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Neuro 2 > Inhalational Anesthesia > Flashcards

Inhalational Anesthesia Flashcards

1
Q

Which inhalational anesthetic is in gas form?

A

nitrous oxide

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2
Q

Which inhalational anesthetic is in liquid form?

A 
sevoflurane
desflurane
isoflurane
halothane
enflurane
methoxyflurane
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3
Q

What are the two overarching ways in which inhalational anesthetics work?

A

both potentiation of inhibitory neural pathways (ex. GABA and glycine) and inhibition of stimulatory pathways (NMDA)

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4
Q

Which interactions are decreased when feedback transfer entropy is reduced in anesthesia?

A

front-to-back (parietal response is attenuated–reducing cortical interactions and integration)

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5
Q

which interactions are preserved in anesthesia?

A

occipital response is preserved

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6
Q

What is the word for relief of pain without intentional production of altered mental state (but this may be secondary)?

A

analgesia

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7
Q

What is the word for decreased apprehension with no change in level of awareness?

A

anxiolysis

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8
Q

What type of sedation is dose dependent with protective reflexes maintained, independent maintenance of airway/O2 saturation/ventilation, and response to physical and verbal stimulation maintained?

A

conscious sedation

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9
Q

What type of sedation does NOT mean the patient is unconscious, but this state can be transitioned to unconsciousness by additional drug application?

A

deep sedation

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10
Q

What type of sedation provides sensory, mental, reflex and motor blockade with concurrent loss of all protective reflexes?

A

general anesthesia

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11
Q

What is of profound importance in general anesthesia?

A

maintenance of the airway

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12
Q

What are the benefits for administering a drug via the inhalational or IV route?

A

anesthesiologist has minute-to-minute control over the depth and duration of unconsciousness

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13
Q

What is the Meyer-Overton hypothesis?

A

anesthetic activity is directly linked to lipid solubility

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14
Q

How is lipid solubility described?

A

described by the physical chemical property known as the oil gas partition coefficient. The larger this number, the more lipid soluble is the drug. (and the more potent).

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15
Q

In inhalational agents, the lipophilicity is related to the what?

A

speed of induction

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16
Q

Which inhalational anesthetic has very rapid time to saturation in the blood?

A

nitrous oxide

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17
Q

Why does it take so long for halothane to reach saturation in the blood?

A

The blood lipid has a “vast appetite” for halothane that must be assuaged before substantial quantities of halothane can reach the brain

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18
Q

How do desflurane and sevoflurane differ from halothane?

A

can equilibrate more rapidly into the brain than does halothane, produce a faster onset of unconsciousness than does halothane, and re-equilibrate from the brain to blood to alveoli quicker to allow a more rapid recovery than halothane

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19
Q

What does accumulation of drug depend on?

A

rate of delivery to the tissue

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20
Q

In what organs does equilibration occur most rapidly?

A

high flow organs (ex. brain)

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21
Q

Which inhalational anesthetics are MAJOR potentiators of GABA?

A

Isoflurane
Sevoflurane
Desflurane

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22
Q

Which Inhalational anesthetics are MAJOR potentiators of NMDA?

A

Nitrous oxide
Sevoflurane
Desflurane

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23
Q

Which inhalational anesthetics are MAJOR potentiators of glycine?

A

Isoflurane

Sevoflurane

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24
Q

What occurs with initial administration of an anesthetic?

A

deliriumm

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25
Q

What are some features of delirium?

A

exaggerated mechanics of respiration, including breath holding, an increase in blood pressure and skeletal muscle tone and accompanying dilation of the pupil (probably due to removal of inhibitory neural pathways prior to anesthetic concentrations being achieved)

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26
Q

When a patient slips into unconsciousness, what occurs?

A

dose-dependent loss of respiratory function, cardiovascular function (decline in blood pressure), and loss of protective reflexes and muscle tone.

27
Q

TRUE or FALSE: loss of memory and perceptive awareness can precede production of analgesia.

A

TRUE (why you need to rely on analgesics to ensure patient is pain free)

28
Q

Volatile anesthetics are most commonly administered in conjunction with what?

A

nitrous oxide and oxygen

29
Q

What is the total pressure to which all of the components of an anesthetic admixure add up to?

A

760 mmHg

30
Q

How do you calculate the partial pressure of a component of an anesthetic admixture?

A

760 X % of drug= partial pressure

31
Q

When the process of equilibration is complete, the partial pressure of hte anesthetic component in the admixture is equal to what?

A

partial pressure of that component found in the systemic circulation

32
Q

What defines the absolute mass of the anesthetic?

A

blood/gas partitioning characteristics

33
Q

What is the blood/gas partitioning coefficient for halothane?

A

2.3

34
Q

What does a partitioning coefficient of 2.3 mean (halothane is 2% of an anesthetic mixture)?

A

That it occupies 2.3 times more volume in the blood than in the gas admixture-so 4.6% in the blood if 2% in the mixture

35
Q

True of false: the higher the blood: gas partition, the faster the person will reach unconsciousness.

