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8361 Exam 2 > Mod IV: Inhalational anesthetic & Intravenous Anesthetic Induction agents > Flashcards

Mod IV: Inhalational anesthetic & Intravenous Anesthetic Induction agents Flashcards

1
Q

Inhalational anesthetic agents

Anesthetic requirement is HIGHEST in infants between 2-3 mos. Why?

A

Reasons not adequately explained

It has been suggested that neuronal density, metabolic rate, oxygen consumption and brain water have contributed to this alteration from birth; however the precise mechanism remains unclear.

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2
Q

Inhalational anesthetic agents

Anesthetic requirement is HIGHEST in infants between 2-3 mos. •Exception:

A

MAC of Sevoflurane same for neonates & infants

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3
Q

Inhalational anesthetic agents

What’s the order of decreasing Inhalational anesthetic requirements from Infants to Adults?

A

INFANTS > TERM NEONATE > PREMATURE NEONATE > OLDER CHILDREN > ADULTS

ITPOA

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4
Q

Inhalational anesthetic agents

What’s 1.0 MAC of Halothane for Infants, Neonates, Small children, and Adults?

A

Infants: 1.1-1.2

Neonates: 0.87

Small children: 0.87

Adults: 0.75

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5
Q

Inhalational anesthetic agents

What’s 1.0 MAC of Isoflurane for Infants, Neonates, Small children, and Adults?

A

Infants: 1.8-1.9

Neonates: 1.6

Small children: 1.3-1.6

Adults: 1.2

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6
Q

Inhalational anesthetic agents

What’s 1.0 MAC of Desflurane for Infants, Neonates, Small children, and Adults?

A

Infants: 9-10

Neonates: 8-9

Small children: 7-8

Adults: 6.0

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7
Q

Inhalational anesthetic agents

What’s 1.0 MAC of Sevoflurane for Infants, Neonates, Small children, and Adults?

A

Infants: 3.2

Neonates: 3.2

Small children: 2.5

Adults*: 2.0

Note that MAC of Sevoflurane same for neonates & infants

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8
Q

Inhalational anesthetic agents

There is Higher alveolar ventilation to FRC ratio. What does this mean?

A

Increased alveolar ventilation

Reduced FRC

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9
Q

Inhalational anesthetic agents

How are Blood/Gas coefficients in neonates

A

Blood/Gas coefficients reduced in neonates

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10
Q

Inhalational anesthetic agents

Blood/Gas coefficients reduced in neonates. What else alters the uptake of the agent? What’s the Ultimate effect?

A

Greater blood flow to vessel rich organs also alters the uptake of the agent

Ultimate effect = FASTER rate of inhalation induction

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11
Q

Inhalational anesthetic agents

Why is there a FASTER rate of inhalation induction with neonates?

A

Higher alveolar ventilation to FRC ratio, which results in Increased alveolar ventilation & Reduced FRC

Blood/Gas coefficients reduced in neonates

Greater blood flow to vessel rich organs

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12
Q

Inhalational anesthetic agents

What properties must the ideal Inhalational Anesthetic have?

A

Pleasant smell

Rapid onset & elimination

Minimal respiratory irritant properties

No CV depression

No respiratory depression

Little effect on cerebral and cardiac Blood Flow

Minimal interaction with catecholamines

Should not be metabolized to toxic compounds

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13
Q

Inhalational anesthetic agents

Why is Sevoflurane the Preferred for inhaled induction in pediatrics

A

Has some of the properties of the ideal agent, including

Less pungent

low blood/gas coefficient

Rapid induction/ emergence

Enhanced CV safety profile

Less bradycardia, arrhythmias, & hypotension

Least respiratory depression

Decreased incidence of laryngospasm & breath holding during induction

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14
Q

Inhalational anesthetic agents

Although (questionable, providers often induce w/ Sevo but then switch to isoflurane for maintenance; why

A

—Sevo is a/w increased incidence of emergence delirium

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15
Q

Inhalational anesthetic agents

How could “Emergence delirium” a/w Sevo in peds be attenuated?

A

Sedation/preemptive analgesia

(e.g. Midazolam)

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16
Q

Inhalational anesthetic agents

What are Concerns regarding metabolism of sevoflurane?

