

Which inhaled anesthetic should you avoid in someone with a pneumothorax? Why?

Answer 12

Nitrous oxide - it enters air filled cavities faster than nitrogen can escape and can cause the cavity to swell and inc pressure

Question 13

Patient after surgery develops severe life threatening hepatitis. What inhaled anesthetic was he most likely exposed to?

Answer 13

Halothane (H for Hepatotoxicity)

Question 14

Which inhaled anesthetic can be nephrotoxic?

Answer 14

Methoxyflurane

Question 15

Patient after emergency intubation with succinylcholine develops tachycardia, severe muscle rigidity, hypercalcemia and acidosis. What is this called? What inhaled anesthetic should absolutely be avoided? Treatment?

Answer 15

Malignant hyperthermia
Avoid halothane
Treat with dantrolene

Question 16

A patient with an autosomal dominant defect in their RYR1 gene is susceptible to what condition? Why? What two drugs should be avoided?

Answer 16

Malignant hyperthermia - defective ryanodine receptor leads to uncontrolled release of calcium from the sarcoplasmic reticulum
Avoid succinylcholine and halothane

Question 17

The ryanodine receptors on the sarcoplasmic reticulum is the equivalent of what receptor on the endoplasmic reticulum? What do they have in common?

Answer 17

IP3 receptor - both control calcium release

Question 18

Why do you see hyperkalemia in malignant hyperthermia?

Answer 18

Energy stores in the muscle fiber are quickly depleted and the muscle fibers begin to die and release potassium (also myoglobin)

Question 19

How do you test someone for susceptibility to malignant hyperthermia?

Answer 19

Halothane-caffeine test

Muscle biopsy fibers tested for strength of contraction when exposed to halothane and caffeine

Question 20

A long-term dental nurse presents with megaloblastic anemia. What anesthetic agent was she most likely exposed to?

Answer 20

Nitrous oxide