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Gen Exam 2 > Inhalational Agents > Flashcards

Inhalational Agents Flashcards

1
Q

First Ether demonstration

A

1846 – William Morton Massachusetts General Hosp.

everyone was exposed to ether lol

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2
Q

Vapor

A

gaseous phase
at a temp where the substance can be either liquid or solid
below its critical temp

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3
Q

Potent inhaled are mostly in the liquid state at which T and atm?

A

room temperature (20 C)
atmospheric pressure (760 mm Hg)

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4
Q

Heat of vaporization

A

calories required: 1 g liquid —> vapor
(w/o changing temperature)

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5
Q

Boiling point

A

temperature at which vapor pressure equals atmospheric pressure (760 mmHg)

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6
Q

Desflurane VP

A

669 mmHg

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7
Q

Variable bypass vaporizer mechanism

A

total gas flow is divided in two streams by a variable resistance proportioning valve

small amount enters a vaporizing chamber, acts as carrier gas

majority travels through a bypass line.

DES DOES NOT USE THIS

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8
Q

Tech 6 Vaporizer (Desflurane)

A

39 C

Raises Vapor Pressure = no need for carrier gas

Dual circuit: fresh/diluted gas separate from vaporizing pressure

Desflurane added directly to fresh gas

vaporizer dial: delivers concentration

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9
Q

T/F
In a Tec 6 Vaporizer, fresh gas mixes with the desflurane.

A

False
Fresh gas and IA mix = variable BP

Tec 6: Des directly added to fresh gas

this is the main difference btwn VB and tec 6

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10
Q

T/F
The Tec 6 does not use a carrier gas mechanism.

A

True
Tec 6 increases the vapor pressure, so that a carrier gas is not needed.

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11
Q

The perfect IA

A

doesn’t exist lol

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12
Q

Ideal IA

A

-non-pungent
-non-flammable
-fast induction
-fast wake-up
-no harmful metabolites

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13
Q

Nociception

A

CNS and PNS processing of noxious stimuli

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14
Q

T/F
Gases can provide muscle relaxation

A

true

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15
Q

most noxious stimulation from anesthesia

A

intubation

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16
Q

General anesthesia

A

reversible state of “loss of sensation”

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17
Q

Which phases are affected by the pharmacodynamics and pharmacokinetics of the inhalational anesthetics?
induction
maintenance
emergence (redistribution)

A

all 3

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18
Q

An Anesthetic state is obtained with a combination of… (3)

A

amnesia, analgesia and lack of response to noxious stimuli

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19
Q

don’t rely on one agent

A

Balanced anesthesia

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20
Q

Myer-Overton Theory

A

(IA)
high lipid solubility = high potency

higher solubility = lower MAC

Mac determines potency

depth of anesthesia is determined by the number of anesthetic molecules that are dissolved in the brain

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21
Q

Unitary Hypothesis

A

All inhalational anesthetics work via a similar mechanism of action but not all the same sites

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22
Q

IA MoA bottom line

A

don’t know for sure where/how they work

Enhancing inhibitory sites/receptors (GABA, Glycine)

Inhibits excitatory channels (Glutamine)

Inhibits calcium channels (Ca2+) & K

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23
Q

Immobility is mediated principally by the effects of inhalationals on the ___.

A

spinal cord

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24
Q

The ultimate effect of an IA depends on…

A

reaching a therapeutic level in the CNS/Brain/Spinal Cord

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25
Q

Sites of Anesthetic Action
Unconsciousness

A

Reticular activating system (Cortex, thalamus, brainstem)

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26
Q

Sites of Anesthetic Action
Analgesia

A

Spinothalamic tract

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27
Q

Sites of Anesthetic Action
Amnesia

A

Amygdala, hippocampus

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28
Q

Sites of Anesthetic Action
Immobility

A

Ventral horn

(immobility: spinal cord mediated)

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29
Q

_____ activity causes motor effects.

A

SPINAL CORD

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30
Q

T/F
Sevo stinks.

A

False

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31
Q

T/F
Des smells good.

A

False
pungent

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32
Q

Most polluting IA

A

Desflurane

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33
Q

Most expensive IA

A

Desflurane

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34
Q

Which IA works on one specific site of action?

