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DH: Clinical Pharmacology > Inhaled Anesthesia Gas > Flashcards

Inhaled Anesthesia Gas Flashcards

1
Q

What are the actions of Inhaled Anesthesia Gas?

A

Produces immobility and amnesia

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2
Q

What are two things that Inhaled Anesthesia Gases do NOT provide?

Which gas is the exception?

A

Do NOT provide any significant analgesia NOR increase/affect skeletal muscle tone (some lower)

Nitrous Oxide provides analgesia AND increases skeletal muscle tone.

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3
Q

What is the mechanism of action for inhaled anesthesia gases?

A

Produce immobility –> via actions on the spinal cord

Produce anesthesia –> by enhancing inhibitory channels and attenuating excitatory channels (unknown whether this occurs through direct binding or membrane alterations)

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4
Q

What is MAC?

A

Minimum Alveolar Concentration

MAC of an inhaled anesthetic is the alveolar (end expiratory) concentration at which 50% of patients will not show a motor response to a standardized surgical incision.

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5
Q

What is the standard deviation of MAC and what does this mean?

A

The standard deviation of MAC is ~10%
thus 95% of patients will respond to 1.2 MAC
and 99% will respond to 1.3 MAC.

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6
Q

What do standard MAC values assume?

A

Standard MAC values assume the absence of all other potentially sedative or hypnotic drugs.
Temp 37, 1 ATM, 30-55yo.

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7
Q

True or False?

According to rat data, MAC values are NOT additive in terms of preventing movement to incision (0.5 MAC of nitrous oxide plus 0.5 MAC of isoflurane ≠ 1.0 MAC of any other agent)

A

FALSE

MAC values ARE ADDITIVE in terms of preventing movement to incision (0.5 MAC of nitrous oxide plus 0.5 MAC of isoflurane = 1.0 MAC of any other agent)

Bonus Question: What Law is this?

Dalton’s Law.

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8
Q

What are the four anesthesia gases we commonly talk about and what are their corresponding brand names?

A

Desflurane/Suprane
Isoflurane/Forane
Sevoflurane/Ultane
Nitrous Oxide

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9
Q

Which inhaled anesthesia gas is the most expensive?

A

Desflurane

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10
Q

Which inhaled anesthesia gas is the least expensive?

A

Isoflurane

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11
Q

Which gas is most commonly used?

A

Sevoflurane

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12
Q

Which gas requires a special heated vaporizer?

A

Desflurane

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13
Q

Which gas has very low solubility making it good for obese patients?

A

Desflurane

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14
Q

Which gas is an airway irritant and smells bad?

A

Desflurane

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15
Q

Which gas can increase heart rate?

A

Desflurane

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16
Q

How is Desflurane absorbed and eliminated?

A

QUICKLY

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17
Q

Which gas is good for pediatric induction?

A

Sevoflurane

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18
Q

What are three downsides to Sevoflurane?

A
  1. Can cause emergence delirium in kids
  2. Can hang around longer in obese patients
  3. Has been indicated to cause nephrotoxicity in rats (not proven in humans)
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19
Q

Is sevoflurane irritable to the airway?

A

No

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20
Q

Which gas is not used very often, but is still very effective if used correctly?

A

Isoflurane

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21
Q

Which gas is very lipid soluble?

How does this effect emergence?

A

Isoflurane

LONGER Emergence

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22
Q

What kind of case is Isoflurane very suitable for?

A

Long cases where quick extubation is not expected
For example: a sick ICU patient going to stay on a ventilator

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23
Q

Which gas must be used as an adjunct and is NOT considered a solo anesthesia gas?

A

Nitrous

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24
Q

Which gas allows decrease of primary anesthesia agents?

A

Nitrous

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25
Q

Which gas provides analgesia?

A

Nitrous

26
Q

How can Nitrous be used?

A

Can be used in many different fashions (ex: help wakeup)

  1. 2nd gas effect
  2. Reduction of narcotic
  3. Reduction of other anesthetic agents
27
Q

In which two types of cases would we NOT use Nitrous?

