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Apex Flashcards > inhaled anesthetics 2 > Flashcards

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
Q

sites of anesthetic action: targets for amnesia and function

A

amygdala: emotion, response to pain formation of stress response
hippocampus: memory formation

26
Q

sites of anesthetic action: target for autonomic regulation and function

A

pons and medulla: control center for autonomic reflexes

27
Q

sites of anesthetic action: targets for unconsciousness and function

A

cerebral cortex: higher order cerebral functions
thalamus: relay station of sensory and motor input to the cortex
RAS: influences consciousness and arousal

28
Q

sites of anesthetic action: target for immobility and function

A

ventral horn: upper and lower motor neurons synapse here

29
Q

sites of anesthetic action: targets for analgesia and function

A

spinothalamic tract: nociceptive signals along ascending pain pathway are ihibited

30
Q

how desflurane affects HR, BP, CO, SVR

A
31
Q

how isoflurane affects HR, BP, CO, SVR

A
32
Q

how sevoflurane affects HR, BP, CO, SVR

A
33
Q

how N2O affects HR, BP, CO, SVR

A
34
Q

how xenon affects HR, BP, CO, SVR

A
35
Q

how halogenated agents decrease MAC (in a dose dependent fashion)

A

decreased intracellular calcium in VSMC–>systemic vasodilation –> decreased SVR and venous return
decreased intracellular ca in myocyte–>myocardial depression–> decreased inotropy

36
Q

how halogenated agents affect cardiac conduction in a dose dependent fashion

A

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
Q

why do des and iso increase HR

A

resp irritation activates SNS

38
Q

potency of coronary artery vasodilation (greatest to least)

A

iso>des>sevo

39
Q

every 1mmHg in PaCO2 above baseline increases MV by

A

3mL/min

40
Q

volatile anesthetics cause a dose dependent depression of which chemoreceptors

A

central chemoreceptors

41
Q

can you assist patients breathing to off set PaCO2

A

not really because apneic threshold is 3-5mmHg below what the patient is maintaining for PaCO2 during spontaneous ventilation

42
Q

which agent impairs hypoxic ventilatory response the least

A

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
Q

afferent path for carotid bodies versus aortic bodies

A

carotid bodies (glossopharyngeal nerve CN9)
aortic bodies (vagus n)

44
Q

impaired response to hypoxia occurs at ___ MAC

A

.1

45
Q

does .1 MAC impair response to PaCO2

A

no

46
Q

neurophysiological effects of inhaled anesthetics

A
47
Q

volatile agents cannot reduce CMRO2 any further after it gets to

A

isoelectric state (1.5-2 MAC)

48
Q

volatile agents and CMRO2/CBF relationship

A

after .5MAC, uncoupled. CMRO2 decreases while CBF increases

49
Q

N2O in relation to CBF/CMRO2

A

increases CBF in relation to CMRO2

50
Q

sevo/iso/des and CSF production/reabsorption

A
51
Q

MEPs monitor the integrity of the

A

corticospinal tract

52
Q

SSEP’s monitor the integrity of the

A

dorsal column (medial lemniscus)

53
Q

be concerned about nerve ischemia when amplitude decreases by _______ OR latency decreases by ______

A

amplitude >50%
latency >10%

54
Q

which anesthetic agent is a methyl isopropyl ether

A

sevo

55
Q

which anesthetic agents are methyl ethyl etheres

A

des and iso

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