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Volatiles > Hall Volatile > Flashcards

Hall Volatile Flashcards

1
Q

At MAC 1 what each volatile effect on HR, SVR, CI?

Halothane, Iso, Des, Sevo

A

HR SVR CI
Halothane - - Decreased
Iso Increased Decreased -
Des Increased Decreased Decreased
Sevo Decreased Decreased Decreased

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2
Q

What is the relationship of context sensitive half time?

A

Between half time & duration.

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3
Q

What are the characteristics of volatile needed to calculate time constant?

A

Volatile time constant = Capacity/flow.

the capacity of tissue to hold the volatile relative to tissue blood flow. (capacity = brain/blood coefficient X volatile mass)
The capacity depends on size of tissue and affinity

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4
Q

What machine or patient’s respiration factors could effect emergence and delay it? and how to decrease it?

A

1) circuit.
2) gases can dissolve in the rubber & plastic of circuit.
3) soda lime of re-absorbent serve as a depository.
4) patient’s own exhaled gases (rebreathing).

By raising fresh gas to at least 5 L/min.

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5
Q

Alveolar partial pressure reduction of half time of the volatile anesthetics?

A

Its all the same for 50% reduction (~ 5 minutes) if duration is very brief. however the recovery time is more profound if longer periods.

for example after 1 hr of desflurane (blood : gas coefficient 0.45) -> a 95% reduction in alveolar % canbe reached within 5 minutes.

with sevo ((blood : gas coefficient 0.65) a 95% reduction requiers 18 minutes.

with iso (blood:gas coefficient 1.4) requiers >30 minutes to reach 95% reduction in alveolar %.

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6
Q

Ways to increase the rate of inhalation induction?

A

1) increase minute ventilation.
2) increasing inspired concentration. (turning up the dial above desired state concentration which is over pressurizing).
3) substituting a less soluble anesthetic such as sevo for iso.
4) Administering volatile at higher atmospheric presure (which decreases uptake and hence increase rate of rise Fa/Fi).

not giving intoropes cause it increases CO which increase uptake and slows induction (decreasing Fa/Fi ratio).

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7
Q

Whats the total washin of anesthesia circuit (the components of the circuit with anesthetic gases)?.

A

7 L and breaks down too; hose 2L, absorbent 2L, bag 3L.

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8
Q

Whats the % of recovered metabolites for each volatile

  • Methoxyflurane
  • Halothane
  • Sevo
  • Iso
  • Des
A
  • 50% (highest and results into fluoride ions which risk for RF)
  • 20%
  • 2% - 5%
  • 0.2%
  • 0.02%
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9
Q

Whats the effect of peripheral left - right AV shunt on induction?

A

It only fasten induction if intracardiac/pulmonary right - left shunt exist.
(the peripheral shunt such as AVF delivers volatile containing venous to lung which it offsets the dilutional effect of a right - left intracardiac/pulmonary shunt and speeds induction).

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10
Q

What factors increases compound A?

A

1) Baralyme insteaed soda lime.
2) high absorbent tempreture.
3) high sevo concentration.
4) closed circuit or low flows < 1L/min.

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11
Q

Which anesthetics are soluble in the rubber & plastic components in the machine?

A

methoxyflurane (worst), Iso & halothane.

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12
Q

What are agents that destroy sevoflurane? and there is one absorbent agent that is not?

A

Baralyme & soda lime, but not calcium hydroxide lime. it is therefore a flow of rate 2L/min is recommended when sevo administered.

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13
Q

Which volatile stored with preservative?

A

Halothane & methoxyflurane. (Halothane stored with thymol preventing it from spontaneous oxidation).

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14
Q

What are anesthesia machine to alveolar that effect partial pressure gradients?

A
  • inspired anesthetics concentration.
  • alveolar ventilation.
  • characteristics of anesthesia breathing system.
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15
Q

What are factors that effect partial pressure gradients from alveoli uptake to pulmonary blood?

A
  • blood:gas partition coefficient.
  • CO
  • Alveolar - venous partial pressure difference.
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16
Q

What are factors that effect partial pressure gradients from arterial uptake to brain?

A
  • brain/blood partition coefficient
  • cerebral blood flow
  • Arterial - venous partial pressure difference.
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17
Q

Will lung dead space effect the influence of patital pressure gradient?

A

No because it dose not produce dilutional effect on the arterial partial pressure.

