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Anesthesiology > Inhaled anesthetics > Flashcards

Inhaled anesthetics Flashcards

1
Q

What are the side effect of N2O?

A

Postop N/V
Inhibits B12-dependent enzymes –> pernicious anemia and CI in pregnancy
Pulmonary HTN
Second gas effect

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2
Q

What are the effects of N2O?

A 
Does NOT drop BP
Minimal changes in CV
No change in minute ventilation 
Increased ICP, CBF and O2 consumption of brain
Decreased renal/hepatic flow
Increase SNS
Analgesia
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3
Q

What is the MAC of N2O?

A

105%

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4
Q

When is N2O contraindicated?

A

Air embolus, Intracranial air, pulm. HTN, pregnancy, pneumothorax, GI obstruction

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5
Q

Of the 4 main inhaled anesthetics, which one is analgesic?

A

N2O

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6
Q

What is the MAC of Isoflurane?

A

1.2

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7
Q

Which inhaled anesthetic has the lowest blood/gas and fat/gas ratio?

A

Desflurane

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8
Q

What are the 3 volatile inhaled anesthetics?

A

Desflurane, isoflurane, sevoflurane

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9
Q

What two inhaled anesthetics are not irritants to the airway?

A

N2O and Sevoflurane

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10
Q

What do all 3 volatile inhaled anesthetics do to the HR and BP?

A

Drop the BP

Increase the HR

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11
Q

Which inhaled anesthetic has the fastest induction and emergence?

A

desflurane because has low solubility

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12
Q

Why are isoflurane and desflurane only used for maintenance?

A

Because they are irritants to the airway and may cause cough or laryngospasm

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13
Q

Which inhaled anesthetic is associated with carbon monoxide poisioning?

A

Desflurane

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14
Q

Which inhaled anesthetic is associated with the accumulation of vinyl compound A?

A

Sevoflurane - compound A is renal toxic

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15
Q

What are the effects of isoflurane on CV?

A

decreased SVR
Increased HR
May cause coronary steal syndrome if rapid increase (increase HR and BP)

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16
Q

What are the pulmonary effects of isoflurane?

A

Rapid shallow breaths that cause a decrease in minute ventilation
Increase partial pressure of CO2
Normal response to hypoxia and hypercarbia is abolished

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17
Q

What are the cerebral effects of isoflurane?

A

Increased CBF and ICP

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18
Q

What are the renal effects of isoflurane?

A

Decreased RBF

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19
Q

What are the CV effects of desflurane?

A

Decreased BP/SVR
Increased HR
Rapid increase –> release of catecholamines

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20
Q

What are the pulmonary effects of desflurane?

A

Rapid shallow breaths that cause a decrease in minute ventilation
Increase partial pressure of CO2
Irritant to upper airway

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21
Q

What are the cerebral effects of desflurane?

A

Increased CBF and ICP

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22
Q

What inhaled anesthetic is the most lipid soluble?

A

Methoxyflurane

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23
Q

What inhaled anesthetic is responsible for causing vasopressin-resistant high output renal failure?

A

methoxyflurane with metabolite fluoride

24
Q

Which inhaled anesthetic causes no change in SVR?

A

Halothane

25
Q

What are the CV effects of sevoflurane?

A

Slight decrease in myocardial contractility, BP, and SVR so slight decrease in CO because no increase in HR.

26
Q

What are the pulmonary effects of sevoflurane?

A

Potent bronchodilator
Rapid shallow breaths that cause a decrease in minute ventilation
Increase partial pressure of CO2

27
Q

What are the renal effects of sevo?

A

Reduces RBF proportionate to decrease in BP

28
Q

What are the CV effects of Halothane?

A

direct myocardial depressant
depresses baroreflex receptors so no reflex tachy
CO increases
sensitizes heart to catecholamines

29
Q

What are the pulmonary effects of halothane?

A

Potent bronchodilator (inhibits release of intracellular calcium)
Rapid shallow breaths that cause a decrease in minute ventilation
Increase partial pressure of CO2

30
Q

What are the CV effects of methoxyflurane?

A

HR rises
CO decreases
Decreased cardiac contractility

31
Q

What are the CV effects of enflurane?

A

Direct myocardial depressant
Decreased SVR
CO drops significant

32
Q

What are the cerebral effects of enflurane?

A

Deep anesthesia level and hypocapnia cause EEG changes from high voltage, high frequecy to spike-and-wave pattern, then epileptic form.

33
Q

What is the MOA of thiopental, phenobarbital, thiamylal, and methohexital?

A

Inhibits presynaptic excitatory NTs
Increases postsynaptic sensitivity to GABA
Stimulates GABA receptors
Chloride channels open longer

34
Q

Why are lower induction doses required for the elderly?

A
  1. Decreased binding protein
  2. Decreased volume of central compartmen
  3. Decreased hepatic blood flow
35
Q

Which agents can potentiate the effects of barbs?

A

BZDs, narcotics, EtOH, H1 blockers

36
Q

What is the MOA of BZDs?

A

Increased frequency of Chloride channels opening

Facilitates GABA binding

37
Q

Which BZDs are well absorbed from the GI tract?

A

Diazepam and lorazepam

38
Q

Which BZDs are well absorbed via the IM route?

A

Midazolam and lorazepam

39
Q

What is a possible side effect of a barb?

A

Acute intermitent porphyria by induction of aminolevulinic acid synthetase

40
Q

What are the cerebral effects of barbs?

A 
Depression of central vasomotor center in the brain
Vasoconstriction
Decreased CBF and ICP
Decreased O2 consumption
Protection against global ischemia
41
Q

What are the CV effects of barbs?

A

vasodilation and increased HR

42
Q

What are the pulmonary effects of barbs?

A

Decreased tidal volume and minute ventilation

Blunted response to hypoxia and hypercapnia

43
Q

The release of what is associated with morphine and meperidine?

A

histamine

44
Q

What are the pulmonary effects of opioids?

A

Increase PCO2
Blunted response to hypercapnia
Chest wall rigidity

45
Q

What are the CV effects of ketamine?

A

Increased BP, SVR, HR and CO due to increase SNS

46
Q

What are the pulmonary effects of ketamine?

A 
potent bronchodilator
Increased secretions (prevent with glycopyrrolate)
47
Q

What are the cerebral effects of ketamine?

A

Increased O2 consumption, CBF and ICP

48
Q

What are some side effects of ketamine?

A

dissociation
analgesia
nystagmus
Ileus/constipation

49
Q

What are the side effects of etomidate?

A

Inhibition of B-11 hydroxylase and adrenocortical suppression
myoclonus
seizures

50
Q

What is unique about etomidate?

A

little change on the heart. It is the DOC when CV stability is in question

51
Q

What is the CV effects of propofol?

A

Myocardial depression

Vasodilation

52
Q

What are the benefits of propofol?

A

Rapid Induction and emergence

Antipruritic and antiemetic

53
Q

How are BZDs metabolized?

A

By the liver into water soluble glucoronides

54
Q

What is the MOA of ketamine?

A

NMDA receptor antagonist

Causes dissociation of the thalamus from the cerebrum

55
Q

What does ketamine do to CO?

A

Increases CO

56
Q

What is the MOA of etomidate?

A

Depresses the RAS by enhancing GABA affinity for its receptor.

57
Q

What is the MOA of propofol?

A

modulates GABA receptors

Anesthesiology (19 decks)

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