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RUSVM Anesthesiology > Inhalant Anesthesia > Flashcards

Inhalant Anesthesia Flashcards

1
Q

What are the predictable effects of inhalant anesthesia?

A

Narcosis
Muscle relaxation
Not analgesic

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2
Q

What dis Dalton’s law of partial pressure?

A

Total pressure of a gas mixture is equal to the sum of partial pressure of individual gases

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3
Q

What is vapor pressure?

A

Pressure exerted by vapor molecules when liquid and vapor phases are in equilibrium

Depends on temperature
-increases with increasing temperature

Inversely related to boiling point

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4
Q

What inhalant anesthetic has the lowest boiling point ?

A

Desflurane

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5
Q

Why is an electric heater required for desflurane?

A

Boiling point is 23.5 C (close to room temp)—> warmed to maintain in gaseous form

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6
Q

Vapors have a maximum administration percentage AKA ___________

A

Saturated vapor pressure

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7
Q

How is saturated vapor pressure calculated?

A

Vapor pressure / barometric pressure

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8
Q

What is the partition coefficient?

A

Concentration ratio of an anesthetic in the solvent and gas phases

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9
Q

What is the blood-gas partition coefficient??

A

Amount of anestheric in the blood vs alveolar gas at equal partial pressure

-> anesthetic in the alveolar gas represents brain concentration

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10
Q

T/F: anesthetic dissolved in blood is pharmacologically inactive

A

True

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11
Q

What is the order of these gases from low to high, blood-gas partition coefficient?

Isoflurane
Sevolfuratne
Halothane
Desflurane

A

Desflurane (least soluble) < sevolfurane < isofurane < halothane (most soluble)

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12
Q

At a low blood-gas PC is there more or less anesthetic dissolved in blood at equal partial pressure ?

A

Less (more in alveoli)

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13
Q

T/F: there is a shorter time required to attain a partial pressure in the brain when there is a low blood- as PC

A

True

-> sort induction and recovery

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14
Q

A _________ blood-gas PC will have more anesthetic dissolved in blood at equal partial pressure

A

High

-> longer time required to attain a partial pressure in the brain
—> long induction and recovery

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15
Q

Partial pressure in the brain is roughly equal to that in the alveoli. How can P(A) be increased?

A

Increase anesthetic deliver to alveoli

Decrease removal from alveoli

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16
Q

What are ways you can increase alveolar delivery of anesthetic ?

A

Increase impaired anesthetic concentration

  • increase vaporizer setting
  • increase fresh gas flow

Increase alveolar ventilation
-increase minute ventilation (tidal vol x respiratory rate)

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17
Q

How can you decrease removal form alveoli?

A

Decrease blood solubility of anesthetic

Decrease cardiac output
-patients with a low CO will have a faster rise of P(A)

Decrease alveolar-venous anesthetic gradient

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18
Q

The (lower/higher) the Pi, the more rapidly Pa approaches Pi

A

Higher

Pi = inspired anesthetic concentration

A high Pi is required at the beginning of anesthesia to quickly increase Pa

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19
Q

How can you quickly decrease Pa?

A

Turn off vaporizer

Disconnect patient and flush O2

Turn up O2 flow - dilute anesthetic in circuit as it is exchanged from patient

Increase ventilation (IPPV) - increase fresh gas to alveoli

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20
Q

What is the MAC?

A

Minimum alveolar concentration of an anestheric that prevents movement in 50% of patients exposed to a noxious stimulus

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21
Q

If a MAC of an anesthetic is high, then its potency is ________

A

Low

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22
Q

T/F: alveolar concentration is the same as the vaporizer setting

A

False

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23
Q

Hyperthermia, hypernatremia, and CNS stimulant drugs cause what to the MAC?

A

Increase the MAC

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24
Q

Hypothermia, hyponatremia, CNS depressants cause what to the MAC?