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18
Q

Factors do not effect MAC?

A

Gender, thyroid function, Paco2 between 15-95 and Pao2 >38

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19
Q

Calculation of washin time for N2O for a given 6L?

A

calculated by time constant which is volume/(volumextime).

for 1 min= 63%
for 2 min= 84%
for 3 min= 95%

memorize this.

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20
Q

Which volatile that decreases arterial pressure by direct effect on heart instead SVR?

A

Halothane. it decreased CO/CI where others lowers BP through reduction of SVR.

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21
Q

Factors that effect inhalation induction (alveolar concentration of volatile)?

A
  • inspired concentration of anesthetics (Fi)
  • solubility of anesthetics (blood:gas coefficient)
  • alveolar ventilation
  • CO
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22
Q

Will a less or more soluble anesthetic fasten or slows speed of induction?

A

less soluble. so the less blood:gas coefficient the volatile the faster induction.

Blood : gas coefficient

  • Des -> 0.45
  • NO -> 0.47
  • Sevo -> 0.65
  • Iso -> 1.4
  • Enflurane -> 1.8
  • Halothane -> 2.5
  • and highest with ether 12
23
Q

increasing of the following, will decrease/increase the speed of induction?

  • CO
  • VA
  • Fo2I
  • solubility
A
  • decrease
  • increase
  • increase
  • decrease
24
Q

Which anesthetic cause coronary steal syndrome?

A

Isoflurane.

when prefusion pressure of coronary artery is reduced, only blood vessels capale of dilation (not athrosclorotic vessels) will dilate. only isoflurane can cause redistribution of blood causing steal phenomena and significant dilatation but since athersclorotic vessels do not, this syndrome is a little of significant.

25
Q

Which of the partition coefficient reflects closely correlates with recovery form anesthetics?

A

Blood;Gas partition coefficient

other factors that effect emergence; alveolar ventilation, CO, tissue concentration, and metabolism.

26
Q

What is the definitions vessel group and what are they?

A

They are the organs who receive 75% or more of CO and weight 10 % of total lean body.

Heart, kidney, liver, brain but not lung (even though it receives 100% blood from heart, but it is not supplied directly to lung it’s mainly for oxygen exchange)

27
Q

Why it’s wise to give 100% O2 for several minutes after emergence from GA especially if N2O used?

A

N2O dilute all gases including O2 & CO2. The reduction in O2 causes hypoxia and reduction in CO2 reduces drive to breath (called diffusion hypoxia). This combination occurs when narcotics or other respiratory depressant on board. So administration of O2 after gas is off ensures the compensation for hypoxia

28
Q

What volatile is airway irritant? And how can it be reduced?

A

Desfulane

Administration of fentanyl or morphine prior

29
Q

What is the vapor pressure of the volatile?

A

160 mm Hg at 20 C temp for all volatiles except Desflurane ( 664 mm Hg at 20 C)

30
Q

Why it’s recommended to keep the flow rate > 2 L when deco administrated?

A

To prevent rebreathing (not formation) of compound A.

Compound A formed by combination of CO2

31
Q

Type of shunts that result into rapid raise in Fa/Fi?

A

Both L-R intracardiac and L-R tissue shunts (like AVF) will result into higher partial pressure of volatile in blood retiring to lung

32
Q

Will right -left intracardiac shunt have greatest impact on rate of induction with more soluble or less soluble volatiles?

A

Less soluble (Desflurane).

In general R-L shunts or transpupmonary shunt will slow the rate of induction of volatiles because of dilutional effect which is blood that contains less volatiles is shunted to rich volatile vessels coming from alveoli. Because the uptake of poorly soluble volatiles into pulmonary venous blood is minimal; thus the dilutional effect of the shunt is unopposed. In contrast the highly soluble volatile is sufficient to offset the dilutional effect.

33
Q

how to know the MAC of a volatile given ?

A

for insoluble like N2O, can be a assumed by thr concentration of inspired concentration as it reaches equilibrium early.

where solubles, its more accurately reflected by end expired concentration.

34
Q

Which volatile causes hypotension by junctional rhythm?

A

Almost all, but most common is Halothane.

35
Q

Anesthetic requirement in related to neonates, infants, and adults?

A

Greatest requirement is Infants (~1.2%), then neonates ( ~0.87% between 3-6 months) then adults (~0.75%)

36
Q

Anesthetic requirement in related to neonates, infants, and adults with sevo?

