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AP Exam 2 > General Anesthesia > Flashcards

General Anesthesia Flashcards

1
Q

Maintaining O2 requirement is accomplished by the ______ ______.

The formula for VO2 is:

A

Brody equation

10 * kg3/4 = ml/min

or 2.5 * kg + 67.5

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2
Q

For maintaining oxygenation/ventilation O2 saturation > _____ %

A

97%

Clinically treat if you see >3% change

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3
Q

Normal ParterioleCO2 = _______mmHg

PA-aCO2 = _______ mmHg

EtCO2 is _____%

A

40 mmHg

5 mmHg

35

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4
Q

Normal PA-a CO2 = _____ mmHg

A

5

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5
Q

EtCO2 = _____ mmHg

A

35 mmHg

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6
Q

VAlveolarCO2 = ________

A

8 * kg3/4

about = 200 ml/min

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7
Q

VaCO2 = __________ (equation)

A

VCO2 / % CO2 in lungs (5%)

= 200/0.05 = 4000 ml CO2/min

not enough ventilation because of dead space

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8
Q

Anatomic dead space = (formula?)

A

2 ml/kg *kg

140 ml/Breath * 10 breaths/min =

1400 ml/min

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9
Q

VACO2 = _____ ml/min

A

5400 ml/min

or 540 ml/Breath

4000 + 1400 dead space

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10
Q

Alveolar Gas Equation

PAO2 =

A

PAO2 =

FiO2 (PB - PH2O) - (PaCO2/R)

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11
Q

If O2 saturation begins dropping, what is the first treatment?

A

increase FiO2

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12
Q

Normal AaO2 equation:

Normal is:

A

PAO2 = PAO2 - PaO2

Normal is < 10mmHg

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13
Q

Abnormal PA-aO2 gradients caused by:

A

anatomic shunting like pulmonary AVM, thebesian minute vessels in heart

diffusion impairment: thickened capillary membrane

low V/Q areas intrapulmonary shunt

high V/Q areas: alveolar dead space

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14
Q

Increase FiO2 by: (3)

A
  • increasing TV
  • increase PEEP
  • change position
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15
Q

Benefits of improved oxygenation by adding PEEP: (3)

A
  • increase FRC (recruitment)
  • improve lung compliance
  • VQ corrections
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16
Q

Advantages of inhalation agents:

A
  • rapid appearance of drug in arterial blood
  • efficient to distribute
  • easy to deliver
  • predictable recovery
  • high safety profile
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17
Q

Drawbacks to inhalation agents (2)

A
  • no analgesia (N2O is exception)
  • PONV
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18
Q

Effectiveness of inhalation agent is measured by: (2)

A
  • ET% agent
  • established MAC
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19
Q

MAC is an average, NOT a predictor

MAC amnestic is _____.

A

0.25

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19
Q

MAC awake is ______

A

0.3-0.5

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20
Q

MACBAR = ______

BAR means:

A

1.5

blocking adregernic receptor

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21
Q

Factors that affect MAC: (3)

A
  • extremes in age (up or down)
  • chronic alcohol abuse (increase MAC)
  • pregnancy (decrease MAC)
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22
Q

Desflurane FA/Fi is ______.

A

0.8

It is the least soluble and works the fastest.

23
Q

The FA/Fi of sevoflurane is: ______

A

about 0.7

24
Q

Factors affecting inspiratory concentration (Fi): (3)

A
  • increase fresh gas flow
  • decrease circuit volume
  • decrease any machine/circuit absorption
25
Q

Time constant is :

A

volume / flow

Volume of circuit / FGF

26
Q

How many liters in circuit of anesthesia machine?

This includes bag, piping, CO2 canister.

A

6L

27
Q

To increase FA/Fi equilibrium (2)

A
  • decrease FRC
  • increase VA (minute ventilation)
28
Q

Most important factor in the rate of FA/Fi is _______.

A

uptake

29
Q

Increase uptake _____ rise of FA/Fi

A

decreases

30
Q

If uptake = 0, then FA = Fi, uptake influencing factors include (3)

A

solubility (partition coefficient)

blood flow (CO)

concentration

31
Q

What coefficient is “blood solubility” based upon?

A

blood/gas partition coefficient

32
Q

Blood/gas partition coefficients:

A

describes relative affinity of anesthetic gas for blood

increased partition coeff –> increased solubility –> increased agent uptake

33
Q

The more soluble agent, larger capacity blood, longer to take to saturate. True or false?

A

true

34
Q

Blood/gas coefficient of isoflurane

A

1.4

35
Q

Desflurane blood/gas coefficient is:

A

0.42

36
Q

Sevoflurane blood/gas coefficient is

A

0.6

37
Q

Overcome uptake of anesthetic gas by changing ventilation:

A
  • hyperventilate
  • large FRC causes dilution and thus slower rate of rise of FA/Fi
38
Q

How to increase CO?

A
  • increase Q
  • flow
  • CO = SV * HR
  • so increase HR
39
Q

Factors affecting FA/Fi

A
  • uptake
    • blood/gas coefficient
    • cardiac output
  • hyperventilation
  • anesthetic overpressurizing
40
Q

Factors affecting arterial concentration:

A
  • V/Q mismatch
  • venous admixture
  • alveolar dead space
  • nonuniform alveolar gas distribution
41
Q

Nitrous oxide advantages:

A
  • powerful analgesic
  • decreases MAC of other inh. agents
  • safe in MH patients
  • rapid induction/recovery
42
Q

Nitrous disadvantages:

A
  • decreases myocardial contractility
  • increase PONV
  • increase ICP by increase CBF
  • teratogenicity
43
Q

Contraindications of N2O

A
  • air embolism
  • pneumothorax
  • acute intestinal obstruction
  • pneumocephalus
  • pulmonary air cyst
  • intraocular air bubbles
  • tympanic membrane grafting
44
Q

Sevoflurane advantages:

A

non-irritant sweet odor

rapid

does not sensitize mycardium

No CO production with NA lime

45
Q

Sevo disadvantages:

A
  • Less potent
  • compound A production (contraindicated with baralyme)
  • post op agitation in children
46
Q

Which agent is a vapor at RT

A

desflurane

47
Q

What agent is capable of increasing HR and documented myocardial ischemia?

A

desflurane

48
Q

Disadvantages of desflurane:

A
  • special vaporizers
  • low potency
  • pungency
  • rapid increase > 1.25 MAC SNS stimulation
49
Q

What agent is good for renal/hepatic dysfunction?

A

isoflurane

50
Q

Eucapnic ventilation = ____ ml/min

A

5400 ml/min

51
Q

R = respiratory quotient =

A

1.2

52
Q

Abnormal PA-aO2 gradient (should be

A

Anatomic shunting: R-L thebesian, bronchiole, pulmonary AVM

diffusion impairment: thickened capillary membrane

Low V/Q areas due to position (supine, to lateral)

53
Q

Lung volume recruitment calculation:

Compliance = ►V / ►P

If compliance = 50

PEEP = 5 cmH20, then…

A

Lung volume : 250 ml

54
Q

Adverse effects of PEEP: (2)

A

barotrauma/pneumothorax

decreased VR/CO

AP Exam 2 (5 decks)

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