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inhaled anesthetics 2 Flashcards

1
Q

N2O is how much more soluble than nitrogen

A

34x

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2
Q

nitrogen B:G partition coefficient

A

0.014

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3
Q

nitrous oxide B:G partition coefficient

A

0.46

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4
Q

how nitrous oxide affects compliant space versus non complaint space (think volume and pressure)

A
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5
Q

where anatomically does N2O increase pressure (in non compliant air spaces) (2)

A

middle ear
brain during intracranial procedures

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6
Q

N2O can increase volume and pressure in the following anesthesia equipment (3)

A

ETT cuff
LMA cuff
balloon tipped pulmonary artery catheter

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7
Q

SE of N2O induced B12 inhibition

A

inhibits methionine synthase (required for folate metabolism and myelin production)

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8
Q

fire risk and N2O

A

not flammable but does support combustion so there is a risk when electrocautery is used during laparoscopy surgeries where pneumoperitoneum is induced

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9
Q

MAC value for
iso
sevo
des
N2O

A
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10
Q

essential triad of anesthetic action includes

A
  1. amnesia
  2. areflexia
  3. LOC
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11
Q

MAC awake during induction versus recovery MAC awake

A

during induction ~.4-.5
recovery MAC awake .15

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12
Q

MAC bar

A

requirement to block autonomic response during painful stimulus and is ~1.5

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13
Q

awareness and recall are assumed to be prevented at

A

.4-.5 MAC

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14
Q

volatile anesthetic potency is increased by (4)
(think lytes, drugs, patient factors)

A

hyponatremia
lithium
clonidine
old age

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15
Q

things that increase MAC
drugs
electrolytes
age
body temp
other

A
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16
Q

things that decrease MAC
drugs
electrolytes
age
body temp
other

A
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17
Q

things that have no effect on MAC
electrolytes
other

A

hypo or hyperkalemia
hypo or hypermagnesemia
hyper or hypothyroidism
gender
PaCO2 15-95mmHg
HTN

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18
Q

disorders of which electrolyte affect MAC?

A

sodium

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19
Q

meyer overton rule

A

lipid solubility is directly proportional to potency

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20
Q

unitary hypothesis r/t volatile anesthetics

A

all anesthetics share a similar MOA but each may work at a different site

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21
Q

primary receptor for volatiles in the brain v spinal cord and where they produce immobility

A

brain: GABA-A (most likely increase duration that chloride channel remains open)
sc: NMDA
immobility: ventral horn of sc

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22
Q

as a general rule, volatiles have the following effects on stimulatory and inhibitory receptors

A
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23
Q

most important sites of volatile anesthetics on spinal cord

A

glycine receptor stimulation
NMDA receptor stimulation
Na channel inhibition

24
Q

gaseous anesthetics (N2O and xenon) act on which 2 receptors

A

NMDA
K 2P channel stimulation

25
sites of anesthetic action: targets for amnesia and function
amygdala: emotion, response to pain formation of stress response hippocampus: memory formation
26
sites of anesthetic action: target for autonomic regulation and function
pons and medulla: control center for autonomic reflexes
27
sites of anesthetic action: targets for unconsciousness and function
cerebral cortex: higher order cerebral functions thalamus: relay station of sensory and motor input to the cortex RAS: influences consciousness and arousal
28
sites of anesthetic action: target for immobility and function
ventral horn: upper and lower motor neurons synapse here
29
sites of anesthetic action: targets for analgesia and function
spinothalamic tract: nociceptive signals along ascending pain pathway are ihibited
30
how desflurane affects HR, BP, CO, SVR
31
how isoflurane affects HR, BP, CO, SVR
32
how sevoflurane affects HR, BP, CO, SVR
33
how N2O affects HR, BP, CO, SVR
34
how xenon affects HR, BP, CO, SVR
35
how halogenated agents decrease MAC (in a dose dependent fashion)
decreased intracellular calcium in VSMC-->systemic vasodilation --> decreased SVR and venous return decreased intracellular ca in myocyte-->myocardial depression--> decreased inotropy
36
how halogenated agents affect cardiac conduction in a dose dependent fashion
decrease in SA node automaticity decreased conduction velocity through AV node, His purkinje system, ventricular conduction pathways increased duration of myocardial repolarization by impairing outward K current. increases AP duration which prolongs QT interval altered baroreceptor function
37
why do des and iso increase HR
resp irritation activates SNS
38
potency of coronary artery vasodilation (greatest to least)
iso>des>sevo
39
every 1mmHg in PaCO2 above baseline increases MV by
3mL/min
40
volatile anesthetics cause a dose dependent depression of which chemoreceptors
central chemoreceptors
41
can you assist patients breathing to off set PaCO2
not really because apneic threshold is 3-5mmHg below what the patient is maintaining for PaCO2 during spontaneous ventilation
42
which agent impairs hypoxic ventilatory response the least
desflurane (the idea is that the agents that undergo the greatest amount of bio transformation in the body affect HPV the most so halothane>sevo>iso>des)
43
afferent path for carotid bodies versus aortic bodies
carotid bodies (glossopharyngeal nerve CN9) aortic bodies (vagus n)
44
impaired response to hypoxia occurs at ___ MAC
.1
45
does .1 MAC impair response to PaCO2
no
46
neurophysiological effects of inhaled anesthetics
47
volatile agents cannot reduce CMRO2 any further after it gets to
isoelectric state (1.5-2 MAC)
48
volatile agents and CMRO2/CBF relationship
after .5MAC, uncoupled. CMRO2 decreases while CBF increases
49
N2O in relation to CBF/CMRO2
increases CBF in relation to CMRO2
50
sevo/iso/des and CSF production/reabsorption
51
MEPs monitor the integrity of the
corticospinal tract
52
SSEP's monitor the integrity of the
dorsal column (medial lemniscus)
53
be concerned about nerve ischemia when amplitude decreases by _______ OR latency decreases by ______
amplitude >50% latency >10%
54
which anesthetic agent is a methyl isopropyl ether
sevo
55
which anesthetic agents are methyl ethyl etheres
des and iso

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