A

None currently only act on 1 site

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35
Q

T/F
Ideally, IAs should not be water-soluble.

A

True
LESS W. SOLUBLE = GOOD
we don’t want it to stay in the blood; we can use pressure to get it in there

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36
Q

N2O has a ___ smell.

A

sweet

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37
Q

SEDLINE monitoring

A

gives 4 leads of EEG
Looks at both frontal lobe hemispheres
Lots of blue = asleep

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38
Q

Burst suppression

A

flat EEG; too much anesthetic

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39
Q

Amnesia and LOC occur at (lower/higher) levels while immobility occurs at much (lower/higher) levels.

A

Amnesia & LOC = lower doses
Immobility = higherrrr

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40
Q

Which route allows us to physically observe all Guedel stages?

A

IA

(IV occurs too quickly)

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41
Q

Guedel’s Stage I

A

I: induction to loss of consciousness

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42
Q

Guedel’s Stage II

A

Delirium + “excitement” period
pupils dilated
disconjugate gaze
increased RR/HR
High risk of laryngospasm/bronchospasm
b/c reflexes come back but cant control
Caution when removing airway
Minimal extra touching/stimulation

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43
Q

Why is Guedel stage II assoc. w/ risk of laryngospasm/bronchospasm?

A

reflexes come back but cant control

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44
Q

Guedel’s Stages III

A

Surgical plane, fixed gaze, constricted pupils

WE LIKE!

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45
Q

Guedel’s Stage IV

A

Overdose
absent/shallow/irregular RR
-hypoTN/profound CV collapse
-dilated/unresponsive pupils

almost ded lol

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46
Q

T/F
Pts pass thru all Guedel stages into anesthesia and on emergence.

A

True
I to IV and back up to I

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47
Q

Which Guedel stage is assoc. w/ disconjugate gaze?

A

II

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48
Q

Vital capacity breathing IA

A

exhale completely and take deepest breath –> speeds induction

(VC: the volume of exhaled air after maximal inspiration)

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49
Q

Nitrous can help speed induction through…..

A

the second gas effect

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50
Q

Tidal Volume breathing IA

A

TV: breathing normal tidal volumes

Slower than IV

Gradual increase of a high concentration

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51
Q

Humans have a constant gas flow of

A

2-3 L/min

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52
Q

If using TV breathing with IA, how long until total plane of anesthesia?

A

9 mins

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53
Q

Which technique reaches total plane of anesthesia faster?
VC
TV

A

VC

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54
Q

T/F
VC breathing IA is the quickest way to reach total plane of anesthesia.

A

False
IV is quickest

however, VC is faster than TV (diff is small)

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55
Q

Agents for Inhalational Induction

A

N2O/O2 (70%:30%) and Sevoflurane (7-8%) until induced

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56
Q

⭐️
Can you use Desflurane for a mask induction?

A

Not reccomended; pungent, coughing

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57
Q

T/F
Volatile agents can also relax airway smooth muscle and produce bronchodilation

A

True

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58
Q

benefits of not provoking an irritant response

A

Less:
breath holding
coughing
secretions
laryngospasm

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59
Q

T/F
IAs can break status asthmaticus.

A

False
cannot drive enough

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60
Q

IA advantages

A

Less traumatic
No IV access
Short pediatric case
Bronchodilator effect

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61
Q

IA Disadvantages

A

Smell/Irritant

Excitatory stage (II)

Delayed airway
(b/c have to wait until stage II over)

Gas bypassing scavenger system

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62
Q

⭐️
Minimum Alveolar Concentration (MAC)

A

inhalational anesthetic/alveolar [ ] at which 50% of the population will not move to painful or noxious stimulus (e.g., surgical incision)

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63
Q

⭐️
MAC is a direct measure of…

A

the potency of the volatile anesthetic

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64
Q

⭐️
The IA [ ] in the alveoli is equal to…

A

The IA [ ] in the brain

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65
Q

⭐️
Lower MAC = (more/less) potent

A

more

lower dose necessary to achieve [ ] = more potent

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66
Q

⭐️
MAC mirrors ____ partial pressure

A

brain

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67
Q

⭐️
T/F
MAC values are additive

A

True

0.5 MAC of N2O + 0.5 MAC of Sevoflurane = effect of 1.0 MAC anesthetic

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68
Q

T/F
MAC
Young/healthy pts need lower

A

False
they need more

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69
Q

⭐️
MAC-BAR

A

MAC needed to
Block Autonomic Responsiveness to painful stimuli
1.5-2.0 MAC

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70
Q

⭐️
Typical MACBAR values

A

about 1.5-2.0 MAC

(varies according to resource)