A

Decrease the MAC

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25
MAP < 50mmHg, PaO2 < 40mmHg, and PaCO2 cause what to the MAC
Decrease the MAC
26
What effects do inhalant anesthetics have on the cardiovascular system?
Decrease CO, BP, SVR, and contractility
27
What effects do inhalant anesthetics have on the respiratory system?
Decrease ventilation Bronchodilation Irritating odor
28
Respiratory arrest can occur at _________ MAC
1.5-3
29
Does inhalant anesthetics cause ain’t increase or decrease in ICP? What about metabolic rate?
Increase (MAC> 1) ICP Decrease metabolic rate
30
Inhalant anesthetics act where to produce immobility?
Spinal cord and brain
31
How are inhalant anesthetics associated with decreased glomerular filtration?
Reduced renal blood flow due to decreased CO
32
How is compound A produced?
Sevoflurane breakdown in CO2 absorbent | -nephrotoxic in rats
33
Higher concentrations of compound A are formed during??
Prolonged anesthesia Low fresh gas flows Desiccated absorbent
34
what inhalant anesthetic causes hepatotoxicity?
Halothane - increase liver enzymes - immune mediated halothane hepatitis
35
T/F: very little of sevoflurane and isoflurane is metabolized in the liver
True —> mostly expired
36
What species have generic predispositions to malignatn hyperthermia?
Pig, dog, cat, and horses
37
What is malignant hyperthermia?
Uncontrolled muscle contraction —> severe hyperthermia —> death
38
What is the first sign of malignant hyperthermia?
Rapid increase in EtCO2
39
What is the treatment for malignant hyperthermia?
Discontinue anesthetic, flush with O2 Provide 100% O2 Dantrolene -muscle relaxant Fluids and active cooling
40
What is the max administration of NO?
75% (need > 25% O2)
41
What is the solubility of NO?
Low (PC 0.47)
42
T/F: nitrous oxide has minimal CV and respiratory depression
True
43
T/F: Nitrous oxide has some analgesic properties
True
44
What is transfer to closed gas spaces in regards to NO?
Equilibration leads to N2O rapidly accumulating (more soluble in blood), while nitrogen leaves slowly (less soluble) GI tract, sinuses, middle er, pneumothorax, cuff of ET tube —> avoid in disease states causing increased closed gas states
45
What is diffusion hypoxia?
When N2O administration is stopped, it diffuses quickly out of blood into alveoli —> displace O2 for alveoli
46
How can diffusion hypoxia be prevented?
When discontinuing N2O, provide 100% O2 for 5-10 minutes
47
How can occupational gas exposure be reduced?
Scavenging system Minimize leaks Avoid mask/chamber induction Keep patient attached to circuit after gas is turned off Minimize exposure to exhaled as from patient Maximize ventilation Monitor waste gas concentrations
48
What is the first thing you should do if your patient becomes hypotensive during anesthesia?
Evaluate patient and turn down the vaporizer
49
If a patient is light under anesthesia but is also hypotensive, what could you do?
Add a MAC-sparing drug (opioid, benzodiazepines, lidocaine, or ketamine) then turn down the vaporizer -> if still hypotensive, crystalloid bolus?, vasopressor?, inotrope (depends on underlying cause)
50
If PaCO2 is greater than 4mmHg the patient is?
Hypoventilating
51
What do you do if your patient is hypoventilating?
Check anesthetic depth, and turn down vaporizer IPPV -manual or mechanical
52
How can you prevent hypothermia during anesthesia ?
``` Warm before induction Bubble wrap feet Keep patient covered, minimize scrub time and exposure to water/alcohol Increase room temp Forced warm air heating ```
53
What happens if you close the pop-off value while your patient is connected to the machine?
Bag fills —> breathing system pressure increases —> transmitted to lung and thoracic cavity Decreased venous return -> compressed vessels —> decreased cardiac output
54
What are clinical signs of a closed pop-off valve?
Apnea, bradycardia, fading Doppler signal
55
What is the treatment for a closed pop off valve?
Pull rebreathing bag off Start CPR if arrested Evaluate for pulmonary injury
56
What happens if your inspiratory-expiratory valves are stuck?
Causes rebreathing of expired gas —> hypercabia
57
What do the waveforms for exhausted soda lime or stuck inspiratory-expiratory valves look like?
Rebreathing CO2 —> capnograph waves gradually increase
58
T/F: tracheal tears are associated with overfilling of the tube cuff and are seen more often in cats
True —> only fill cuff until there is no leak at 15-20cm H2o
59
What signs are associated with tracheal tears ?
Subcutaneous emphysema | Pnumomediastinum or pneumoretroperitoneum
60
What is the treatment for tracheal tears?
Supportive care-> provide time for trachea to from a fibrin seal and emphysema to resolve Severe—> surgical repair
61
T/F: Inhalant anesthetics have a very high therapeutic index
False Low therapeutic index —> overdose can happen quickly
62
A very low BP(MAP < 50) indicates inadequate cerebral blood flow for consciousness. What should you do in this case?
Turn inhalant off until BP has improved

RUSVM Anesthesiology (32 decks)

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