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Pharmacology Test 1 > Inhaled Anesthetics > Flashcards

Inhaled Anesthetics Flashcards

1
Q

Inhaled Anesthetics

Goal is to have enough pressure so the anesthetic gas goes from a higher pressure to a lower pressure. This involves getting gas from machine to the lungs, then from the lungs to the blood, then from the blood to the brain

Ultimate goal is _______ so the anesthetic level is maintained and doesn’t fluctuate

A

Equilibrium

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2
Q

Blood/Gas Partition Coefficient

Halothane (most _____ in blood)

Isoflourane (second most ____ in blood)

Sevoflourane

Nitrous Oxide

Desflourane

A

  1. 4, Soluble
  2. 4, Soluble
  3. 65
  4. 47
  5. 42
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3
Q

Inhaled Anesthetic/GABA

Binding of GABA is _____ by inhaled anesthetics, resulting in greater entry of _____ ions

Entry of Cl- hyperpolarizes the cell, making it more difficult to ______, therefore reducing neuronal excitability

A

Enhanced, Cl-

Depolarize

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4
Q

Partial Pressure (P)

Dalton’s Law: The total pressures (Ptot) of a mixture of gases is the ____ of the pressures each gas would exert if it were present _____

The goal is to achieve a _____ and _____ brain partial pressure of inhaled anesthetic

A

Sum, Alone

Constant and Optimal

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5
Q

Partial Pressure (P)

Brain (Pbr) and all other tissues _____ with the partial pressure of inhaled anesthetics delivered by arterial blood (Pa)

Arterial blood _____ with _____ partial pressure of anesthetics (PA)

A

Equilibrate

Equilibrates, Alveolar

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6
Q

Partial Pressure (P)

PA mirrors ____

PA is an index of _____ of anethesia, _____ from anesthesia, and anesthetic equal potency or (____)

A

Pbr

Depth, Recovery, MAC

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7
Q

Ventilation Rate

Minute Ventilation: ____ of all exhaled gas volume in ___ minute

Minute Ventilation Formula?

Normal minute ventilation?

Ex: At rest, normal person moves about 450 mL /breath at about 10 breaths/minute = 4,500 mL/min = 4.5 L/min

A

Sum, 1

MV = Tidal Volume x Breaths/min

Around 5L/min

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8
Q

Alveolar Ventilation

Volume of inspired gases actually taking part in ____ ______

_____ indicates alveolar ventilation

AV = ( ____ _____ - _____ _____) x Breaths/min

A

Gas Exchange

PC02

(Tidal Volume - Dead space)

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9
Q

Dead Space (Vd)

Any volume of inspired air that does not enter the ____ ______ areas of the lung

Airway (______) dead space: portion of breath which goes to the mouth, pharynx, etc., but does not enter the alveoli

______ dead space: portion of breath that enters alveoli which are ventilated, but not perfused

A

Gas Exchange

Anatomic

Alveolar

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10
Q

Determinants of Alveolar Partial Pressure (PA)

PA is determined by _____ (input) of inhaled anesthetic into alveoli minus the _____ (loss) of drug from alveoli into arterial blood

Delivery depends on: inhaled ______ ______ (PI), ______ ______ (how many lung units are being ventilated), and the ______ of the anesthesia breathing system (delivery)

Uptake (alveoli to pulmonary capillary blood) depends on: ______ of anesthetic in body tissues, _____ _____, and _____ to _____ partial pressure difference (A-vD)

A

Delivery, Uptake

Partial Pressure, Alveolar Ventilation, Characteristics

Solubility, Cardiac Output, Alveolar to Venous

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11
Q

Determinants of Alveolar Partial Pressure (PA) **Recap**

_______ ventilation

_______ breathing system

________

______ ______

______ to _____ partial pressure differences

A

Alveolar

Anesthetic

Solubility

Cardiac Output

Alveolar to Venous

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12
Q

Inhaled Partial Pressure (PI)

•Concentration Effect•

Impact of PI on the rate of rise of PA of onhaled anesthetic

The ______ the inspired concentration of the anesthetic agent, the more _____ the relative rise in _______ _______ of the agent

Anesthetic agents follow a ______ ______ from machine to ______ to ______ then to the ______

Higher ____ equals higher ______ ______

A

Higher, Rapid, Alveolar Concentration

Concentration Gradient, Alevoli, Blood, Brain

PI (inspired pressure of gas), Alevolar Concentration

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13
Q

Second Gas Effect

Reflects ability of high volume uptake of one gas to ______ the rate of increase of PA of a _______ administered “companion” gas

Large volume uptake of Nitrous Oxide ______ the rate of rise of PA of other gases (O2, volatile anesthetics)