A

Fluoride toxicity

Compound A toxicity

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17
Q

Inhalational anesthetic agents

Although No reported instances of nephrotoxicity attributed to inorganic fluoride production during sevoflurane anesthesia in pediatric, why is the use Sevoflurane contraindicated in children with limited renal reserve?

A

Subtle urinary markers of occult renal damage have been demonstrated with prolong use, therefore use probably contraindicated in children with limited renal reserve

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18
Q

Inhalational anesthetic agents - Halothane

Halothane was well tolerated for inhaled induction; why?

A

Less airway tract irritation (< laryngospasm)

Less breath holding

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19
Q

Inhalational anesthetic agents - Halothane

Muscle relaxant properties of Halothane are evidenced by:

A

Facilitate induction/intubation w/o use muscle relaxant

Potentiates NDMBs

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20
Q

Inhalational anesthetic agents - Halothane

What was the benefit of using Halothane for SLOW AND STEADY induction in asthmatic?

A

Halothane is a Potent bronchodilator

However, largely replaced by sevoflurane

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21
Q

Inhalational anesthetic agents - Halothane

Why was Halothane replaced if it seems so ideal?

A

Greatest cardiovascular depression

Hypotension, bradycardia, arrhythmias

Dose dependent

Sensitizes the myocardium to catecholamines

Ventricular arrhythmias common

Limit dose to 10 ug/kg of epinephrine

Halothane hepatitis?

Contraindicated in patient with hepatic dysfunction

More common in adult than pediatric population

High blood/gas coefficient (2.5)

Slow rate of inhaled induction

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22
Q

Inhalational anesthetic agents

Which Inhalational anesthetic agents causes the Greatest cardiovascular depression? How does it manifest?

A

Halothane

Manifest as Hypotension, bradycardia, arrhythmias

In a Dose dependent manner

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23
Q

Inhalational anesthetic agents

Which Inhalational anesthetic agent Sensitizes the myocardium to catecholamines? How does it manifest?

A

Halothane

Ventricular arrhythmias common

Limit dose to 10 ug/kg of epinephrine

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24
Q

Inhalational anesthetic agents - Halothane

Why is Halothane contraindicated in patient with hepatic dysfunction?

A

Halothane hepatitis

More common in adult than pediatric population

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25
Q

Inhalational anesthetic agents - Halothane

Why does Halothane have a slow rate of inhaled induction?

A

High blood/gas coefficient (2.5)

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26
Q

Inhalational anesthetic agents - Halothane

T/F: Halothane is no longer available in the US

A

True

May still be available oversea

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27
Q

Inhalational anesthetic agents

Between Halothane and Isoflurane, which agent has Less cardiac depression

A

Isoflurane

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28
Q

Inhalational anesthetic agents

What’s the primary cause of hypotension w/ Isoflurane?

A

Vasodilation

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29
Q

Inhalational anesthetic agents

What’s the primary cause of hypotension w/ Halothane?

A

Myocardial depression

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30
Q

Inhalational anesthetic agents

Why is Isoflurane not ideal for inhalation induction?

A

Pungent odor/potential airway irritant

High incidence laryngospasm

Not suitable for inhalation induction

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31
Q

Inhalational anesthetic agents - Isoflurane

Isoflurane has a Moderate rate uptake and elimination. What’s its Blood/gas coefficient?

A

Isoflurane Blood/gas coefficient is 1.46

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32
Q

Inhalational anesthetic agents - Isoflurane

What makes Isoflurane attractive for neurosurgical procedures?

A

A/w smaller increases in CBF than the other volatile agents

33
Q

Inhalational anesthetic agents - Desflurane

Desflurane is a/w rapid induction, rapid alteration of anesthetic depth, and rapid emergence. What’s Desflurane blood gas solubility coefficient?

A

Desflurane blood gas solubility coefficient is (0.42)

34
Q

Inhalational anesthetic agents - Desflurane

Why is Desflurane not suitable for nhalational inductions?

A

Pungent odor

Respiratory tract irritant (breath holding, apnea, laryngospasm)

35
Q

Inhalational anesthetic agents - Desflurane

Desflurane is highly a/w Emergence delirium highest. How could this be Attenuated?