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71
Q

⭐️
MAC-awake

A

alveolar concentration at which patient opens their eyes

0.4-0.5 = unconsciousness
0.15 = regain

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72
Q

⭐️
MAC value of LOC

A

0.4-0.5 = unconsciousness

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73
Q

⭐️
MAC value to regain consciousness

A

0.15

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74
Q

⭐️
MAC value: awareness/recall
(Not the same as MAC awake)

A

0.4-0.5

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75
Q

⭐️
MAC value that will prevent movement in 95% of surgical patients

A

1.2-1.3

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76
Q

T/F
MAC is the IA/alveolar [ ] that will block autonomic response to pain.

A

False

MAC: 50% won’t move to painful/noxious stimulus

MACBAR: MAC that
Blocks Autonomic Responsiveness to pain

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76
Q

⭐️
Know dis

A
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77
Q

IA potency
most to least potent

A

Iso > Sevo > Des > N2O

“I’m So Dead Now”

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78
Q

Desflurane:
potency
lipophilicity
onset
clearance

A

less potent
high lipophilic
fast onset
fast expiratory clearance

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79
Q

T/F
higher MAC = higher lipid solubility

A

False
higher MAC = LOWER lipid sol.

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80
Q

Des
Dial for 1 MAC
VP

A

Dial 6.6
VP 669

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81
Q

N2O
Dial for 1 MAC
VP

A

Dial 104
VP 38,770

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82
Q

Iso
Dial for 1 MAC
VP

A

Dial 1.17
VP 240

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83
Q

Sevo
Dial for 1 MAC
VP

A

Dial 1.8
VP 157

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84
Q

No Change in MAC

A

Duration of anesthesia
Anesthetic metabolism
Hyperkalemia
Hyper/Hypocarbia
Gender
Thyroid function (not directly)
Metabolic alkalosis

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85
Q

T/F
Thyroid fxn directly alters MAC.

A

False
not directly

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86
Q

Increases MAC

A

Hyperthermia

Excess catecholamines (MAO inhibitors, cocaine, ephedrine, levodopa, amphetamine abuse)

Excess pheomelanin production (true redhead)

Hypernatremia

Chronic ethanol abuse

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87
Q

We would expect a (higher/lower) MAC in a chronic drinker.

A

higher

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88
Q

Hypernatremia (increases/decreases) MAC. Hyponatremia (increases/decreases) MAC.

A

HyperNa = increase MAC
HypoNa = decrease MAC

“MAC is high in sodium”

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89
Q

Ephedrine (increases/decreases) MAC.

A

increases

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90
Q

Decreases MAC

A

Hypothermia
Benzos
> 40Y
Pregnancy
Alpha agonists (Precedex)
Acute alcohol ingestion
Hyponatremia
Induced hypotension (MAP<50)
Lots of drugs (Lidocaine, Lithium, Ketamine, opioids, benzos)
Severe anemia/traumatic blood loss

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91
Q

We would expect a trauma pt w/ blood loss to have (increased/decreased) MAC.

A

decreased

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92
Q

We would expect a pregnant pt to have (increased/decreased) MAC.

A

decreased

d/t uterine atony & increased Vd

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93
Q

Opioids and benzos (increase/decrease) MAC.

A

decrease

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94
Q

HypoTN (increases/decreases) MAC.

A

decreases

MAP <50

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95
Q

T/F
All IAs are rapid acting.

A

True

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96
Q

Only true gas

A

N2O; rest are mixed

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97
Q

Potent inhaled anesthetics are vapors of

A

volatile liquids

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98
Q

Why do IAs diffuse rapidly?

A

nonionized
low molecular weights

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99
Q

Major advantage of IAs

A

delivered to the bloodstream via the lungs

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100
Q

Know dis too

A

ugh

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101
Q

T/F
IAs are heavily metabolized by the body.

A

False

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102
Q

Which IA is metabolized by the body the most?