Reflects increased tracheal inflow of all the inhaled gases (1st and 2nd) and concentration of 2nd gas in _____ lung volume due to ____ volume uptake of the 1st gas (concentrating effect)

A

Accelerate, Concurrently

Accelerates

Smaller, High

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14
Q

Second Gas Effect

Ability of large volume _____ of one gas (first gas) to _____ the rate of rise of alveolar partial pressure of a co-administered second gas

______ is used as the first gas

The effect is more applicable to an agent with _____ blood:gas solubility (solubility discussed more later)

A

Uptake, Accelerate

Nitrous (N2O)

Higher

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15
Q

Alveolar Ventilation

_____ alveolar ventilation promotes ______ (input) of anesthetics to offset uptake

Causes a more ____ rate of _____ in PA toward PI (inhaled partial pressure), resulting in _______

Decreased ______ is produced by ________ of the lungs, resulting in a decrease in _____ ______ ______

A

Increased, Delivery

Rapid, Rise, Induction

PaCO2, Hyperventilation, Cerebral Blood Flow

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16
Q

Alveolar Ventilation

A ______ in alveolar ventilation decreases ______ (delivery) and slows the establishment of PA and Pbr for ______

The ______ the alveolar ventilation: FRC ratio, the more rapid the rise of PA

5:1 in neonates (greater metabolic rate) and 1.5:1 in adults

_____ is _____ in neonates because of the ______ _____

A

Decrease, Input, Induction

Greater

Induction, Quicker, Metabolic Rate

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17
Q

Alveolar Ventilation

Inhaled anesthetics have a _____ dependent ______ effect on alveolar ventilation

______ _______ protective mechanism exists to prevent excessive depth of anesthesia when high PI is administered with _______ breathing

______ decreases parallel to _______ ventilation; anesthetic is _______ from tissues of high _______ to tissues of low _______

When concentration in brain falls below a certain threshold, ventilation _______ and the delivery of anesthetic to lungs is _______

A

Dose, Depressive

Negative Feedback, Spontaneous

Input (delivery), Decreased, Redistributed

Concentration, Concentration

Increases, Increased

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18
Q

Alveolar Ventilation

When a patient is breathing in a volatile anesthetic, you will typically see a ______ tidal volume and ______ respiratory rate (shallow, rapid breathing pattern)

Alveolar minute ventilation ______ because more anesthetic is going to the dead space. Low tidal volume breaths _____ alveolar minute ventilation

______ ______ is reduced by all volatile anesthetics. All inhaled anesthetics ______ the natural ventilatory response to ____ and ____

If CO2 increases, normally you would breathe _____, but inhaled anesthetics _____ that response

A

Decreased, Increased

Decreases, Decrease

Airway Resistance, Depress, CO2 and O2

Faster, Depress

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19
Q

Alveolar Ventilation

Normally, if we become ______, our body will respond with _______, but this response is greatly ______ by volatile anesthetics

Inhaled anesthics are altering peripheral and chemoreceptor functioning in a ____ dependent manner

The body’s protective ______ ______ mechanism (discussed earlier) is _____ with mechanical ventilation, especially when you ______ them and assume control for all of the patient’s _______

A

Hypoxic, Hyperventilation, Depressed

Dose

Negative Feedback, Lost, Paralyze, Breathing

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20
Q

Impact of Solubility

Alveolar ventilation influences the rate of rise of PA toward PI _____ in _____ anesthetics than in _____ soluble ones

In ______ soluble anesthetics, the rise of PA is _____, regardless of other factors (less soluble gas is in blood, faster it enters alveoli)

More soluble anesthetics have a greater _____ (in the blood), so increase in _____ will ______ rate of rise of PA; Hence why mechanical ventilation _____ the depth of anesthesia produced by a more blood _____ anesthetic

A

More, Soluble, Poorly

Poorly, Rapid

Uptake, Ventilation, Increase

Increases, Soluble

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21
Q

Solubility

Solubility in tissues and blood is denoted by a _____ _____; a ______ ratio describing how inhaled anesthetic distributes itself between two phases of _______

A blood:gas partition coefficient of _____ = the concentration of inhaled anesthetic in blood is ____ that of alveolar gases when _____ _____ is equal in both phases

A blood:brain partition coefficient of ___ = the concentration in blood is ____ that in the _____

A

Partition Coefficient; Distribution

Equilibrium

0.5, 1/2, Partial Pressure

2, Twice, Brain

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22
Q

Solubility

Partition coefficient reflects the relative ______ of each phase to ______ anesthetic, and is _______ dependent

A

Capacity, Accept, Temperature

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23
Q

Blood:gas Partition Coefficent

Rate of increase of PA toward PI is _____ ______ to the solubility of anesthetic in the blood

