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GNURS625/Pharmacology for Anesthesia > Inhalation anesthesia 3 > Flashcards

Inhalation anesthesia 3 Flashcards

1
Q

T/F: MAP decreases as concentration of desflurane, sevoflurane, and isoflurane increases, in a dose dependent manner.

A

True

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2
Q

T/F: Increase in MAP reflects a decrease in systemic vascular resistance (SVR).

A

False

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3
Q

T/F: Desflurane decreases MAP by decreasing CO/ direct myocardial depression.

A

False (Halothane)

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4
Q

____ activates the sympathetic nervous system and increases SVR, which can lead to an increase in CVP and arterial pressure.

A

N2O

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5
Q

Alterations in HR from inhaled anesthetic gases are a result of several variable. What are they?

A

Antagonism of SA node automaticity
Modulation of baroreceptor reflex activity
Sympathetic nervous system activation via tracheopulmonary and systemic receptors.

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6
Q

T/F: Incremental increases in delivered concentrations of inhaled agents increase heart rates in patients.

A

True

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7
Q

T/F: Responses in heath rate occurs at unique concentration for each agent.

A

True

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8
Q

What is the heart rate response of Forane?

A

Starting at concentrations 0.25 MAC, a linear, dose dependent increase in HR is observed

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9
Q

What is the heart rate response of Desflurane?

A

Minimal increase in HR at concentrations < 1 MAC

At concentrations ≥ 1 MAC , a linear, dose dependent increase in HR is observed

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10
Q

What is the heart rate response of Sevoflurane?

A

HR does not increase until concentrations >1.5 MAC

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11
Q

T/F: Cardiac index is minimally influenced by inhalation agents.

A

True

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12
Q

T/F: TEE demonstrates that desflurane produces minor increase in EF compared with awake measurements.

A

True

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13
Q

What gas would you avoid if pt. is known to have congenital long QT syndrome.

A

Sevoflurane (Safe if on B-blocker therapy)

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14
Q

T/F: No data effectively demonstrates a difference in outcomes between inhalation and IV opioid anesthesia.

A

True

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15
Q

What is coronary steal?

A

a reduction in perfusion of ischemic myocardium with simultaneous improvement of blood flow to nonischemic tissue.

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16
Q

What might forane do to the heart vessels?

A

dilate small-diameter coronary arteries might cause a susceptible patient to develop regional myocardial ischemia as a result of coronary vasodilatation…. Questionable validity.

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17
Q

What is ischemic preconditioning?

A

Protective benefits of volatile anesthetics against myocardial ischemia in setting of compromised regional perfusion.
Not related to alteration of myocardial oxygen supply-demand ratio.

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18
Q

Ischemic preconditioning has two periods. What are they?

A

First period
1-2 hours after the conditioning episode.
Second period
Benefit reappears 24° later and can last as long as 3 days.

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19
Q

What confers the protective activity to ischemic preconditioning?

A

Opening of mitochondrial adenosine triphosphate (ATP)-sensitive potassium channels (KATP) is the crucial event that confers the protective activity.

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20
Q

T/F: Patients given a general anesthetic and who are on amiodarone can have significant dysrhythmias intraoperatively or postoperatively

A

True

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21
Q

What do you do if atropine is not working for bradycardia?

A

Isoproterenol infusion

AV sequential pacing

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22
Q

How long can Amiodarone and its major metabolites be detectable in plasma.

A

9 months.

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23
Q

_________ respiratory rate and _______ tidal volume as anesthetic concentration ______.

A

Increased, decreased, increases

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24
Q

Minute ventilation is relatively preserved, but the decreased TV leads to greater ______ space ventilation relative to alveolar ventilation.

A

dead

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25
Q

T/F: Gas exchange becomes more efficient as anesthetic depth increases.

A

False (less)

26
Q

T/F:PaCO2 increases proportionate to anesthetic depth.

A

True

27
Q

Ventilatory stimulation response evoked by arterial hypoxemia is ________ by volatile anesthetics.

A

blunted

28
Q

Dose related blunting of the respiratory response to _________ CO2.

A

increased

29
Q

Cephalad _________ of the diaphragm and inward displacement of the rib cage occur from enhanced expiratory muscle activity. This results in a ________ in FRC.

