Inhaled anesthetics 1: pharmacokinetics 2 Flashcards

1
Q

_______ is the tendency of a solute to dissolve in a solvent

A

Solubility

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2
Q

In the case of inhalation anesthetics, solubility is the ability of the

A

anesthetic agent to dissolve into the blood and tissues

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3
Q

___________ describes the relative solubility of an inhalation anesthetic in the blood vs. in the alveolar gas when the partial pressures between the two compartments are equal.

A

The blood:gas partition coefficient

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4
Q

Blood: gas coefficient for sevoflurane.

A

0.65

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5
Q

Blood: gas coefficient for isoflurane.

A

1.46

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6
Q

Blood gas coefficient for desflurane.

A

0.42

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7
Q

Blood gas coefficient for nitrous oxide is

A

0.46

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8
Q

How easily a solute will dissolve into a solvent depends on the

A

physiochemical characteristics of both compounds- “like dissolves like”

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9
Q

A polar solute will be more soluble in a

A

hydrophilic solvent

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10
Q

A nonpolar solute will be more soluble in a

A

liphophilic solvent

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11
Q

An anesthetic gas with low blood:gas solubility is

A

less likely to be taken up into the blood
as a result, more of the agent is available to exert a partial pressure in the alveoli and brain

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12
Q

An anesthetic gas with high blood: gas solubility is

A

more likely to be taken up into the blood;
as a result, less of the agent is available to exert a partial pressure in the alveoli and brain

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13
Q

While administering a volatile anesthetic, we produce a state of anesthesia by

A

building up a partial pressure of anesthetic agent inside the patient’s brain and spinal cord

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14
Q

These three factors determine anesthetic uptake into the blood:

A

agent solubility
partial pressure difference between the alveoli and the blood
cardiac output

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15
Q

The amount of anesthetic agent inside the alveoli is a balance between

A

input (the setting on the vaporizer) and uptake into the blood

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16
Q

The Fa/Fi curve helps us appreciate the speed at which

A

FA equilibrates with Fi (speed of induction)

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17
Q

The concentration of an agent inside the alveoli is proportional to its

A

concentration inside the brain
for this reason, we use alveolar partial pressure (FA) as a surrogate for the brain partial pressure

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18
Q

Describe how low solubility affects Fa/Fi.

A

Faster equilibration of Fa/Fi–> faster onset

19
Q

Describe how high solubility affects Fa/Fi.

A

slower equilibration of Fa/Fi–> slower onset

20
Q

Determinants of alveolar delivery include

A

setting on the vaporizer
time constant of the delivery system
anatomic dead space
alveolar ventilation
volume of the FRC

21
Q

The Fa/Fi curve approximates the

A

speed at which Fa will approximate Fi

22
Q

Describe which inhalational anesthetic has the highest Fa/Fi in order

A

N20> des>sevo>iso

23
Q

Which group is the first group to become saturated with anesthetic?

A

vessel rich group

24
Q

Fa is the

A

partial pressure of the anesthetic inside the alveoli

25
Q

Fi is the

A

concentration of the anesthetic exiting the vaporizer

26
Q

Which factor reduces the rate of rise of Fa/Fi? (select 3)
a. increased cardiac output
b. decreased time constant
c. increased FRC
d. decreased anatomic dead space
e. decreased fresh gas flow
f. increased alveolar ventilation

A

a. increased cardiac output
c. increased FRC
e. decreased fresh gas flow

27
Q

Factors that influence the rate of anesthetic delivery to the alveoli:

A

setting on the vaporizer
time constant of the delivery system
anatomic dead space
alveolar ventilation
functional residual capacity

28
Q

Factors that influence the removal of anesthetic from the alveoli (uptake):

A

agent solubility
partial pressure difference between the alveoli and the blood
cardiac output

29
Q

For Fa/Fi to increase, there must be

A

greater wash in or reduced uptake

30
Q

Increased Fa/Fi means that there is

A

a faster onset or the curve is pushed up

31
Q

Factors that lead to an increased wash in include

A

high fresh gas flow
high alveolar ventilation
low FRC
low time constant
low anatomic dead space

32
Q

Factors that lead to reduced uptake include

A

low solubility
low cardiac output
low Pa-Pv difference

33
Q

Decreased Fa/Fi means that

A

there is slower onset; curve is pushed down

34
Q

Factors that lead to decreased wash in include

A

low fresh gas flow
low alveolar ventilation
high FRC
high time constant
high anatomic dead space

35
Q

Factors that lead to increased uptake include

A

high solubility
high cardiac output
high Pa-Pv difference

36
Q

What percentage of body weight is accounted for by the vessel rich group?
a. 20%
b. 50%
c. 10%
d. 75%

A

C. 10%- the vessel rich group accounts for only 10% of the body weight, yet it receives 75% of the cardiac output

37
Q

Tissue uptake is dependent on

A

tissue blood flow
solubility of the anesthetic in the tissue
arterial blood: tissue partial pressure gradient

38
Q

The vessel rich group consists of the

A

heart, brain, kidneys, liver and endocrine glands

39
Q

The muscle/skin group is ____ of the body mass but receives _____ of the cardiac output.

A

50%; 20%

40
Q

The fat group is ____ of the body mass but receives ____ of the cardiac output.

A

20%; 5%

41
Q

The vessel poor group is_____ of the body mass but receives ____ of the cardiac ouptut.

A

20%; <1%

42
Q

The vessel-poor group includes

A

bone, tendon & cartilage

43
Q

The uptake of nitrous oxide by any of these groups is

A

minimal; it partitions nearly the same into all of the compartments