A

Sevo

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103
Q

Inhaled gases quickly transfer bidirectionally (when dial is at ___) via…

A

dial = 0

lungs <—>bloodstream <—> CNS

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104
Q

⭐️
Gases are delivered and removed by…

A

ventilation thru the lung

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105
Q

T/F
Plasma and tissues have a high capacity to absorb the anesthetic

A

False
low capacity

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106
Q

bidirectional flow

A

high vaporizer [ ] = into lungs

low vaporizer [ ]= exhausted out of pt as they expire

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107
Q

When does
PCNS = PBlood = PAlveolar ?

A

at equilibrium
EtCO2 constant

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108
Q

Constant rate of EtCO2 = reached equilibrium
(assuming no changes in ____)

A

delivery

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109
Q

Expired [ ] is measured from…

A

venous blood returning to alevolus

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110
Q

increases the speed of onset of inhaled anesthetics

A

High inspired concentration (FI)

High alveolar minute ventilation

Low blood solubility

High MAC

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111
Q

Higher gas delivery = (higher/lower) FI

A

higher

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112
Q

Why do we want low blood solubility for faster IA onset?

A

Low blood solubility: will not sit in blood; will cross into brain rapidly

higher blood solubility = will sit in blood; requires saturating systemic circulation (wait longer)

113
Q

Lower blood solubility is preferred with IAs.
How do we get into into circulation to reach the brain?

A

drive across capillary membrane with high alveolar [ ]

114
Q

T/F
The high water solubility of IA’s allow them to act quickly.

A

False
Their low blood solubility allows fast onset

IA’s do not sit in blood and cross into brain quickly

115
Q

FGF

A

fresh gas flow

flowmeter settings & vaporizer [ ]

116
Q

FI
definition
depends on…

A

inspired gas concentration

FGF, breathing circuit volume & circuit absorption

117
Q

The common gas outlet sensor senses the:
FGF
FI
FA
Fa

A

FI
inspired gas concentration

118
Q

T/F
FA can be measured directly.

A

False
End tidal detection of returning volatile thru expiratory limb

119
Q

FA
definition
depends on…

A

alveolar gas

uptake, ventilation, the concentration effect & second gas effect

120
Q

Fa
definition
depends on…

A

arterial gas

affected by ventilation-perfusion mismatch

121
Q

We want our Et [ ] to equal ___ for that particular agent.

A

1 MAC

122
Q

FA (alveolar gas) reflects [ ] in ….

A

brain and spinal cord

not to be confused with Fa (arterial gas)

123
Q

T/F
FA (alv. gas) is always less than the vaporizer [ ].

A

True
~0.4-0.6 less
adjust vaporizer [ ] so that Et correlates with 1.0 MAC

124
Q

Gives info on MAC
FA or Fa

A

FA (alveolar gas)

125
Q

T/F
Fa tells us how much gas is being absorbed.

A

False
FA (alveolar gas) does

126
Q

arterial gas [ ] in blood/cap bed on the other side of avleolus that’s picking up the gas

A

Fa

127
Q

Goal of Inhalational Anesthesia

A

anesthetic state in the CNS/Brain

optimal and constant partial pressure of anesthetic in the brain (Pbr)

128
Q

Increased Induction or Fast Recovery

A

High fresh gas flow
Small breathing circuit
Less absorption

129
Q

Organ of uptake for inhalation agents is the

A

LUNGS

130
Q

Target Organs

A

Brain and spinal cord

131
Q

⭐️
Solubility in the ___ determines speed of onset

A

blood

(not lipid solubility!)

132
Q

When we talk about solubility with IAs, we are referring to (blood/lipid) solubility.

A

blood (water)

insoluble= faster; crosses into brain

soluble= slower; stays in blood

133
Q

Faster induction is achieved with an (insoluble/soluble) IA.