A

Here the neonates (0-30 days) is the greatest > infants (1-6 months) > adults.

37
Q

Alveolar ventilation will effect FA/Fi with more soluble or insoluble volatile?

A

With soluble (increased VA will increase ratio with the more blood gas coefficient)

Halothane (2.54) > Enflurane (1.9) > Iso (1.46) > Iso (0.69) > N2O (0.46) > des (0.42)

38
Q

Only volatile that dose not decrease CO with MAC of 1?

A

Isoflurane.

39
Q

2 volatile increases HR?

A

Iso & Des

40
Q

What the mechanism of Halothane not increasing HR?

A

it inhibits barorecepts reflex response. therefore depite the reduction of BP, the HR remains unchanged.

41
Q

How would mainstem intubation effect of the rate of increase in arterial partial pressure of volatile?

A

its a situation of transpulmonary shunt, the blood emerging from unventilated alveolar contains no anesthetics and mixes with blood coming from ventilated area which contains anesthetics and that will produce less arterial partial pressure . this will be more profound with poorly soluble anesthetics (so poorly soluble in transpulmonary shunts will increase FA/FI ratio but arterial partial pressure will significantly reduced).

42
Q

Which volatile undergo the greatest metabolism?

A

Halothane.

43
Q

Which volatile cause fluride ion induced nephrotoxicity? and what type of toxicity?

A

Sevo & Enflurane

The floride ion directly inhibits adenylate cyclase activity which is necessary for normal functioning ADH, this result into ADH-resistant DI (nephrogenic DI) characterized by polyuria, dehydration, and hypernatremia with increased serum osmolarity.

44
Q

in cardiogenic shock, the greatest impact on rate of increase in FA/FI for soluble or insoluble anesthetics?

A

with soluble anesthetics.

decreased CO will cause slower rate of uptake from alveolar which will increase the rate of FA/FI ratio.

Where insolubles (Des, Sevo, N2O) will be minimally affected by CO.

so in general “ Low CO = Increased FA/FI ratio”

  • soluble is heavily dependent by CO = increase FA/FI
  • insoluble independent to CO = minimal effect FA/FI
45
Q

which volatile will cause abrupt transiate increase in BP & HR if sudden & large of concentration delivered?

A

Des.

This is likely related to aireay irritation and a systemic response. if des increased slowly or narcotics given prior, this abrupt increase in BP & HR my not occur. (this can occur with isoflurane but less extent)

46
Q

What effect of Isoflurane with MAC of < 1?

A
  • antigen-induced bronchospasm by reducing vagal tone.
  • decreases SV & SVR resulting into low BP but because a reflex tachycardia is sufficient to offset the decreased SV, CO will remain unchanged. (however, SV & CO may decreased with MAC > 1).
47
Q

Volatile increases CO?

A

N2O through increasing sympathetic tone.

48
Q

How volatile decreases CO except N2O which increase CO?

A

Halothane + Enflurane decreases MAp through direct myocardial depression where the rest by decreasing SVR.

49
Q

Whats the vapor pressure for sevo & enfulrane?

A

170 mm Hg & enfularne of 160 mm Hg

50
Q

Why Des not used for induction?

A

Because of its pungency and airway irritation that leads to coughing, increased salivation, breath holding and sometime laryngospasm. also the abrupt increase in concentration can cause increase sympathetic discharged which develops abrupt tachycardia and hypertension.

51
Q

Anesthetic that is not an ester derivative?

A

Halothane.

made of halogens fluoride, bromine, and chlorine which makes it non-flammable and provides blood solubility, molecular stability, and anesthetic potency.

52
Q

Whats the effect on TV and RR of volatile during spontaneous breathing?

A

decreases TV and increases RR by direct activation of the respiratory center in the CNS rather than stimulating pulmonary stretch receptors. (alters the breathing system from normal awake pattern to intermittent deep breaths separated by varying time intervals to one of rapid, shallow, regular, and rhythmic breathing).

53
Q

All voltiale has the greatest MAC requirements in infants more then neonates except one gas that has MAC requirement greater in neonates then infants?

A

SEVo.

Neonates 0-30 days -> 3.3%
infants 1-6 months -> 3.2%
6-12 months -> 2.5%

Volatiles (2 decks)

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