If blood:gas partition coefficient is high, a _____ amount dissolves in blood before _____ can occur between PA and Pa toward PI; meaning induction is _____

If blood:gas partition coefficent is low, a _____ amount dissolves in blood before _____ is reached; meaning rate of rise of PA and Pa is _____, and induction is _____

A

Inversely Proportional

Larger, Equilibrium, Slow

Smaller, Equilibrium, Rapid, Rapid

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24
Q

Blood:gas Partition Coefficent

Can offset high blood:gas partition coefficient (slower induction) by increasing ___ above that required for maintenance of anesthesia. This is called an ______ ______

This _____ induction, but sustained delivery at this level can cause _______

A

PI, Overpressure Technique

Speeds, Overdose

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25
Q

Blood:gas Partition Coefficent

Blood:gas partition coefficient is influenced by variations in ____, ____, and _____ content, as well as ____ of blood

There is ______ solubility of anesthetics in ______ blood, meaning these patients will have a more _____ induction (anesthetic agent won’t stay in blood- it will quickly move to lungs/brain)

A

Water, Lipid

Protein, Hct

Decreased, Anemic, Rapid

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26
Q

Blood:gas Partition Coefficent

(Recap)

States how ______ the anesthetic is in the blood

It is ______ related to ______ time of the anesthetic agent

_____ ______ gas in the blood = ______ induction via inhalation

______ ______ gas in the blood = ______ induction via inhalation

A

Soluble

Inversely, Induction

Less Soluble, Faster

More Soluble, Slower

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27
Q

Tissue:blood Partition Coefficient

Determines _____ of anesthetic into ______ and time necessary for ______ of tissues with Pa

Time for _______ is estimated calculating a _____ ______ for each tissue

For volatile anesthetics, __ time constants (5-15 minutes for Pa and Pbr to equilibrate and cause induction)

A

Uptake, Tissues, Equilibration

Equilibration, Time Constant

3

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28
Q

Tissue:blood Partition Coefficient

____ has a large anesthetic holding capacity with ____ blood flow, so time to equilibrate is ______ (25-46 hours)

Clinical Example: ________ may be a better agent for obese patient’s (quick off time) versus _______, which has more of a tendency to harbor in fat when gas is turned off

A

Fat, Low

Prolonged/Slower

Desoflurane, Sevoflurane

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29
Q

Tissue:gas Solubility

Concerns ____ tissues (muscles, vessel rich organs: heart, liver, kidney, brain) _____ for a given anesthetic agent

Predicts ______ ______ from anesthesia

______ tissue:gas ratios indicate that the gas is relatively ______ in tissues, therefore, emergence will be more _____

A

Lean, Affinity

Emergence Time

Lower, Insoluble, Rapid

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30
Q

Stages of Anesthesia

Stage 1

Begins with ______

Ends with loss of _______ (no _____ reflex)

Patient can still sense _____ (evidenced by increased HR and BP)

A

Induction

Consciousness, Eye-lid

Pain

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31
Q

Stages of Anesthesia

Stage 2

Delerium ______, uninhibited ______

Pupils ______ with divergent gaze

Potentially ______ response to noxious stimuli (Do not want patient stimulated at this time)

Stimulation may lead to ______ holding, muscular _____, ______, or ________

A

Excitement, Excitation

Dilated

Dangerous

Breath, Rigidity, Vomiting, Laryngospasm

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32
Q

Stages of Anesthesia

Stage 3

Where we want to be for ______

Centralized gaze with ______ of pupils

Regular ______

Anesthesia depth is ______ for noxious stimuli (when the noxious stimuli does not cause an increase in ______ response)

A

Surgery

Constriction

Respirations

Sufficient, Sympathetic

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33
Q

Stages of Anesthesia

Stage 4

Stay ____ from, this is too ____

Will cause _____

Pupils are ______ and ____-______

_______ resulting from complete CV collapse is possible

A

Away, Deep

Apnea

Dilated, Non-Reactive

Hypotension (may be a big sign that you need to turn your gas down)

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34
Q

Cardiac Output and Induction

Represented by ______ blood flow

Influences uptake and PA by _____ _____ either more or less anesthetic from alveoli

Increased CO: More _____ uptake and _____ induction

Decreased CO: speeds rate of rise in PA, _____ uptake and _____ induction

A

Pulmonary

Carrying Away

Rapid, Slowed

Less, Faster

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35
Q

Cardiac Output and Induction

Increased cardiac output ______ capacity of the blood to ____ anesthetic. This has the most infuence on _____ anesthetics