A

insoluble

taken up much slower by the blood faster induction
does not want to enter/stay in blood

134
Q

Solubility of an anesthetic is expressed as

A

Partition Coefficients

135
Q

Partition Coefficients

A

ratio
IA [ ] in blood phase : gas phase

(at equilibrium between the two phases)

136
Q

Higher blood : gas coefficient means

A

highly blood soluble

137
Q

Most to least blood soluble

A

Halo > Iso > Sevo > N2O > Des

“Hate Ice So No 2 Drinking”

138
Q

Overpressure technique

A

speeds induction for blood soluble agent

increase inhaled [ ]
speeds up equilibrium

139
Q

Which has faster induction/wakeup?
Iso or Des

A

Desflurane
0.42 (Poor bld Solubility)
Rapid induction/wakeup

140
Q

⭐️
T/F
Insoluble IAs have faster onset.

A

True
insoluble IA = not water soluble

will not sit in blood
crosses into brain

141
Q

Parallels anesthetic requirements

A

Oil:Gas Partition Coefficients

B/c brain & SC = lots of lipids

142
Q

⭐️
Potency of volatile agents correlates w/

A

physical property of lipid solubility

**potency = lipid sol.
onset = w. sol

143
Q

⭐️
T/F
higher MAC = higher B:G coefficient

A

False
higher MAC = lower B:G coefficient

144
Q

Decrease in potency is associated with

A

a decrease in the oil:gas partition coefficient

145
Q

How does increased CO affect IA uptake?

A

higher CO = higher lung blood flow

more rapid uptake
more removed from alveolar [ ]
constantly have to refresh [ ]

146
Q

Increased CO = (shorter/longer) induction time

A

longer induction time

**longer time for IA to reach equilibrium (alveoli & brain)

147
Q

(high/low) solubility agents are more effected by changes in CO.

A

High

148
Q

(high/low) solubility agents are rapid onset regardless of CO changes.

A

low

149
Q

Decreased CO = ___ PA (Alveolar blood flow)

A

Slow flow = pick up more

150
Q

A-vD

A

tissue uptake of inhaled anesthetics

never will be 1:1 d/t tissue extraction!

151
Q

Transfer of anesthetic from blood to tissue is determined by:

A

Tissue solubility
Tissue blood flow (perfusion)
Arterial blood/tissue partial pressure difference

152
Q

The brain and spinal cord are vessel (rich/poor)

A

Rich

153
Q

(VRG/VPG) gets IA first

A

VRG

154
Q

Inhalational agents are very (blood/lipid) soluble

A

lipid

155
Q

Greater affect on emergence than induction d/t…

A

Diffusing out of tissues
(reservoir for drug)

156
Q

(Fat/blood) equilibrates slower due to ___.

A

Fat
perfusion

(fat is vessel poor)

157
Q

What do this graph tell us?

A

Gas builds in alveoli the fastest

When gas is turned off:
-[ ] drops rapidly in alveoli and VRG
-[ ] in muscle and fat are now higher

shows why effects of gases are still evident on emergence

158
Q

FA/FI

A

Ratio
alveolar [ ] anesthetic/inspired anesthetic over time

159
Q

⭐️
alveolar fraction is directly proportional to…

A

the partial pressure of the anesthetic in the brain (CNS)

160
Q

3 time constants = __% of max theoretical value of anesthetic

A

95

161
Q

Anesthetic [ ] in gas circuit follows which order of kinetics?

A

first

162
Q

How to lower number of time constant

A

higher gas flow
decrease FRC (supine)
low dead space

163
Q

How can we increase the FI?

A

Increase the fresh gas flow
Increase the ventilation
Decrease the Functional Residual Capacity (FRC)

164
Q

T/F
Supine pts will experience Equilibrium of FA/FI faster.

A

True
Supine = decreases FRC

decreased FRC = increased FI

165
Q

Uptake (increases/declines) as the tissues become saturated

A

declines

166
Q

Augmented gas flow

A

absorbed gas replaced by FGF (new gas)

we refresh by giving FGF plus IA

167
Q

⭐️
achieves a faster rate of rise of FA/FI

A

N2O

Desflurane is less soluble in blood, but the volume of Nitrous compensates for the minimal difference in solubility

168
Q

Second Gas Effect

A

Uptake large volume of first/primary gas (ie: Nitrous) from alveoli

sharper increase in PA of second gas

169
Q

Factors that are responsible for the concentration effect also control

A

the second gas effect

170
Q

Factors responsible for the [ ] effect & control the second gas effect

A

Increasing ventilation
Concentrating the IA

171
Q

Second Gas Effect is associated with which law?

