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AP I > Maintenence* > Flashcards

Maintenence* Flashcards

1
Q

what’s included in a “balanced anesthetic?”

A

IV
Inhalation
Narcotics
Muscle Relaxants

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2
Q

what are two ways to calculate the O2 maintenance requirement?

A 
VO2 = 10*kg^0.75 = ml/min or 
VO2 = 2.5*kg+67.5 = ml/min
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3
Q

numeric values for dead space

A

Anatomic Dead space = 2 ml/kg

= 140 ml/B *10 = 1400 ml/min

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4
Q

Alveolar Oxygen Equation

A

PAO2 = [(PB-PH2O)(FiO2)]-(PaCO2/R)

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5
Q

What is the initial treatment for a patient whose sats begin to drop?

A

increase FiO2

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6
Q

why does a low BP lead to VQ mismatch?

A

poor perfusion

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7
Q

PEEP can be simplified to mean what?

A

resistance to expiration

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8
Q

therapeautic range for PEEP

A

7.5-10mmHg

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9
Q

What is the physiological value for PEEP?

A

5 mmHg

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10
Q

advantages of inhalational agents

A 
Rapid appearance of drug in arterial blood
Efficient to distribute
Easy to deliver - Unique route
Predictable recovery
High safety profile
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11
Q

drawbacks of inhalational agents?

A 
No analgesia (N20 exception)
PONV
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12
Q

MACBAR =
MACawake =
MACamnestic =

A 
MACBAR = 1.5
MACawake = 0.3-0.5 (10% of MAC)
MACamnestic = 0.25
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13
Q

what effects do age, accute intoxication and pregnancy have on MAC?

A 
age = increase/decrease
EtOH = decrease
Pregnancy = decrease
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14
Q

rate of rise for the Fa/Fi curves depends on what?

A

Solubility

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15
Q

The more _____ the anesthetic agent, the quicker the pt will go to “sleep”

A

INsoluble

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16
Q

Factors affecting inspiratory concentration (Fi)

A

Fresh gas flow (increase)
Circuit Volume (decrease)
Any machine/circuit absorption (decrease)

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17
Q

In terms of time constants, what percent must change in order for the change to be therapeautic?

A

95%

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18
Q

What pathway does the agent take once in the body?

A

lung -> blood -> brain

19
Q

Describes relative affinity of anesthetic gas for blood

A

Blood/gas partition coefficient

20
Q

Increased partition coeff -> _______ solubility -> ________ agent uptake

A

increased

increased

21
Q

Increased agent uptake -> ______ induction

A

slower

22
Q

Blood/Gas values for Iso, Des, Sevo

A 
Iso = 1.4
Des = 0.42
Sevo = 0.65
23
Q

Muscle/Blood values for Iso, Des, Sevo.

& why are they important?

A

Iso = 4.0
Des = 2.0
Sevo = 3.1
Determines speed of wake up

24
Q

What is Cardiac Output?

A

CO = HR x SV

25
Q

Which agents are most effected by CO?

A

Highly soluble agents are most effected by CO

26
Q

What are some factors affecting arterial concentration (Fa)?

A

V/Q mismatch
Venous admixture
Alveolar dead space
Nonuniform alveolar gas distribution

27
Q

What effect does N2O have on MAC?

A

cuts MAC requirement by 50%

28
Q

N2O advantages

A

Powerful analgesic properties
Decreases MAC of other inhal. Agents
Safe in MH patients
Rapid induction/recovery

29
Q

N2O disadvantages

A

Decreases myocardial contractility
Increase risk PONV
Increase ICP by inc CBF
Teratogenicity

30
Q

N2O contraindications

A 
Air embolism
Pneumothorax (75% 2-3x 10 min)
Acute intestinal obstruction
Intracranial air (tension pneumocephalus)
Pulmonary air cyst
Intraoccular air bubbles
Tympanic membrane grafting
31
Q

What does Sevo smell like?

A 
juicy fruit (according to Sam) 
If you sniff enough, you won't remember it though
32
Q

What is a potential risk with Sevo and when is it seen?

A

Compound A (fluoromethyl-2,2-difluoro-1-(trifluoromethyl)vinyl ether
Low gas flows
High temperatures
Desiccated absorbent

33
Q

Sevo advantages

A

Non-irritant sweet odor
Rapid induction/recovery
Does not sensitize myocardium to catecholamine
No CO production with Na lime

34
Q

Sevo disadvantages

A

Less potent
Compound A production (2L/min)
Contraindicated with Baralyme
Post op agitation in children*

35
Q

Which agent is a gas at room temp?

A

Des

36
Q

Which gas is Capable of increasing HR, documented myocardial ischemia?

A

Des

37
Q

Des advantages

A

Rapid onset/recovery

Stable with CO2 absorbers

38
Q

des disadvantages

A

Requires special vaporizer
Low potency
Pungency (not good for asthma)
Rapid increase >1.25 MAC SNS stimulation

39
Q

which agent can you not use in pt’s with renal or hepatic dysfunction?

A

Iso

40
Q

xenon advantages

A 
Inert
Min CV effects
Low blood solubility
Rapid induction/recovery
Nonexplosive
Environmentally friendly
41
Q

xenon disadvantages

A

High cost
Low potency (MAC – 70%)
Not readily available

42
Q

Sam’s 10 commandments

A
  1. never turn down a break
  2. You can always give more
  3. Go ahead it is not my MAMA
  4. Tank ‘em till they froth, then back off
  5. Give them what they need add it up later
  6. Straighten out your lines , keep them that way
  7. There is always an exception to what you think you know
  8. Learn how to disagree without being disagreeable
  9. Never say it has not happened to me
  10. Never Never use the drugs you give to your patients
43
Q

Sorry if these cards are confusing

A

Sam’s slides are hard to work with

AP I (8 decks)

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