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Spring 2020 - Pharmacology 1 > Inhalation Anesthesia Part 3 - Quiz 6 > Flashcards

Inhalation Anesthesia Part 3 - Quiz 6 Flashcards

1
Q

What is the relationship of the concentrations of Des, Sevo, and Isoflurane have with Mean Arterial Pressure?

A

As the concentration of these gases increase, MAP decreases in a dose dependent manner d/t a decrease in SVR

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2
Q

Out of Des, Sevo, and Isoflurane, which gas has the least Dose-Response relationship in regards to MAP

A

Sevoflurane

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3
Q

How does Halothane decrease MAP?

A

Halothane decreases MAP by decreasing Cardiac Output

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4
Q

How does N2O affect the MAP?

A

N2O mi**ldly increases MAP if at all

Activates SNS to increase SVR

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5
Q

What happens if you add N2O to other gases?

A

Decreases the magnitude of BP drop

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6
Q

At what concentration of Isoflurane would you start to see HR increase?

A

0.25 MAC

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7
Q

At what concentration of Desflurane would you see start to see a HR increase?

A

< 1 MAC: mininmal HR increase

≥ 1 MAC: linear dose dependent HR increase

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8
Q

At what concentration of Sevoflurane would you start to see a HR increase?

A

> 1.5 MAC

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9
Q

How do Inhalation Anesthetics affect Cardiac Index?

A

Cardiac Index is minimally influenced by gases

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10
Q

What are the Circulatory Effects with an abrupt increase of Desflurane & Isoflurane

to > 1 MAC?

A

Transient Circulatory Stimulation - increased plasma Epi & Norepi

Not seen w/ other gases

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11
Q

How do gases (except for Halothane) effect Myocardial Conduction?

A

Does not cause PVC’s d/t prolonging effective refractory period

Halthone makes it easier for PVCs to happen

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12
Q

How do Inhaled Anesthetics affect the QT Interval?

A

Prolongs QT Interval

Avoid Sevo in pts w/ Long QT Syndrome

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13
Q

What is Coronary Steal?

A

Side effect of Isoflurane that can worsen myocardial ischemia - Not found valid

Reduced blood flow from ischemic part of the heart & increases blood flow to the healthy part of the heart

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14
Q

What is Ischemic Preconditioning?

A
  • Anesthetic gas exposes heart to brief episodes of ischemia that protects it from subsequent prolonged ischemia
  • Present in all tissues
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15
Q

When do the Two Periods of Ischemic Preconditioning occur?

A
  1. 1-2 hours after episode
  2. 24 hours later & lasts 3 days
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16
Q

What is the crucial event in Ischemic Preconditioning that causes the protective activity?

A

Opening of ATP-Sensitive Potassium (KATP)

30-40% d/t this

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17
Q

How does the concentration of anesthetic gas relate to Respiratory Rate & Tidal Volume?

A

As gas concentration increases, Respiratory Rate increases & Tidal Volume decreases

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18
Q

How does anesthetic gas affect Minute Ventilation, Gas Exchange & PaCO2?

A

Minute Ventilation: Same

↑Dead Space Ventilation

↑PaCO2

↓Gas Exchange

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19
Q

How does Anesthetic Gas affect Respiratory Response to CO2?

A

Dose Dependent decreased/blunted response to CO2

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20
Q

How does Anesthetic Gas affect the Chest Wall?

A

Diaphragm goes toward the Head

Ribs go Inward

Results in Decreased FRC & Atelectasis

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21
Q

How does Anesthetic Gas affect Hypoxic Pulmonary Vasoconstriction (HPV)?

A

Limited Effect unless there is Bronchoconstriction

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22
Q

Which volatile gases are Nonpungent?

A

Sevo

Halothane

N20

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23
Q

Which volatiles gases are Pungent?

A

Desflurane & Isoflurane

Produces Irritation - Cough, Breath Holding, Laryngospasm

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24
Q

What affect does Anesthetic Gas have on Cerebral Vascular response to PaCO2?

A

No Effect

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25
Q

Inhalation agents ________ CMRO2, cerebral metabolic O2 requirement, except for N2O?

A

Inhalation agents decrease CMRO2, cerebral metabolic O2 requirements

N2O increases CMRO2

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26
Q

At what MAC does Cerebral Vasodilation occur?

A

> 0.6 MAC

Dose-dependent increase in CBF

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27
Q

What happens in the 2 Phases of dose-dependent effect of inhalation agents on CBF?

A
  • First Phase
    • @ 0.5 MAC: Decreased CMRO2 offsets Vasodilation - No change in CBF
  • Second Phase
    • ≥ 1 MAC: Vasodilation takes over - Increased CBF
28
Q

What are the effects of N2O on the CNS?

A

Cerebral Vasodilation

&

↑CMRO2

29
Q

What would you give with N2O to counteract its effect on the CNS?

A

Opioids

Barbituarates

Propofol

30
Q

Which gases would Increase ICP with a MAC > 1?

A

All of them @ MAC > 1

31
Q

At what MAC is CNS Autoregulation impaired?

A

< 1 MAC

32
Q

What is SSEP?