A

FALSE! The higher the blood: gas parition, the longer it takes til the person reaches unconsciousness.

36
Q

What are two ways to speed up the onset of unconsciousness?

A
  • Temporarily increasing the percentage of anesthetic delivered with each breath
  • Increasing ventilation rate
37
Q

Would increasing ventilation rate help to equilibrate nitrous oxide or halothane faster?

A

nitrous oxide (halothane must saturate a much larger component of hte blood to reach equilibrium)

38
Q

What is MAC?

A

minimum alveolar concentration is the concentration in the inspired gas required to render half of a group of patients unconscious (unresponsive to painful stimulus)

39
Q

In terms of MAC, what makes a more potent anesthetic?

A

lower the required MAC, the more potent

40
Q

True or false: the anesthesiologist is only allowed to give the MAC in patients.

A

FALSE: The anesthesiologist will never administer a drug at a concentration is only 50% effective. In clinical practice, it is customary to titrate dose of anesthetic upwards to successfully anesthetize the patient.

41
Q

What is the MAC for nitrous oxide?

A

105%

42
Q

How do you make it possible to reduce the dose of nitrous oxide needed to render a patient unconscious?

A

By combining together a volatile agent such as desflurane (MAC of 6%) with nitrous oxide (MAC of 105%), the effects in producing unconsciousness are additive. Therefore, the dose required for individual effect is approximately halved.

43
Q

What is the only anesthetic that does NOT block reflex response to CO2?

A

nitrous oxide

44
Q

Why does cardiac output decrease with increasing depth of unconsciousness?

A

decreased sympathetic outflow, periphral ganglion blockade, decreased adrenal catecholamine release, baroreceptor attenuation, decreased calcium flux, and vagal stimulatio

45
Q

Which inhalational anesthetic has no discernable effects of the CV system unless used with an agent that blocks reflexive sympathomimetic effects?

A

nitrous oxide (if used with opiate, the opioid unmasks a direct depressant action of nitrous oxide)

46
Q

Which inhalational anesthetics have a pungent smell that may produce tracheobronchial irritation?

A

enflurane
isoflurane
desflurane

47
Q

Which inhalational anesthetics are muscle relaxers?

A

enflurane

Isoflurane

48
Q

Which inhalational anesthetics provide pain relief?

A

nitrous oxide

possibly enflurane and isoflurane

49
Q

Which inhalational anesthetic causes arrhythmias?

A

halothane (sensitizes the myocardium to circulating catecholamines)

50
Q

Which inhalational anesthetic causes hepatic toxicity?

A

Halothane (produces “halothane hepatitis”)

51
Q

What is halothane hepatitis? Who gets it?

A

metabolism in the liver gave rise to a highly-reactive intermediate which bound to hepatic protein thereby causing damage most frequently in women who had experienced previous exposure to this anesthetic agent

52
Q

What is the only inhalational anesthetic that can cause seizures?

A

enflurane

53
Q

Fluorine in the structure of volatile anesthetics poses what problem?

A

has potential to produce renal damage anddysfunciton

54
Q

Why do you put fluorine into volatile anesthetics?

A

prevent explosive nature of the drug

55
Q

Which inhalational anesthetic has been associated with increased spontaneous abortion rates upon exposure?

A

Nitrous oxide

56
Q

What vitamin does nitrous oxide inhibit and how might this lead to problems?

A

nitrous oxide is indeed an inhibitor of vitamin B12, which deficiency might lead to myelin sheath degeneration

57
Q

Because N2O has a MAC of 105%, what is it known as?

A

incomplete anesthetic (no good as sole agent but great when mixed with volatile agents)

58
Q

What is a major side effect after using nitrous oxide after surgery? How might this be remedied?

A

Increased incidence of nausea and vomiting may be attenuated by increasing oxygen tension during surgical procedures

59
Q

List the 3 “special features” with nitrous oxide.

A

2nd gas effect
Diffusional hypoxia
Higher N2O solubility –> increased pressure

60
Q

What is the second gas effect?

A

because N2O is so rapidly taken up into the blood, there is a mass action effect so that the volatile agent is “carried along” so that it accumulates more rapidly in the presence of N2O than without

61
Q

What is diffusional hypoxia?

A

that brief period of time when the anesthetic is turned off and large quantities of anesthetic gas exit the body by being exhaled.

62
Q

How do you maintain adequate oxygen saturation during diffusional hypoxia?

A

In order to maintain adequate oxygen saturation it is important that the anesthesiologist applies oxygen by mask during this critical period.

63
Q

Why is it that N2O can produce increased pressure in gas containing areas of the body?

A

N2O is more soluble that nitrogen (that it replaces) and can lead to increased pressure (ex. pneumothorax, ear drum perforation, etc.)

64
Q

What are the three major ways N2O differs from the volatile anesthetics?

A
  • Analgesic action
  • Lack of an effect upon protective reflexes
  • Minimal adverse effects on the heart and respiration.

*also is cheaper!

Neuro 2 (11 decks)

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