Some volatile agents _____ cardiac output, resulting in a ______ ______ response (Decreased CO due to excessive _____ leads to increased PA, increased ____, and subsequently, further reduced CO and cardiac ______ secondary to the increased anesthetic depth

A

Increases, Hold

Soluble (agents prone to dissolve more in blood)

Decrease, Positive Feedback

Dose, Depth, Depression

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36
Q

Recovery from Anesthesia

Rate of _____ of Pbr is reflected by decrease in PA

At conclusion of anesthesia, ______ of anesthetic in ______ depends on its _______ in the tissue and ______ of administration

Some tissues may not reach _____ with PA during maintenance

This is seen mostly in ______ anesthetics; Time to recover is ______ proportional to the duration of administration mostly in ______ anesthetics

Exhaled gases will be _____, unless fresh gas flow rate is _____

A

Decrease

Concentration, Tissues, Solubility, Duration

Equilibrium

Soluble, Prolonged, Soluble

Rebreathed, Increased

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37
Q

Recovery from Anesthesia

If your patient is not waking up, make sure you turned gas ____

Also make sure that you _____ oxygen flow rate (8-10 L/min)

A

Off

Increase

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38
Q

Diffusion Hypoxia

Happens _____ use of nitrous

When the nitrous is discontinued, nitrous diffuses rapidly out of the _____, into the _____, subsequently into the _____

This rapid _____ into the alveoli _____ alveolar gas and ______ oxygen, causing ______

Net result will be _______

A

After

Tissues, Blood, Alveoli

Flood, Dilutes, Displaces, Hypoxia

Hypoventilation

39
Q

EEG Effects of Anesthetics

At ______, increase in frequency and voltage similar for all anesthetics (all gases have same effect at this point)

At ______, shift of voltage activity from ______ to ______ portions of brain

At ______, ______ in cerebral O2 requirement (may reflect transition from wakefulness to unconsciousness)

A

< 0.4 MAC

~ 0.4 MAC, Posterior to Anterior

~ 0.4 MAC, Decrease

40
Q

CNS Effects - Seizure Activity

______ has fast frequency and high voltage on EEG, indistinguishable from changes produced by _____ activity

Twitching of ______ and ______ muscles occurs and can be initiated by repetitive ______ stimuli

_____, _____, and _____ are agents that have no seizure activity on EEG; they actually ______ convulsant properties

_____ may induce increased motor activity; withdraw in animals may indicate _____ ______

A

Enflurane, Seizure

Facial, Extremity, Auditory

Iso, Sevo, Des; Suppress

N20, Acute Dependence

41
Q

CNS Effects

Evoked Potential

Volatile anesthetics cause a dose-related ______ in amplitude and ______ in latecy of cortical component of the ______ nerve somatosensory, visual, and auditory evoked potentials

A

Decrease, Increase

Medial

42
Q

Cerebral Blood Flow

Volatile anesthetics at ______, produce cerebral _______, decreased cerebral vascular ______, and dose-dependent _____ in cerebral blood flow

At ______, _______ is most potent CNS vaodilator, secondary to ______, with ______ and _______ producing equal and less significant CNS effect

____ also increases CBF

Increased CBF occurs within _____ of anesthetic administration

Increased CBF and dilation not good for what patient population?

A

> 0.6 MAC, Vasodilation, Resistance, Increase

At 1.1 MAC, Halothane, Enflurane

Isoflurane and Desoflurane

N2O

Minutes

Patient’s with increased ICP or brain bleeds

43
Q

Cerebral Metabolic O2 Requirements

Dose dependent ______

Decreases _______ requirement, leading to _____ CO2 production, causing ______ and ______ in CBF

Agents such as ______, ______, and ______ will equally reduce _____ and decrease CO2 production, causing _______ effects

For Neuro patients, use ____, _____, or ____ and avoid ______ or _____

A

Decrease

Metabolic, Decreased, Vasoconstriction, Decrease

Iso, Sevo, Des, CBF, Vasocontricting

Iso, Sevo, Des, Halothane, N2O

44
Q

Cerebral Protection

In humans undergoing carotid endarterectomy, _______ appears to provide a degree of cerebral ______ (The CBF at which _____ changes appear is lower during administration, compared to other agents)

(may reduce the transient cerebral ischemia that happens with this procedure)

For carotid endarterectomies, use ______

A

Isoflurane

Protection, Ischemic

Isoflurane

45
Q

Intracranial Pressure

Increases in ICP parallel increased ____ that is produced by anesthetics

_______ of lungs decreases PaCO2, therefore producing _______ and reducing tendency for increased ____

____ increases ICP ____ _____ volatile anesthetics (mostly because of the low dose it’s given in) (N2O safer than volatiles)