A

SamatoSensory Evoke Potentials - Evaluates integrity of Brain & Spinal Cord

33
Q

How do Anesthetic Gases & N2O affect SSEP?

A

Depresses Amplitude & Increase Latency of SSEP according to dose

34
Q

At what MAC are Evoked Potentials abolished?

A

1 MAC

or

0.5 MAC if Gas + N2O

35
Q

What would Increased Depth of Anesthesia look like on an EEG?

A

Increased Amplitude & Synchrony

36
Q

As Depth of Anesthesia increases, Burst Supression occurs with _______ frequency

A

As Depth of Anesthesia increases, Burst Supression occurs with greater frequency

37
Q

At what MAC will you see an Isoelectric pattern on an EEG?

A

1.5 - 2.0 MAC

38
Q

Which gases are associated with Epileptiform Activity on the EEG?

A

Sevoflurane & Enflurane (Ethrane)

39
Q

How do Inhalation Agents affect Neuromuscluar Activity?

A

Dose-Dependent skeletal muscle relaxation & enhances neuromuscular blocking drugs

40
Q

Which gas from most to least triggers Malignant Hyperthermia?

A

Halothane > Isoflurane > Sevoflurane > Desflurane

41
Q

What are symptoms of Malignant Hyperthermia?

A

Increased EtCO2 - Earliest/Most sensitive sign

Fever

Tachycardia

Cyanosis

Rigidity/Trismus

42
Q

What rare liver effects might result after receiving Inhaled Anesthethics?

A

Immune Mediated Liver Injury

Liver Necrosis leading to death

Caused by Trifluoroacetate Metabolite

43
Q

Other than immune mediated, how else can inhaled anesthetics cause mild liver injury?

A

Decreased O2 to Liver & Decreased Liver Blood Flow

↑Serum Transaminase Levels

44
Q

Which gases are most hazardous to the liver due to metabolism?

A

Halothane > Isoflurane > Desflurane

Halothane Hepatitis

45
Q

When are Inhaled Anesthetics avoided with patients who have liver disease?

A

Avoid using gases in patient who previously had liver damage d/t inhaled anesthetics.

Not harmful otherwise.

46
Q

How does Methoxyflurane cause Nephrotoxicity?

A

Production of Inorganic Fluoride

47
Q

How might Sevoflurane & Halothane cause Nephrotoxicity?

A

Sevo & Halothane breaksdown into Compound A –> Prolonged exposure = Nephrotoxicity

48
Q

What can happen if Sevo has been given with low fresh gas flow for over 2 hours?

A

Compound A –> Proteinuria, Enzymuria & Glycosuria

49
Q

Which Inhaled Anesthetic should be avoided for pts with Vitamin B Deficiency?

A

N2O - stops methionine from regulating Vitamin B & Folate metabolism

50
Q

What causes Homocysteine levels to increase, which increases risk for coronary events?

A

N2O - stops methionine from converting Homocysteine to methionine

51
Q

Why does N2O cause air filled cavities to expand?

A

N2O goes into cavity 34x faster than Nitrogen can leave the cavity, increasing the volume and pressure.

This can cause a Pneumo

52
Q

What happens when the Soda Lime is fully dessicated?

A

Carbon Monoxide production from the Gases

53
Q

Which gas has the highest risk of fire when used with a fully dessicated soda lime?

A

Sevoflurane

54
Q

What is produced when Isoflurane & Desflurane is exposed to a fully dessicated Soda Lime?

A

Carbon Monoxide

55
Q

What is the best way to prevent Soda Lime related Fires?

A

Adequate Hydration of Absorbent

Change Frequently & When in Doubt

Turn off fresh gas b/t cases

56
Q

What compounds are in the conventional CO2 Absorbents?

A

94% Ca(OH)2 - Calcium Hydroxide

5% NaOH - Sodium Hydroxide

1% KOH - Potassium Hydroxide

57
Q

Which gases use a Variable-Bypass Vaporizer?

A

Sevoflurane

Isoflurane

Halothane

58
Q

How does a Variable-Bypass Vaporizer work?

A
  • Two streams of fresh gas
    • One goes to the agent
    • One bypasses agent reservoir
59
Q

What is the Vapor Pressure of Sevoflurane

A

170 mmHg

60
Q

What is the Vapor Pressure of Enflurane?

A

172 mmHg

61
Q

What is the Vapor Pressure of Isoflurane?

A

240 mmHg

62
Q

What is the Vapor Pressure of Halothane?

A

244 mmHg

63
Q

What is the Vapor Pressure of Desflurane?

A

669 mmHg

64
Q

What happens if you put an Inhaled Agent in the wrong Vaporizer?

A

High-Low-High
High VP Agent + Low VP Can = Higher amt. delivered than dialed

Low-High-Low
Low VP Agent + High VP Can = Lower amt. delivered than dialed

65
Q

Which gas uses a special Heated Vaporizer?

A

Desflurane (Suprane)

66
Q

How does a Tec 6 Vaporizer Work in different altitudes?

A

Heats Desflurane to 2 atm

High Altitude = lower amt. delivered

Spring 2020 - Pharmacology 1 (11 decks)

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