A

Fick’s Law of Diffusion

all about [ ] gradients

172
Q

V/Q mismatch may occur in

A

R mainstem bronch intubation

173
Q

T/F
Ventilation/Perfusion mismatch can affect the uptake and distribution of the inhaled anesthetics

A

True

174
Q

Longest recovery time (gas)

A

Iso

“Iso slow”

175
Q

⭐️
Concentration of Inhaled anesthetics in the tissues at the end of anesthetic depends on…

A

the solubility of the agent and time of administration

176
Q

⭐️
Exhaled gases from the patient containing anesthetic will be rebreathed unless

A

fresh gas low rates are >5L/min

177
Q

T/F
Return of spont. breathing can cause increase in expired IA

A

True
spont breathing has greater lung recruitment

178
Q

T/F
During emergence, can permissively let CO2 climb to trigger brainstem breathing reflexes

A

True
esp sleep apnea

179
Q

T/F
Recovery is exact mirror of induction

A

True

180
Q

T/F
Long induction = long recovery

A

True

181
Q

Primary factor in recovery/exhalation

A

Anesthetic solubility

others:
circuit volume
increased CBF
CO
increase ventil8n & FGF

182
Q

non-pungent

A

Sevoflurane, Halothane, and Nitrous

“Smells Hella Nice”

183
Q

pungent

A

Isoflurane
Desflurane

“I’m Dead”

184
Q

⭐️
dose dependent IA changes in resp parameters

A

Increase: RR, PaCO2

Decrease: TV, MV

185
Q

IAs (increase/decrease) MV.

A

decrease
gradually

186
Q

How IA affects respiratory parameters

A

increased:
RR
PaCO2

Decrease:
TV
MV

187
Q

How do IAs increase PaCO2?

A

Dose dependent depression of the ventilatory response to hypercarbia

188
Q

⭐️
T/F
all IA’s cause bronchodilation

A

true

189
Q

Which IA should we not give to a smoker?

A

Des
airway irritant

190
Q

Inhalationals (except N2O)
CV effects

A

reduce MAP, CO, and CIndex in (dose-dependent)

Reduce BP –> decrease in SVR (relaxes vascular smooth muscle)

191
Q

N2O
hemodynamic effects

A

Activates SNS
increases SVR, CVP & art.pressures

192
Q

Nitrous + inhalationals
CV effects

A

increase SVR
help support BP

balance each other out:
N20 inc HR but temper with IA

193
Q

can increase HR and BP due to the sympathetic stimulation

A

!!! Desflurane
Isoflurane

194
Q

has an irritant effect (gas)

A

Des

“Stop it, Des irritating me”

195
Q

minimal effect on HR (inhaled agent)

A

Sevoflurane

“Sevo the heart saver”

196
Q

Use ___ to blunt tachycardic effects of some IAs

A

opioids

197
Q

T/F
IAs lower the CO.

A

False
Cardiac Output is well preserved with minimal effect

198
Q

T/F
IAs decrease SVR, leading to hypoTN.

A

True

199
Q

T/F
IAs are coronary vasodilators.

A

True

200
Q

T/F
IAs cause myocardial depression.

A

True

201
Q

⭐️
Coronary Steal

A

Diversion of blood from a myocardial bed with limited or inadequate perfusion to a bed with more perfusion

(Dilation pulls blood away from areas that usually lack oxygenation)

currently debated

202
Q

T/F
All inhalationals increase Cardiac Blood Flow less than the myocardial oxygen demand

A

False
increase blood flow more than O2 demand

203
Q

IA
CNS effects

A

increases:
CBF (vasodilation cerebral BVs)
ICP (N2O)

decreased:
Cereb. metab rate

204
Q

How to attenuate increased ICP from IAs.

A

Hyperventilation

205
Q

T/F
All volatiles cause dose-dependent:
increase in latency
decrease amplitude in all cortical SEPs

A

True

“I’m late b/c my cortical sep isn’t working”

206
Q

IA
OB effects

A

Mag + too much IA = uterine atony and bleeding!

dose-dependent decreases in uterine smooth muscle contractility and blood flow

207
Q

⭐️
OB
IAs cause undesired effects for uterus at which flows?