Avoid elevated ICP in _____ _____

A

CBF

Hyperventilation, Vasocontriction, ICP

N2O, Less Than

Head Injuries

46
Q

Circulatory Effects

Mean Arterial Pressure

Agents ____, ____, ____, and ____ have dose dependent ____ on MAP due to decrease in the _____

______ decreases map due to decrease in cardiac ______

True circulatory affect of agents may not be reflected by BP since the BP may be elevated due to _____ stimulation elicited from surgery

A

Halo, Iso, Des, Sevo Decrease, SVR

Halothane, Contractility

SNS

47
Q

Circulatory Effects

Heart Rate

Agents that increase HR are ____, ____, and ____

Confounding Variables: increased HR with ____ only with ______

Increased HR may also be due to _____ or _____ activity

______ may disrupt baroreceptor reflex and decrease ______ system of the heart

_____ affect on HR not determinable (it’s always given with other drugs)

A

Iso, Des, Sevo

Sevo, > 1.5 MAC

Opioids, SNS

Halothane, Conduction

N2O

48
Q

Cardiac Output/Stroke Volume

______ has dose dependent decrease in _____ ______

____ and ____ have no effect on CO/SV

________ decreases CO up to _____, but when ______, CO recovers

Left SV _____ with all anesthetics

____ increases CO slightly

A

Halothane, Cardiac Output

Iso, Des

Sevoflurane, 2 MAC, > 2 MAC

Decreases

N2O

49
Q

Systemic Vascular Resistance

Decreased SVR reflects increased ______ ______ and ______ blood flow (patient may appear flushed), which results from excess ______ relative to O2 needs

Decreased SVR also reflects loss of ____ ____, with enhanced drug delivery to the ______ ______

_______ dilates ONLY _____ and _____ vessels

A

Skeletal Muscle, Cutaneous

Perfusion

Body Heat, Neuromuscular Junction

Halothane, Cerebral, Cutaneous

50
Q

Pulmonary Vascular Resistance

Volatile anesthetics have ____ to ____ effect

____ increases PVR; exaggerated effect in those with ______ ______, ______, and patients with congenital _____ ______

A

Little to No

N2O, Pulmonary HTN, Neonates, Heart Disease

51
Q

Cardiac Dysrhythmias

Anesthetics ______ the dose of ______ required to produce ______ dysrhythmias

Effect greatest with ______

Interference with _______ rate of cardiac impulses through conduction system of heart

A

Decrease, Epinephrine, Ventricular

Halothane

Transmission rate

52
Q

Coronary Blood Flow

Volatile anesthetics cause coronary _____, mostly in vessels 20-200 um ( ______ vessels)

______ dilates small coronary vessels more than larger conductance vessels

____ is capable of causing a maldistrubution of blood flow from ______ to ______ areas. This is called _____ ______ _____

Ischemia has resulted in patients with CAD when ____ and ____ were used

A

Vasodilation, Small

Isoflurane

Iso, Ischemic, Non ischemic

Coronary Steal Sydrome

N2O and Isoflurane

53
Q

Coronary Blood Flow

No increased risk of acute ___ with volatile anesthetics as long as _______ are maintained

**May need to pretreat patients with _____ or a ____ _____

(If patient is already on beta blocker, ask if they took their dose the morning of surgery. If not, esmolol or similar agent may need ti be administered)

A

MI, Hemodynamics

Opioids, Beta Blocker

54
Q

Neurocirculatory Response

______’s solubility make it a good choice to treat abrupt increases in systemic ___ and ____ associated with changes in intensity of _____ stimulation (This does NOT occur with Sevo)

Pre-existing _____ may influence the significance of ______ effects produced by inhaled anesthetics

A decrease in ______ associated with anesthetics is significant if there is diseased or ______ cardiac muscle

Neurocirculatory responses are a concern for patients with ____

A

Desflurane

BP, HR, Surgical

Disease, Circulatory

Contractility, Failing

CAD

55
Q

Mechanism of Circulatory Effects

Direct myocardial _______

Inhibition of ____ _____ outflow

Peripherla autonomic _____ blockage

Attenuation of _____ _____ reflex activity

Decreased formation of ____, Decreased release of ______, Decreased influx of ____ ion