A

displacement, reduction

30
Q

T/F:Atelectasis occurs in dependent areas of the lung and to a greater extent when spontaneous ventilation is permitted.

A

True

31
Q

T/F:Inhalation agents have major effect on the principle of “hypoxic pulmonary vasoconstriction”.

A

False (Limited)

32
Q

T/F: In the absence of bronchoconstriction, bronchodilating properties of inhalation agents are limited.

A

True

33
Q

What are the non-pungent inhalation gases?

A

Sevoflurane, halothane, and nitrous oxide

34
Q

What are the pungent inhalation gases?

A

Desflurane (>6% for mask induction) and forane

35
Q

T/F: Volatile agents decrease cerebral metabolic rate of O2 consumption in a dose dependent manner with N20 being the exception ~ increase CMRO2

A

True

36
Q

Nitrous oxide has what effect on the CNS?

A

Causes cerebral vasodilation
Increases CMRO2
Coadministration of opioids, barbiturates, or propofol (not ketamine) counteract these effects.

37
Q

What occurs to the ICP after a MAC of greater than 1 with colatile anesthetics.

A

Increases

38
Q

T/F: Autoregulation is impaired at concentrations < 1 MAC.

A

True

39
Q

What is the most sensitive evoked potential of the CNS when using volatile agents?

A

Visual

40
Q

What is the most resistant evoked potential of the CNS when using volatile agents?

A

brainstem

41
Q

Evoked potentials may be abolished at ___ MAC.

A

1

42
Q

N20 and 0.5 MAC inhalation also abolish _______ potential.

A

evoked

43
Q

T/F: Low concentrations 0.2-0.3 MAC decrease the reliability of motor evoked potentials.

A

True

44
Q

What level must MAC get to for isoelectric pattern to predominate?

A

1.5-2

45
Q

Sevoflurane and ethrane may be associated with _________ activity on the EEG, especially at high concentrations.

A

epleptiform

46
Q

T/F: Inhalation agents produce a dose dependent skeletal muscle relaxation and enhance the activity of neuromuscular blocking drugs.

A

True

47
Q

What least to greatest what is the likely hood that a inhalation agent will trigger MH.

A

Desflurane<Halothane

48
Q

T/F: Immune mediated liver injury can occure with all inhalation agents?

A

True

49
Q

What is the causative agent thought to cause liver damage with inhalation agents?

A

trifluoroacetate metabolite

50
Q

What inhalation agent show to increase or maintain hepatic blood flow?

A

Iso, des, sevo

51
Q

What will methoxyflurane produce and what does it cause?

A

inorganic fluoride, and nephrotoxicity

52
Q

Sevoflurane should only have how many hours of low fresh gas (<2 L/min)?

A

2 hours of MAC

53
Q

What does Nirtrous Oxide do and what does it cause?

A

inactivates methionine synthase, enzyme that regulate vitamin b12 and folate metabolism

54
Q

When is N2O contraindicated?

A

Preexisting vitamin B12 deficiency or underlying critical illness

55
Q

T/F: Full desiccation of conventional carbon dioxide absorbents containing sodium and potassium hydroxide causes degradation and carbon monoxide production from all volatile anesthetic agents regardless of temperature.

A

True

56
Q

T/F: Low fresh gas flow rates (exceeding normal minute ventilation) accelerate the desiccation of CO2 absorbents, and thus accelerated degradation of inhaled agents.

A

False (High)

57
Q

What determines the concentration of the anesthetic gas leaving the vaporizer?

A

Relative flow togas through the reservoir channel versus the bypass channel

58
Q

How is each inhalation gas container unique?

A

Temperature compensated
Calibrated for individual anesthetic d/t differing vapor pressures
Tilting or overfilling may lead to overdose if liquid anesthetic gets into bypass channel

59
Q

Vapor pressure of desflurane at sea level is ___mm Hg at __°C

A

700, 20

60
Q

T/F: A variable bypass vaporizer is used for desflorane.

A

False (Heated Vaporizer Tec 6)

61
Q

What is another name for desflorane?

A

Suprane

62
Q

T/F: At high altitudes, the partial pressure of desflurane will be lower at a give Tec 6 vaporizer setting and output concentration will be lower, leading to underdosing if no adjustments are made to account for higher altitude.

A

True

GNURS625/Pharmacology for Anesthesia (13 decks)

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