Inhaled anesthetics 2: Pharmacodynamics 3 Flashcards

1
Q

Sevoflurane at 1.5 MAC increases:
a. cerebral metabolic rate of oxygen
b. cerebral blood volume
c. cerebral vascular resistance
d. cerebrospinal fluid production

A

b. cerebral blood volume (volatile anesthetics supply the brain with more blood flow than it needs)

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2
Q

What level of MAC is required to produce an isoelectric state?

A

1.5-2.0 MAC

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3
Q

How do halogenated anesthetics impact CMRO2?

A

dose-dependent reduction in CMRO2

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4
Q

How do halogenated agents impact cerebral blood flow?

A

dose-dependent increase in CBF

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5
Q

How do halogenated agents impact cerebral blood volume?

A

dose-dependent increase

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6
Q

How do halogenated agents impact ICP?

A

dose-dependent increase

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7
Q

___________ in high concentrations (2.0) MAC can produce seizure activity.

A

Sevoflurane

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8
Q

Sevoflurane’s ability to produce seizure activity in high concentrations is exacerbated by

A

hypocapnia & is more common with inhalation induction

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9
Q

How does nitrous oxide impact CMRO2?

A

increases CMRO2

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10
Q

How does nitrous oxide impact cerebral blood flow?

A

increases CBF

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11
Q

Which volatile anesthetic increases CSF production?

A

desflurane

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12
Q

CMRO2 is dependent on:

A

electrical activity (60% of total brain oxygen consumption)
cellular homeostasis (40% of total brain oxygen consumption)

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13
Q

What impact do volatile anesthetics have on cerebral vascular resistance?

A

cerebral vasodilators (they decrease CVR)

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14
Q

Desflurane affects somatosensory evoked potentials by:
a. increasing amplitude and increasing latency
b. increasing amplitude and decreasing latency
c. decreasing amplitude and increasing latency
d. decreasing amplitude and decreasing latency

A

c. decreasing amplitude and increasing latency

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15
Q

_______ are most resistant to the effects of anesthetics

A

brain auditory evoked potentials

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16
Q

________ are the most sensitive to the effects of anesthetic agents

A

visual evoked potentials

17
Q

When using a volatile agent with evoked potentials, it is recommend to use

A

<0.5 MAC; you can supplement with IV agents (propofol, opioids) but don’t use N2O

18
Q

The best anesthetic technique to preserve evoked potentials is

A

TIVA without N2O

19
Q

Volatile anesthetics impair evoked potential monitors by

A

decreasing the amplitude and increasing the latency of the signal

20
Q

As a general rule, you should be concerned about nerve ischemia when amplitude ____________ or latency __________

A

amplitude decreases by >50% or latency increases by >10%

21
Q

______ monitor the integrity of the dorsal column (medial lemniscus)

A

SSEPS

22
Q

SSEPs monitor the ___________ spinal artery(ies).

A

posterior

23
Q

_________ monitor the integrity of the corticospinal tract.

A

MEPs

24
Q

MEPs monitor the _____spinal artery (ies).

A

anterior

25
Q

Amplitude refers to

A

the strength of the nerve response

26
Q

Latency refers to the

A

speed of nerve conduction

27
Q

Anesthetic goals when evoked potential signals diminish or go away during surgery include

A

improving neural tissue perfusion by increasing BP, volume expansion, and transfusion (if anemic),