A

Sedation and Preemptive analgesia

36
Q

Inhalational anesthetic agents - Nitrous Oxide

What’s the most common reason for using Nitrous Oxide in Peds?

A

Second gas effect

37
Q

Inhalational anesthetic agents - Nitrous Oxide

Why does the use of Nitrous Oxide needs supplementation with adjunct agents?

A

Potent analgesic, but

Weak anesthetic!!!

38
Q

Inhalational anesthetic agents - Nitrous Oxide

What are characteristics of Nitrous Oxide that make it suitable for use frequently during induction and for 2nd gas effect

A

Very low blood gas coefficient→ extremely rapid uptake and elimination

Decreases MAC by 25% when used with inhalational agents

Exception: desflurane & sevoflurane

39
Q

Inhalational anesthetic agents - Nitrous Oxide

Decreases MAC by 25% when used with inhalational agents. What are Exceptions?

A

Desflurane & Sevoflurane

40
Q

Inhalational anesthetic agents - Nitrous Oxide

What concentration of Nitrous Oxide depresses swallowing reflex?

A

50%

41
Q

Inhalational anesthetic agents - Nitrous Oxide

What are Contraindications for use of Nitrous Oxide?

A

…

42
Q

Intravenous Anesthetic Agents - PROPOFOL

Larger doses of Propofol are required in peds, why?

A

Larger volume of distribution

43
Q

Intravenous Anesthetic Agents - PROPOFOL

PROPOFOL induction dose < 2yrs =

A

3-4 mg/kg

44
Q

Intravenous Anesthetic Agents - PROPOFOL

PROPOFOL induction dose > 2yrs =

A

2-3 mg/kg

45
Q

Intravenous Anesthetic Agents - PROPOFOL

PROPOFOL induction dose in adults:

A

1-2 mg/kg

46
Q

Intravenous Anesthetic Agents - PROPOFOL

Dose for maintenance is higher compared to adults; why?

A

Rapid redistricbution

Rapid metabolism and clearance

47
Q

Intravenous Anesthetic Agents - PROPOFOL

Porpofol not licensed for sedation in children d/t

A

Risk of “Propofol infusion syndrome”, which cause

Metabolic acidosis

Refractory Bradycardia

Rhabdomyolosis

Hepatomegaly

48
Q

Intravenous Anesthetic Agents - PROPOFOL

PROPOFOL is a/w More rapid recovery following continuous infusion; why?

A

Shorter elimination ½ lives

Higher plasma clearance

49
Q

Intravenous Anesthetic Agents - PROPOFOL

T/F: Recovery from single bolus of PROPOFOL is appreciably different

A

False

Recovery from single bolus not appreciably different

50
Q

Intravenous Anesthetic Agents - PROPOFOL

T/F: PROPOFOL infusion rate must be increased for maintenance

A

True

Increased infusion rates for maintenance

(up to 250 ug/kg/min)

51
Q

Intravenous Anesthetic Agents - PROPOFOL

PROPOFOL is Effective in blunting airway responses. Which drug has it replaced for asthmatics?

A

Ketamine

52
Q

Intravenous Anesthetic Agents - PROPOFOL

T/F: PROPOFOL is More painful on injection in pediatric patient

A

True

53
Q

Intravenous Anesthetic Agents - PROPOFOL

PROPOFOL Lacks “hang-over” effect; why?

A

Low context-sensitive ½ life

54
Q

Intravenous Anesthetic Agents - PROPOFOL

T/F: PROPOFOL lacks propensity to cause PONV

A

True

55
Q

Intravenous Anesthetic Agents - PROPOFOL

T/F: PROPOFOL is a/w less emergence agitation

A

True

56
Q

Intravenous Anesthetic Agents - PROPOFOL

Why is PROPOFOL not recommended for prolonged sedation of critically ill pediatric patient?

A

“Propofol Infusion Syndrome”

Could cause:

Metabolic acidosis

Hemodynamic instability

Hepatomegaly

Rhabdomyolysis

Multi-organ failure

57
Q

Intravenous Anesthetic Agents

Intravenous Anesthetic Agent that is classified as an NMDA receptor antagonists, is a/w Dissociative anesthesia that cause sedation, is often use in the induction of general anesthesia, and also has some analgesic properties:

A

Ketamine

58
Q

Intravenous Anesthetic Agents - Ketamine

Clinically useful IV doses for Ketamine is:

A

1-2 mg/kg IV

59
Q

Intravenous Anesthetic Agents - Ketamine

Clinically useful IM doses for Ketamine is:

A

3-4 mg/kg IM

60
Q

Intravenous Anesthetic Agents - Ketamine

—Why do Neonates and infants require slightly higher doses of Ketamine?

