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LANCE > Inhalation Anesthetics > Flashcards

Inhalation Anesthetics Flashcards

1
Q

Apneic threshold

A

highest blood CO2 level at which a patient can remain apneic

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2
Q

Do anesthetics lower or raise the apneic threshold?

A

raise, suppresses the drive to breathe

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3
Q

Does pain lower or raise the apneic threshold?

A

lowers, stimulates breathing

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4
Q

hypoxic drive

A

lowest oxygen level a patient can no longer remain apneic

normal patient ~60mmHg

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5
Q

for a healthy patient is it hypoxia or hypercarbia that causes them to breathe?

A

hypercardia

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6
Q

for a patient with lung disease is it hypoxia or hypercarbia that causes them to breathe?

A

hypoxia

less responsive to increase in CO2

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7
Q

The CNS chemoreceptors respond to changes in what?

A

PaCO2

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8
Q

The PNS chemoreceptors respond to changes in what?

A

PaO2

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9
Q

minimum alveolar concentration (MAC)

A

mac of an exhaled gas that will prevent movement in 50% of patients during incision

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10
Q

A patient is exhaling 0.8 MAC of Des. What is the percentage they’re exhaling?

A

4.8%

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11
Q

A patient is exhaling 0.3 MAC of Sevo. What is the percentage they’re exhaling?

A

0.6%

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12
Q

1.2% Des + 30% N2O = _____ MAC

A

0.2 MAC Des + 0.3 MAC N2O = 0.5 MAC

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13
Q

MAC awake

A

0.4 MAC

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14
Q

Reliable awareness prevention (with narcotics)

A

0.8 MAC

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15
Q

Reliable awareness prevention (even without narcotics)

A

1.0 MAC

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16
Q

50% chance of movement (w/o paralytics)

A

1.0 MAC

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17
Q

5% chance of movement (w/o paralytics)

A

1.3% MAC

18
Q

How to know if patients are aware or not when paralyized

A

vital signs would be high

19
Q

What are the two reasons to give volatile agents?

A

prevent movement

prevent awareness

20
Q

What are factors that decrease MAC?

A 
1- IV anesthetics
2- Old age (4-6% per decade)
3-ACUTE intoxication
4- pregnancy (progesterone sedative)
5-temperature factors
6- blood factors
21
Q

What are the 4 blood related factors that decrease MAC?

A

hypoxia
hypercarbia
hypotension
anemia

22
Q

What are the factors that increase MAC?

A

YOUNG HOT SALTY ALCOHOLICS

young
hot (hyperthermia/ burn pt)
salty (hypernatremia)
alcoholics (chronic)

23
Q

Blood/Gas Partition Coefficients

A

When you reach equilibrium then it is the % of blood concentrated compared to the lungs

24
Q

If the agent is soluble in the blood, the blood will have more agent than the lungs at equilibrium and the blood gas coefficient will be lower or higher?

A

Higher

25
Q

What are the neurologic effects of Volatile agents (not N2O)?

A

1-Dilates the cerebral vasculature, increases CBF, increases ICP
2- emergence delirium in kids
3- decrease seizures
4- decrease cerebral metabolic rate of oxygen

26
Q

What are the cardiac effects of volatile agents?

A

1-decrease cardiac contractility
2-cause systemic vasodilation
3- cause coronary vasodilation

27
Q

What are the respiratory effects of volatile agents?

A

1-rapid, shallow breathing (increase in CO2), lower Vd
2- increase apneic threshold
3- decrease hypoxic drive
4- bronchodilation

28
Q

Other effects of volatile agents?

A 
1-decreases renal blood flow
2- decreases hepatic blood flow
3- prolongs muscle relaxant
4- PONV
5- MH
6- inhibits "non-shivering thermogenesis" in peds
29
Q

Nitrous oxide

A 
1-analgesic
2-PONV
3-stimulates sympathetic 
increases PVR
4-dilates cerebral vasculature
5-seizures less likely
6-supports combustion
7- post op diffusion hypoxia
8- expands air containing cavities
9- increases cerebral metabolic rate of oxygen
10- prolonged exposure bad
30
Q

What does prolonged exposure to N2O cause?

A

1-bone marrow depression
2- can inhibit enzymes in DNA synthesis
3-neurological deficiencies

31
Q

How does Nitrous oxide expand air bubbles?

A

Nitrous oxide will diffuse into air pocket faster than the nitrogen can diffuse into the blood

32
Q

What are the contraindications for N2O?

A 
1- facial or throat surgery with laser
2-ophthalmic surgery
3- severe COPD
4- cardiopulmonary bypass surgeries
5- certain abdominal surgeries (laparoscopic, bowel obstruction)
6- inner ear surgery
7- 1st trimester of pregnancy
8- neurosurgery
33
Q

What are the advantages of iso?

A

mimimal cardiac depression

causes coronary vasodilation

34
Q

what are the disadvantages of iso?

A

pungent odor

associated with coronary steal syndrome

35
Q

Coronary steal phenomenon?

A

when iso causes coronary vasodilation the stenotic coronary arteries cannot vasodilate as well as the normal coronary arteries

36
Q

What are the advantages of sevo?

A

least pungent

37
Q

what are the disadvantages of sevo?

A

potential risk for nephrotoxicity (free fluoride ions & compound A)

38
Q

What are the effects of compound A thought to be more significant with?

A

prolonged sevo use
high conc of sevo
low FGF used

39
Q

desflurane

A 
1- high vapor pressure
2- specialized vaporizer
3- fastest induction and emergence
4- possible sympathetic response
5- pungent
40
Q

What are the advantages of xenon?

A

inert
low b:g co
minimal cardiovascular effects
doesnt trigger MH

41
Q

What are the disadvantages of xenon?

A

rare and expensive

low potency

LANCE (17 decks)

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