A

Depression

CNS Sympathetic

Ganglion

Carotid Sinus

cAMP, Catecholamines, Ca++

56
Q

All volatiles produce dose dependent _____ in BP

_____ produces the most profound _____ in SVR

_____ does NOT cause decrease in BP when administered _____

A

Decrease

Isoflurane, Decrease

Nitrous, Alone

57
Q

Heart Rate

HR increases the most with the use of ____, closely followed by ____

____, ____, and ____ produce coronary vasodilation

_____ causes least amount of coronary vasodilation

______ is the most _____ of the volatile anesthetics, and is also a potent coronary _______

A

Des, Iso

Iso, Des, Sevo

Sevo

Isoflurane, Potent, Vasodilator

58
Q

Cardiac Preconditioning

Can use concentrations of Isoflurane as low as ______

May protect against ______ ______ and _____ ______ injury

APC limits infarct ____

___ ______ elevation decreases

______ production decreases

A

0.25 MAC

Prolonged Ischemia, Reperfusion Injury

Size

ST Segment

Lactate

59
Q

Possible mechanisms of Cardiac Preconditioning

Release of ______ (a vasodilator substance) that binds to adenosine receptors A1 and A2

Binding to A2 receptors: increased ____ leads to stimulation of ___ channels, leading to ________, causing relaxation of vascular _____ _____

Binding to A1 receptors: decreased ____ leads to inhibition of ___ entry, causing a decreased _____ _____ of the ___ _____

A

Adenosine

cAMP, K+, Hyperpolarization, Smooth Muscle

cAMP, Ca++, Action Potential, SA Node

60
Q

Possible mechanisms of Cardiac Preconditioning

Opening of ___ channels is critical for beneficial cardioprotective effects of IPC

K+ channels can be closed by ______, abolishing anesthetic preconditioning (Should be discontinued 24-48 hours prior and administer sliding scale ____)

_______ also antagonizes the function of K+ channels

A

K+

Sulfonylureas, Insulin

Ketamine

61
Q

Possible mechanisms of Cardiac Preconditioning

_____ and _____ may mimic IPC

______ antagonizes APC, use in caution in patients at risk for _______ ____

A

Adenosine, Opioids

Ketamine, Perioperative MI

62
Q

Pulmonary Effects

Inhaled anesthetics cause a dose dependent _____ in frequency of breathing

_____ _____ decreases with increased _______ (rapid and shallow breathing pattern)

This causes decreased ______ ______ and increased _____, leading to _______ ______

A

Increase

Tidal Volume, Frequency

Minute Ventilation, PaCO2

Respiratory Acidosis

63
Q

Pulmonary Effects

Inhaled agents cause dose dependent ______ in ______ evidenced by decreased ventilatory response to CO2 and _____ in PaCO2

_____ may accentuate increased _____ production

Mechanism of depression pertains to depressant effects on the ______ _____ ______

A

Depression, Ventilation

Increases

COPD, PaCO2

Medullary Ventilatory Center

64
Q

Pulmonary Effects

Anesthetics produce decreased ______ ______

Nitrous causes an ______ incident of pulmonary vascular resistance, but ______ agents cause a decrease in PVR (except Des)

A

Airway Resistance

Increased, Volatile

65
Q

Hypoxic Pulmonary Vasocontriction

Ability of pulmonary vasculature to ______ in response to _______

Results in more optimal ______ to ______ match

Volatile agents mildly _____ the HPV mechnism

Read Flood, Page 599

A
66
Q

Hepatic Effects

Anesthetics may interfere with _____ due to decreased ______ blood flow or inhibition of _______

Inhibition may be _______ specific; more important than ______ in blood flow

Transient ______ in LFT’s (surgical stimulation increases all LFTs

Increase in _____ with ______ and ______, none with ______

A

Clearance, Hepatic, Enzymes

Enzyme, Decrease

Increase

ALT, Enflurane, Des, None with Iso

67
Q

Hepatic Effects

Anesthetics produce mild _____ _____ due to inadequate hepatic ______

Metabolism of anesthetic agent can result in _____ liver protein which can produce a _____ ______ response

Potential for hepatic ______, is _______ proportional to the degree of ______

A

Hepatic Dysfunction

Acetylated

Severe Antibody

Injury, Directly, Metabolism

68
Q

Hepatic Effects

____ is NOT metabolized to _____ _____, so no antibody production to _____ liver proteins can occur

_____ can be degraded by CO2 absorbents to produce _______, which is hepatotoxic in animals, but the concentration in the breathing circuit is ______ toxic levels

A

Sevo, Acetyl Halide, Acetylated

Sevo, Compound A, Below

69
Q

Renal Effects

Anesthetics cause ______ renal blood flow, decreased ____, and decreased _____ _____, which is most likely related to the effects that anesthetic agents have on ____ and ____

Preoperative _______ helps prevent this

A

Decreased, GFR, Urine Output

BP and CO

Hydration (IV Fluids)

70
Q

Renal Effects

*Fluoride Induced Nephrotoxicity*

Observed with ________, which is highly metabolized to ______ _____, which is a renal toxin

