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PMI > Inhalation Induction > Flashcards

Inhalation Induction Flashcards

1
Q

Fi

A

inspired concentration of volatile agent

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2
Q

Fa

A

concentration of volatile agent in alveoli (and expiratory tubing)

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3
Q

inhalation induction mechanism

A
  1. volatile agent on
  2. Fi increases
  3. Fa increases
  4. agent diffuses into blood
  5. agent diffuses from blood to brain
  6. pt asleep when conc in brain is sufficient
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4
Q

how does concentration gradient effect diffusion speed?

A

the greater the conc gradient from the lungs to blood the faster the diffusion to the blood

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5
Q

T/F diffusion is slow at first and then rapid.

A

false, rapid at first then slows as the concentration gradients decrease

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6
Q

Fa/Fi ratio

A

how concentrated the alveoli are compared to machine

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7
Q

why is the Fa/Fi ratio less than one?

A

b/c blood is always absorbing agent from the lungs

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8
Q

list the volatile agents in order from fastest to slowest for Fa/Fi ration approaching 1

A 
nitrous oxide
des
sevo
iso
halo
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9
Q

what does a steep slope on the Fa/Fi curve mean?

A

Fa is rapidly increasing and leads to faster diffusion and faster induction

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10
Q

why is low blood solubility important?

A

slower initial diffusion into blood and Fa builts up, rapidly diffuses to brain b/c low blood solubility

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11
Q

high blood solubility

A

quickly diffuses to blood, slow to the brain bc wants to stay in the blood

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12
Q

If Desflurane has a lower blood gas coefficient than nitrous oxide, why does nitrous oxide have a steeper Fa/Fi curve?

A

Because N2O is typically used in much higher concentrations

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13
Q

how to speed up inhalational induction

A

higher % poison
higher FGF rate
decrease circuit volume
agent with lowest blood solubility

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14
Q

how much oxygen does a patient need?

A

250mL

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15
Q

When do you need to run at least 2L/min?

A

sevo is used

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16
Q

advantages of low FGF

A

cost effective
preserves heat and moisture
slows drying of CO2 granules
preserves pt temp

17
Q

disadvantages of low FGF

A

slower induction

slower emergence

18
Q

advantages of high FGF

A

faster induction

faster emergence

19
Q

disadvantages of high FGF

A

expensive
dries out airway
accelerates drying of granules

20
Q

what are the patient factors that affect the speed of induction?

A

cardiac output
minute ventilation
FRC

21
Q

low cardiac output

A

faster buildup of agent conc in blood
faster buildup of agent conc in lungs
faster induction

22
Q

high cardiac output

A

slower buildup of agent conc in blood
slower buildup of agent conc. in lungs
slower induction

23
Q

T/F low cardiac output quickens the intravenous induction?

A

false, it slows the intravenous induction (how long it takes to travel to the brain)

24
Q

higher minute ventilation

A

alveoli are open longer
deeper breath= more surface area
faster breaths = more gas

25
Q

low FRC

A

less space in alveoli
higher conc of agent in lungs
faster induction
***peds pts

26
Q

high FRC

A

more space in alveoli
lower conc agent in lungs
slower induction

27
Q

where do volatile agents go in the body other than the brain?

A

vessel rich group, fat group, muscle group

28
Q

what are the vessel rich organs

A 
brain
heart
liver
kidney
endocrine glands
29
Q

what percent of cardiac output do the vessel rich organs get?

A

75%

30
Q

clinical implications of vessel rich group

A

saturate quickly

desaturate quickly

31
Q

muscle group includes

A

muscle and skin

32
Q

how much cardiac output does the muscle group get?

A

20%

33
Q

how much cardiac output does the fat group get?

A

5%

34
Q

clinical implications of fat group

A

slow to saturate

slow to desaturate

35
Q

wake up mechanism

A
  1. turn vapor off
  2. conc in machine and lungs decrease
  3. agent diffuse from blood to lungs
  4. conc agent in blood decrease
  5. diffuse out of tissues (brain) into blood
  6. conc in fat decreases and blood conc further decrease
  7. blood and brain conc decrease enough pt wakes
36
Q

what are the factors that affect wakeup

A 
age (geriatric=longer)
amount of agent in fat
FGF rate
blood solubility of agent
minute ventilation (higher=faster)
amount of narcotic (more=longer)
body temp- hypothermia (longer)
cardiac output (low=longer)
lung disease/decreased alveolar diffusion (longer)
APL valve
FRC (low=faster)
37
Q

when will there be more agent dissolved in fat?

A

obesity
time surgery time
high conc of agent

38
Q

if you want your patient to wake up faster do you want your APL valve open or closed?

A

OPEN

PMI (21 decks)

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