A

(risk uterine atony from too much relax8n)

Modest: 0.5 MAC
substantial: >1 MAC

208
Q

OB
We want to keep volatile dosing as low as possible. What can we do to reduce it?

A

Nitrous

can decrease the need for volatile anesthetics

209
Q

____ degradation with the older carbon dioxide absorbents = compound A

A

Sevo

210
Q

Renal concerns with Compound A

A

nephrotoxic in rats

211
Q

IAs are most commonly biodegraded by…

A

hepatic metabolism
cytochrome P-450 oxidation

**Keep in mind: minimal liver metabolism

212
Q

Depolarizing and nondepolarizing muscle relaxants have an additive effect/potentiates IA’s; except for ____

A

Suxx
gone too quick

213
Q

How do IAs relax skeletal muscle?

A

Reduced CNS neural activity
Prominent postsynaptic effect at NMJ

214
Q

Inhalationals ____ recovery from nondepolarizing muscle relaxants

A

delay
synergsitic effect

215
Q

Which pt population is prone to emergence delirium with IAs?

A

Children

Put back to sleep
re-emerge usually w/o stage II

216
Q

Emergence delirium
duration
how to treat

A

10-15 minutes

propofol, midazolam, clonidine, dexmedetomidine, ketamine, opioids

217
Q

T/F
Emergence Delirium can resolve spontaneously

A

true

218
Q

Emergence Delirium is more common with ___ and ___ compared to Iso & TIVA.

A

Des
Sevo

“they be on some Dumb Shit”

219
Q

Compound A

A

Degradation of Sevoflurane by strong bases (soda lime) in the CO2 absorbers

220
Q

increases chances of compound A

A

low flow rates
closed circuit
warm/dry CO2 absorbents

221
Q

Induced Nephrotoxicity risk factors

A

Sevo: >2 MAC hours

FGF <2 L/min

222
Q

degradation product of volatile agents(especially Desflurane) due to dry/desiccated CO2 absorbents

A

C. Monox

223
Q

Monday morning phenomena contributes to ___ production

A

CO

224
Q

Dry CO2 absorbers produce ___.

A

CO

225
Q

Optimal CO2 absorbent size

A

2.5 mm
4-8 mesh

226
Q

CO2 absorber channeling

A

loose packing allowing exhaled gases to bypass absorber granules in the canister

227
Q

⭐️
Final Products of CO2 Neutralization

A

Ca carbonates, water and heat

228
Q

T/F
Ideal CO2 absorbents have high resistance to gas flow.

A

False
low resistance

229
Q

Turns sodalime purple

A

ethyl violet

230
Q

T/F
Current CO2 absorbers use NaOH or KOH.

A

False
contain Calcium or lithium hydroxides

strong bases + sevo = compound A

231
Q

what kind of compound is Compound A?

A

vinyl ether

232
Q

⭐️
Other than turning purple, what indicates our CO2 abs. is exhausted?

A

rising ETCO2 waveform on capnograph

233
Q

Why does des need diff vaporizer?

A

Vapor pressure close to atm

234
Q

Vapor Pressure

A

The pressure exerted by a vapor in equilibrium with its liquid or solid phase inside of a closed container

235
Q

Vapor pressure is ____ proportional to temperature

A

directly

236
Q

T/F
All anesthestic gases used today are based off ethers.

A

False
N2O is not an ether

237
Q

⭐️
Who dis

A

Isoflurane

5 fluorine atoms and 1 chlorine atom

238
Q

⭐️
Who dis

A

N2O

239
Q

Who is she?

A

Sevoflurane

7 fluorine atoms
(sevo=seven)

240
Q

New phone, who dis?

A

Desflurane
6 fluorine atoms

241
Q

⭐️
Which IA is not chiral?

A

Sevo

“Sevo’s So different”

242
Q

Isoflurane (Forane)

A

Halogenated methyl ethyl ether

Coronary Steal

Low flow OK, resistant to degradation

B:G Coeff 1.46 (soluble)
Vapor Pressure 238

Decrease MAP (d/t dec. SVR)
Increase CBF

most potent

pungent

243
Q

Sevoflurane (Ultane)

A

Fluorinated methyl isopropyl ether

bronchodilator

Minimal sympathetic activation

Compound A

B:G coefficient of 0.65

VP 157

244
Q

Desflurane (Suprane)

A

Fluorinated methyl ethyl ether
Carbon Monoxide if dry absorber

Insoluble (faster sleep & wake)

potential irritant over 1 MAC

B:G 0.42
VP 669

SNS stimulation (Increased HR and BP)

245
Q

T/F
You cannot fill the Tec 6 vaporizer while its in use.

