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Anaesthetics > Inhalational Agents > Flashcards

Inhalational Agents Flashcards

0
Q

Halogenated inhalational agents

A 
Halothane
Enflurane
Isoflurane
Sevoflurane
Desflurane
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1
Q

Inorganic molecule used as inhalational anaesthetic agent

A

Nitrous Oxide

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2
Q

Old anaesthetics no longer used

A

Chloroform - liver toxicity
Ether
Methoxyflurane - kidney toxicity
Cyclopropane

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3
Q

Critical temperature (defn)

A

Temperature above which a substance cannot be liquefied, regardless of how much pressure applied (ie. It is a gas)

*anaesthetic agents are below critical T at room temperature (vapours)

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4
Q

Inhalational agent with boiling point near room T, requiring special vapouriser

A

desflurane

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5
Q

Uses of inhalational agents (4)

A
  1. Maintenance of anaesthesia (ventilator/spontaneous breathing)
  2. Sevoflurane/halothane –> Induction
  3. N2O –> Analgesia (labour, intra-op)
  4. N2O –> second gas effect, diluting potent agents in maintenance
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6
Q

The ideal inhalational anaesthetic agent (10)

A 
Cheap
Stable (non-flammable, easy storage)
No metabolism (less toxic effect)
Potent (can use hi O2 concentration)
No long term effects/resp depression/cardiovascular depression
Non-irritant
Hypnotic and analgesic
Readily reversible
Neuroprotective 
Non excitatory
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7
Q

Second gas effect

A

N2O’s effect of speeding up an inhalational induction

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8
Q

The agent analyser’s end tidal value reading indicates ___________

A

Alveolar concentration of anaesthetic agent

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9
Q

Benefits of inhalational induction

A

Use in Children

Safer if Compromised Airway (inhalational - pt breathes spontaneously, IV - risk of apnea and loss of airway)

Stages of anaesthesia can be observed and used to ensure anaesthetic adequacy and prevent overdose

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9
Q

FiAA

A

Inspired concentration of anaesthetic agents

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11
Q

FaAA

A

Alveolar concentration of anaesthetic agent

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12
Q

Factors which INCREASE MAC (1+1+2+3)

A 
Infancy
Hyperthermia
Hyperthyroidism
Hypernatraemia
Chronic opioid use
Chronic alcohol intake
Acute Amphetamine intake
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13
Q

Factors affecting FaAA

A
  1. Inspired concentration (Fi)
  2. Uptake
  3. Alveolar ventilation
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15
Q

The greater the uptake, the _____________ the rate of induction and recovery/emergence

A

Slower

?Dye dropping into water: If water is flowing fast, the dye will continually be diluted, and take longer to change color

?People getting onto a train: if the train is in a rush, it stops for a short time and will take longer for the train to fill.

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16
Q

Respiratory depression and Airway obstruction cause ____ventilation and will ____________ induction

A

Hypoventilation —> deccelerate

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17
Q

Factors affecting anaesthetic uptake

A

Solubility of agent in blood (BGPC)

Cardiac output (train analogy)

Alveolar to mixed venous partial pressure difference**

V-Q shunt

18
Q

NO2 uses

A

Analgesia intra-op and in labour
Second gas effect during induction
Reducing potent volatile agents during maintenance

19
Q

Blood : gas partition coefficient (BGPC)

A

Ratio of the amount of volatile present in blood compared with the alveolar gas, when the two phases (gas and blood) are of equal volume and at equilibrium

Indicates agent’s solubility in blood

20
Q

Hyperventilation will ________ induction

A

Accelerate

20
Q

Halothane (BGPC = 2,3) is a __________(more/less) soluble volatile; therefore it is a ___________(fast/slow) induction agent.

A

Halothane is a highly soluble volatile, and therefore a slow induction agent.

Hi solubility –> large quantities removed from lung by circulation –> lo PaAA –> slow rise in arterial and brain partial pressures

22
Q

Factors affecting FiAA

A
  1. Volume of breathing circuit
  2. Fresh gas flow rate
  3. Absorption of inhalational agent by breathing circuit
22
Q

The substance used in muscle relaxants, initially used by Pygmy hunters to shoot monkeys in trees

A

Curare

23
Q

Shunts affecting arterial concentration of anesthetic agent (FaAA)

A

Intrapulmonary: atelectasis, bronchial intubation

intracardiac: ASD, VSD, Fallot’s tetralogy

24
Q

Factors which DECREASE MAC (non-drug)

A 
Neonates and elderly
Pregnancy
Hypotension
Hypothermia
Hypothyroidism
25
Q

MAC of Halothane

A

0.75

25
Q

Which class of drugs significantly lowers MACbar

A

Opiates

27
Q

Sevoflurane is a __________(more/less) soluble volatile; therefore it is a ___________(fast/slow) induction agent.

A

Sevoflurane has low solubility therefore it is a fats induction agent

28
Q

Factors which DECREASE MAC (drug)

A 
Acute opioid use
Acute alcohol intake
Chronic Amphetamine intake
Lithium
A2 agonists
Sedatives
31
Q

Desflurane, Sevoflurane and NO2 are __________(poorly/highly) soluble agents with ______(slow/rapid) recovery and induction.

A

These are poorly soluble agents with RAPID induction and recovery.

32
Q

2 volatiles which are metabolized in the liver as well as via the lungs

A

HE! Halothane and enflurane!

33
Q

Minimum alveolar concentration (MAC)

A

The steady-state minimum alveolar concentration at sealevel that prevents movement to a standard surgical stimulus (skin incision) in 50% of non premedicated adults. (MAC50)

34
Q

POTENT ANALGESIC POOR ANAESTHETIC

A

NO2

35
Q

Desflurane has a LOW potency; therefore it requires a ______ (higher/lower) MAC

A

HIGHER. The MAC of Desflurane is 6.

36
Q

Halothane has a HIGH potency due to its HIGH fat solubility therefore it requires a ______(higher/lower) MAC.

A

halothane requires a LOW MAC I.e. 0.75

38
Q

In a clinical situation, what is the appropriate amount of agent (in terms of MAC) that will provide surgical anaesthesia in the patient

A

1.3 x MAC

39
Q

MACawake

A

Average of concentrations above and below those permitting VOLUNTARY RESPONSE to COMMAND

40
Q

MAC of NO2

A

105

41
Q

Factors which do not affect MAC

A

Gender
Duration of anaesthesia
Hypocarbia
Time of day

42
Q

MACbar

A

The alveolar concentration that Blocks Autonomic Response to surgical stimulation.

43
Q

MAC of Desflurane

A

6

Anaesthetics (8 decks)

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