A

neuro ( head ?) or most bowel cases

28
Q

What is the most mentioned negative trait of Nitrous?

A

N/V at higher doses

29
Q

What factors INCREASE anesthetic requirements?

A
  1. Chronic ETOH
  2. Infant (highest MAC at 6 mo.)
  3. Red hair
  4. Hypernatremia
  5. Hyperthermia
30
Q

Which factors DECREASE anesthetic requirements? 8

A
  1. Acute ETOH
  2. Elderly
  3. Hyponatremia
  4. Hypothermia
  5. Hypoxia
  6. HYPERcarbia
  7. Anemia
  8. Pregnancy
31
Q

True or False

We don’t really know how anesthesia gases work.

A

TRUE

“We don’t really know how they work…”

32
Q

What are the benefits of using Gas? 5

A
  1. Speed of onset
  2. Titratable
  3. Very potent
  4. Little/no metabolism
  5. Available measure (watching contents of breath tells us whats in the patient’s brain)
33
Q

Which gas has no effect on the cardiovascular system?

A

Nitrous

34
Q

Which two gases decrease blood pressure the most?

A

Isoflurane and Desflurane

(Sevoflurane decreases too but not as much as the other two)

35
Q

Which two gases can increase heart rate and of those two which one is more likely to increase heart rate?

A

Isoflurane and Desflurane

Isoflurane is more likely to increase HR while desflurane might cause no change in HR at all.

36
Q

How does Sevoflurane effect the cardiovascular system?

A

Decrease BP
Decrease SVR
Decrease CO

no change in HR

37
Q

How does Desflurane effect the cardiovascular system?

A

Substantial decrease in BP
Substantial decrease in SVR
Decrease (or no change) in CO
Increase (or no change) in HR

38
Q

How does Isoflurane effect the CV system?

A

Substantially decrease BP
Substantially decrease SVR
Increase HR

no change in CO

39
Q

True or False?

All anesthesia gases increase respiratory rate

A

TRUE

40
Q

True or False?

All anesthesia gases decrease tidal volume.

A

TRUE

Although, Isoflurane has the greatest impact on tidal volume

41
Q

True or False?

All anesthesia gases increase resting PaCO2.

A

FALSE

Nitrous has no change on resting PaCO2

42
Q

Which anesthesia gases increase cerebral blood flow?

A

All of them
(Nitrous, Iso, Des, Sevo)

43
Q

Which anesthesia gases increase intracranial pressure?

A

All of them

44
Q

Which anesthesia gases decrease cerebral metabolic rate?

A

Isoflurane, Desflurane, and Sevoflurane

Nitrous INCREASES cerebral metabolic rate

45
Q

Which gases decrease seizure activity?

A

All of them

46
Q

Which two gases have the highest increase in nondepolarizing blockade?

A

Isoflurane and Desflurane

47
Q

Which two gases have the greatest impact on renal function?

A

Isoflurane and Nitrous Oxide

48
Q

What do inhaled anesthesia gases do to hepatic blood flow?

A

Decrease hepatic blood flow

49
Q

What is the MAC % of Sevoflurane?

A

1.8

50
Q

What is the MAC % of Desflurane?

A

6.6

51
Q

What is the MAC % of Isoflurane?

A

1.17

52
Q

What is the MAC % of Nitrous Oxide?

A

104

53
Q

What is the Blood:Gas of Sevoflurane?

A

0.69

54
Q

What is the Blood:Gas of Desflurane?

A

0.42

55
Q

What is the Blood:Gas of Isoflurane?

A

1.46

56
Q

What is the Blood:Gas of Nitrous Oxide?

A

0.46

57
Q

What is the vapor pressure of Sevoflurane?

A

157

58
Q

What is the vapor pressure of Desflurane?

A

669

59
Q

What is the vapor pressure of Isoflurane?

A

238

60
Q

What is the vapor pressure of Nitrous Oxide?

A

Trick Question no vapor!
Gas (38,770)

61
Q

Which gases can trigger MH?

A

Halothane
Enflurane
Isoflurane
Sevoflurane
Desflurane

DH: Clinical Pharmacology (3 decks)

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