Current volatile anesthetics have decreased solubility, so most are _____ and never metabolize into _____ ______

Toxicity may include _____, ______, _______, increased serum _____, and the inability to concentrate ______ (think dehydration symptoms)

A

Methoxyflurane, Inorganic Fluoride

Exhaled, Inorganic Fluoride

Polyuria, Hyper Na+, Hyperosomlarity, Creatinine, Urine

71
Q

Renal Effects

_____ is metabolized to ______ ______, which doesn’t impair renal function in patient’s without pre-existing ______ ______

_____ has greater _______ metabolism of inorganic fluoride

______ has greater ______ metabolism of inorganic fluoride

A

Sevo, Inorganic Fluoride

Renal Disease

Enflurane, Intrarenal

Sevoflurane, Hepatic

72
Q

Renal Effects

*Vinyl Halide Nephrotoxicity*

CO2 absorbents such as ______ or _____ _____, react with ______ to form breakdown product known as ________, a vinyl ether

Need to use at least ______ fresh gas flow rate with Sevo to minimize concentration of ______ that may accumulate in the breathing circuit

A

Baralyme, Soda Lime, Sevo

Compound A

2L/Minute, Compound A

73
Q

Skeletal Muscle Effects

Skeletal muscle ______ produced with most _____-derived anesthetics, but not with ______ or _____

_____ derivates can cause dose dependent _______ of NM blockers

A

Relaxation, Ether

Halothane, N2O

Ether, Enhancement

74
Q

Skeletal Muscle Effects

Malignant Hyperthermia

______ susceptible patients

______ is the most potent trigger

A

Genetically

Halothane

75
Q

Malignant Hyperthermia

Can develop _____ or _____ GA

Volatile anesthetics and ________ cause an increase in _______ ___ concentration in susceptible patient, resulting in persistent _____ contraction

________ state with increased ___ and unexplained increase in _____

Will also see ______, ______, _____, and ____

Rise in temperature is a _____ sign

A

During, After

Succinylcholine, Sarcoplasmic Ca++

Muscle

Hypermetabolic, HR, ETCO2

Acidosis, Rhabdo, Arrythmias, Hyper K+

Late

76
Q

Malignant Hyperthermia

Unexplained increase in _____ (most sensitive indicator in the OR)

_____ _____ fever

Skeletal _____ rigidity

Lactic ______ (hyper metabolism)

Constant leak of SR ____ through defective ______ receptor

A

ETCO2

High Grade

Muscle

Acidosis

Ca++, Ryanodine

77
Q

Malignant Hyperthermia

Must use ____ ____ anesthesia for these patients

Notify _____ immediately, _____ triggering agents, ______ with 100% O2 (with ____, not anesthesia circuit)

____ procedure

IV ______ (prevents release of Ca++ from the SR)

Give _____, Cool patient, _____ and _____ for Hyper K+, Monitor _____ output to watch for _____ to kidneys or _____

A

Total IV

Surgeon, Stop, Hyperventilate, TANK

Abort

Dantrolene

Bicarb, Insulin and D50, Urinary, Shock, ATN

78
Q

Obstetric Effects

Dose dependent ______ in _____ smooth muscle contraction and blood flow

Relaxation is beneficial and may help remove retained _____, but may also contribute to blood loss in _____ ______

Anesthetics rapidly enter _____, but are rapidly _____

A

Decrease, Uterine

Placenta, Uterine Atony

Fetus, Exhaled

79
Q

Resistance to Infection

Normal functions of the immune system may be _____ after anesthesia and surgery

Causes decreased ____ _____; affecting influenza and measles viruses

Inhaled anesthetics do not have ______ effects, but the liquid form of volatile anesthetics may be ______

A

Decreased

DNA Synthesis

Bateriostatic, Bactericidal

80
Q

Metabolism

Metabolites may be toxic to ____, _____, or ______ organs (always check a _______ test in women of child bearing age)

Degree of metabolism may be influenced by rate of decrease of PA at end of anesthesia case

Assess magnitude of metabolism by measuring ______ or a comparison of total amount recovered in exhaled gases with amount taken up during administration (_____ _____)

A

Kidney, Liver, Reproductive, Pregnancy

Metabolites, Mass Balance

81
Q

Metabolism of Volatile Agents

Metabolism is affected by what four main factors?