A

More resistant to hypnotic effects

61
Q

Intravenous Anesthetic Agents - Ketamine

What are respiratory benefits of using Ketamine?

A

Preserves airway reflexes

Maintains respiratory drive

Excellent bronchodilator

62
Q

Intravenous Anesthetic Agents - Ketamine

Administration of an anticholinergic w/ Ketamine is to minimize which effect:

A

Increased secretions → coughing, gagging, laryngospasm

63
Q

Intravenous Anesthetic Agents - Ketamine

What are Emergence concerns w/ Ketamine?

A

Hallucinations/bad dreams

Midazolam MAY attenuate but not reliable

PONV

Delayed awakening

64
Q

Intravenous Anesthetic Agents - Ketamine

Ketamine Largely been replaced by propofol for almost all clinical uses except for:

A

Brief sedation for painful procedures (burns, dressing changes)

IM as sedative for uncooperative developmentally delayed patient

65
Q

Intravenous Anesthetic Agents - THIOPENTAL

Neonates/infants induction dose for THIOPENTAL

A

3-4 mg/kg

66
Q

Intravenous Anesthetic Agents - THIOPENTAL

Why are Neonates/infants More sensitive to THIOPENTAL?

A

Immature blood-brain barrier

Less protein binding

67
Q

Intravenous Anesthetic Agents - THIOPENTAL

Why is THIOPENTAL a/w Longer elimination ½ life and Impaired clearance

A

Immature hepatic metabolism/function

68
Q

Intravenous Anesthetic Agents - THIOPENTAL

Children induction dose for THIOPENTAL:

A

5-6 mg/kg

69
Q

Intravenous Anesthetic Agents - THIOPENTAL

THIOPENTAL volume of distribution in children:

A

Larger volume of distribution

70
Q

Intravenous Anesthetic Agents - THIOPENTAL

THIOPENTAL elimination ½ life in children:

A

Shorter elimination ½ life

71
Q

Intravenous Anesthetic Agents - THIOPENTAL

THIOPENTAL Plasma clearance in children:

A

Plasma clearance is greater

72
Q

Intravenous Anesthetic Agents - ETOMIDATE

Clinical use of ETOMIDATE in pediatric patients is limited to:

A

Traumatized, hypovolemic patient

Cardiomyopathy

Decreased CV function

73
Q

Intravenous Anesthetic Agents - ETOMIDATE

Dose range of ETOMIDATE in peds:

A

0.2 – 0.3 mg/kg IV

74
Q

Intravenous Anesthetic Agents - ETOMIDATE

Side-effects of ETOMIDATE in peds include:

A

Pain on injection

Myoclonus

Vomiting

Side-effects of ETOMIDATE in peds are similar to those in adults

75
Q

Intravenous Anesthetic Agents

Alpha 2 agonist similar to clonidine, often used as an infusion to assist with emergence delirium

A

Dexmedetomidine (Precedex)

76
Q

Intravenous Anesthetic Agents - Dexmedetomidine (Precedex)

T/F: Dexmedetomidine (Precedex) has NO set DOSE

A

True

77
Q

Intravenous Anesthetic Agents - Dexmedetomidine (Precedex)

Review these two studies about Dexmedetomidine (Precedex)

A

http: //www.ncbi.nlm.nih.gov/pubmed/16101707
http: //www.aana.com/newsandjournal/documents/dexmedetomidine_0611_p219-224.pdf

78
Q

Intravenous Anesthetic Agents - Dexmedetomidine (Precedex)

Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy

A

True

The study referenced below concluded that 0.5 ug/kg dexmedetomidine reduces agitation after sevoflurane anesthesia in children undergoing adenotonsillectomy

Source: http://www.ncbi.nlm.nih.gov/pubmed/16101707

8361 Exam 2 (20 decks)

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