A

False
Can fill the vaporizer during use

246
Q

⭐️
T/F
volatiles decrease incidence of PONV.

A

FALSE
all volatile agents increase PONV

247
Q

T/F
N2O is a triggering agent for MH.

A

False
It is not

248
Q

T/F
N2O does not offer muscle/uterine relaxation, as opposed to other IAs.

A

True

249
Q

⭐️
N2O diffusion & solubility

A

Diffusion into closed spaces

INSOLUBLE

Nitrous is 34x more soluble than N2, both are insoluble (increase in volume and pressure with the closed space)

250
Q

When to avoid N2O

A

bowel cases
pneumothorax/blebs
venous air emboli
middle ear surgery
some eye surgeries

251
Q

T/F
N2O is an analgesic.

A

True

252
Q

⭐️
N2O inactivates ________, a key enzyme in folate metabolism. This affects vitamin ____.

A

methionine synthetase
B12

pic: “inactivation of vitamin B12 by nitrous oxide”

253
Q

N2O can cause ____ in a noncomplicant airspace, esp it pf does not have a chest tube.

A

tension pneumothorax

254
Q

In a fixed/noncompliant airspace, N2O will increase ____.

A

pressure

255
Q

In a compliant airspace, N2O will increase ____.

A

volume

256
Q

______ effects responsible for PONV

A

Middle ear

257
Q

⭐️
best approach to prevent operating room pollution with anesthetic gases and reduce wastage

A

Shut off FGF (not vaporizer) during intubation or airway instrumentation

258
Q

⭐️
Diffusion Hypoxiais SPECIFIC TO

A

N2O

259
Q

Diffusion Hypoxia

A
  1. nitrous stopped abruptly
  2. reverses prtl pressure gradients
  3. nitrous: blood –> alveoli

washout of high N2O [ ] lowers alveolar [ ] of oxygen and carbon dioxide

260
Q

How to avoid diffusion hypoxia

A

Stop nitrous early

initiate recovery from N2O anesthesia with 100% oxygen rather than less concentrated O2/air mixtures.

261
Q

how does diffusion hypoxia affect respiratory drive?

A

decreases
(Diluted PACO2)

262
Q

MAC of ____ will decrease potential for intraop awareness

A

0.4 - 0.5

263
Q

Malignant Hyperthermia

A

massive release of Ca from sarcoplasmic reticulum

Ryanodyne receptor (RYR1)

Induced by inhalational agents and succinylcholine

264
Q

T/F
O2 will displace N2O

A

False
N2O displaces O2

265
Q

T/F
Early signs of MH include increased temperature.

A

False
this is a late sign

266
Q

First sign of MH

A

unexplained rising EtCO2

267
Q

Determines bill for gases

A

FGF

268
Q

(low/high) solubility needs less FGF.

A

low solubility = less FGF

269
Q

T/F
All volatiles are greenhouse gases.

A

True

270
Q

How long does Des last in atmosphere?

A

14 Yrs

271
Q

chlorofluorocarbon that directly contributes to the destruction of the ozone layer

A

N2O

272
Q

atmospheric lifetime of 114 years

A

N2O

273
Q

Minimizing IA pollution

A

✅sevoflurane & isoflurane ❌desflurane & nitrous oxide

Total intravenous anesthesia (TIVA)

274
Q

Which takes priority when choosing anesthetic?
Environmental effect
Patient Safety

A

Patient Safety

Earth can’t sue me, but the patient/family sure can

275
Q

Henry’s Law

A

More Dissolved gas = higher partial pressure

276
Q

Graham’s Law

A
277
Q

Ideal Gas Law

A

volume of a gas is directly proportional to mass

entire mixture behaves just as if it were a single gas

278
Q

LeChatelier’s Law

A
279
Q

Fick’s Law of Diffusion

A

gas: high [ ] area –> low [ ] area proportional to the concentration gradient

Gen Exam 2 (7 decks)

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