A

Chemical structure, Enzyme activity, Blood concentration, Genetic factors

82
Q

Metabolism

N2O

Very _____ metabolism, mainly by ______ bacteria in the GI tract

An O2 concentration of _____ than ____ inhibits metabolism of N2O

A

Little, Anaerobic

Greater, 10%

83
Q

Metabolism

Halothane

15-20% metabolized by _______ enzymes

Oxidative metabolism produces ______ _____ that may acetylate hepatic proteins resulting in formation of _______

Reductive metabolism in hepatocyte hypoxia produces _____ _____

A

Cytochrome P-450 Enzymes

Trifluoroacetyl Halide, Antibodies

Inorganic Fluoride

84
Q

Metabolism

Enflurane

3% metabolized by _______ enzymes

Oxidative metabolism may produce _______ hepatic ______ complexes

Low _____ in tissues

_______ increases nephrotoxic potential

A

Cytochrome P-450

Fluoroacetylated, Protein-Ab

Solubility

Isoniazid

85
Q

Metabolism

Isoflurane

0.2% metabolized by ______ enzymes

Oxidative metabolism to _______ ____, possibility of producing acetylated hepatic ______ complexes

Low ______

Concentration of inorganic flouride produced is less than with _____

A

Cytochrome P-450

Trifluoroacetric acid, Protein-Ab

Solubility

Enflurane

86
Q

Metabolism

Desflurane

0.02% metabolized by _______ enzymes

Oxidative metabolism to _______ _____, possibility of producing acetylated hepatic ______ complexes

Low ______

A

Cytochrome P-450

Trifluoroacetic acid, Protein-Ab

Solubility

87
Q

Metabolism

Sevoflurane

5% metabolozed by _______ enzymes

Oxidative metabolism does NOT produce _____ _____, therefore, there is no possibility of hepatic _______ complexes

Degraded by CO2 ______ to potentially nephrotoxic _______, which is more likely to happen with _______

Renal exposure to flouride concentration is not concerning because most ______ is through the lungs

A

Cytochrome P-450

Acetyl Halides, Protein-Ab

Absorbents, Compound A, Baralyme

Elimination

88
Q

Carbon Monoxide Toxicity

CO formation is a product of _____ of anethetics

_____, followed by _____, have the highest production of CO

_____ and _____ have no _____ group, therefore, they do not produce CO

CO toxicity increases intraoperative _______ concentration

____ detection difficult since oximeter can’t detect Carboxy-Hgb versus Oxy-Hgb

CO toxicity may produce delayed ________ effects (cognitive effects), ______ changes, _____ distrubance - can occur 3-21 days later

A

Degradation

Desflurane, Enflurane

Halothane, Sevoflurane

Carboxyhemoglobin

CO

Neurophysiological

89
Q

Metabolism

(Factors that increase magnitude of CO production)

Dryness of ___ ______ - Prevented by ______

High ______ of absorbent - occurs during _____ fresh gas flows or increased metabolic production of ____

Prolonged ____ fresh gas flows (contribute to _____ of absorbent)

______ absorbent predispositioned to CO production more than ______ absorbent

A

CO2 Absorbent, Hydration

Temperature, Low, CO2

High, Dryness

Baralyme, Soda Lime

90
Q

CO2 Absorber Fires

______ reacts with dessicated CO2 absorbents to produce CO and ______ organic compounds such as ______ or _______

This reaction produces _____, which increases chemical reaction _____ so that _____ breaks down rapidly

_______ metabolites can spontaneously ______ at high temperatures

Most often associated with ______

A

Sevoflurane, Flammable, Methanol, Formaldehyde

Heat, Speed, Sevoflurane

Flammable, Combust

Baralyme

91
Q

Minimal Alveolar Concentration

Each gas has a different _____

A _____ (or 1 MAC) is the % of anesthetic agent (gas) which ceases movement in response to noxious stimuli in _____ of patients

An increase to a MAC of ____ will prevent movement in _____ of patients

See Table 4.6 in Stoelting Book

MAC is _____ in women with natural red hair due to mutations of the _______ receptor gene

A

MAC

MAC, 50%

1.3, ~95%

Increased, Melano-cortin-1

92
Q

MAC

MAC _____ : opposite of MAC

MAC Awake is where ____ of patients will respond appropriately to verbal command and stimuli

Nitrous (About 60%) will decrease the MAC by ____ (roughly)

______ of a MAC should produce MAC Awake for volatiles

A

Awake

50%

1/3

1/10

93
Q

Xenon (Inert Gas)

MAC is gender dependent, being less in ______

Non-explosive, Not pungent, minimal ______ depression

Main issue is the high _____ & needs more studies to prove ______

Lowest blood:gas coefficient of ______

Does have a tendency to _____, like N2O

Does not contribute to ______ ______

Emergence is _____ faster than nitrous or Sevo

A

Females

Cardiac

Cost, Morbidity

0.115

Bubble

Malignant Hyperthermia

2-3 x

Pharmacology Test 1 (3 decks)

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