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GNURS627/Respiration/Physiology for Anesthesa > Quiz 10 - Inhalation Agents and MAC > Flashcards

Quiz 10 - Inhalation Agents and MAC Flashcards

1
Q

What is MAC amnesia?

A

25% MAC (blocks anterograde memory in 50% of awake patients)

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2
Q

What is MAC awake?

A

50% MAC - prevents eye opening on verbal command

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3
Q

What is MAC intubation?

A

130% MAC - concentration required to prevent movement and coughing during ETT intubation

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4
Q

What is MAC BAR?

A

150% MAC - concentration that blocks adrenergic response to skin incision

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5
Q

What factors increase MAC?

A

Age - term infant to 6mos has highest MAC
Chronic ETOH abuse
Hyperthermia
Hypernatremia

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6
Q

What are some factors that decrease MAC?

A
  • Pregnancy
  • Hypothermia (every 1 degree C drop in temp, MAC decreases 2-5%)
  • Elderly
  • Acute ETOH ingestion
  • Premature infants
  • preop meds
  • hyponatremia
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7
Q

Factors that have no effect on MAC

A
  • Thyroid gland dysfunction
  • Gender
  • Hypo/Hyperkalemia
  • Hypo/Hypercarbia
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8
Q

MAC for ISO?

A

1.15 (according to notes)

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9
Q

MAC for Sevo?

A

2.05 (according to notes)

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10
Q

MAC for Des?

A

6 (according to notes)

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11
Q

MAC for N2O?

A

105 (according to notes)

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12
Q

MAC for Halothane?

A

0.75

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13
Q

What alveolar factors influence uptake?

A

Inspired concentration, Alveolar ventilation, Anesthetic system, uptake from alveolar space

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14
Q

What is the single most important factor determining the speed of induction and rate of emergence?

A

Solubility

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15
Q

How is solubility of gasses expressed?

A

Blood:Gas partition coefficient

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16
Q

Blood gas coefficient for Des?

A

0.42

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17
Q

Blood gas coefficient for N2O?

A

0.47

18
Q

Blood gas coefficient for Sevo?

A

0.68 (according to notes)

19
Q

Blood gas coefficient for Iso?

A

1.4 (according to notes)

20
Q

Which gas will have the quickest onset a poorly soluble agent or a highly soluble agent?

A

the poorly soluble agent

21
Q

How does Cardiac Output affect induction of anesthesia?

A

CO is inversely proportional to the speed of induction - low CO will have quicker induction

22
Q

What is Second Gas effect?

A

The ability of a gas (N2O) with rapid induction to speed up the rise in alveolar pressure of a second gas (agent)

23
Q

What is diffusion hypoxia?

A

dilution of alveolar oxygen by a large amount of N2O “outgassing” - rapid desaturation can be seen - stop N2O before extubating and turn 100% oxygen on.

24
Q

Is N2O a good analgesic?

A

yes

25
Q

Does N2O increase or decrease PONV?

A

increases

26
Q

When should you avoid N2O use?

A

when you have enclosed gas spaces: Pneumothorax, bowel obstruction, inner ear…

27
Q

Will N2O increase or decrease PVR?

A

increase PVR - especially in pt with pre-existiing pulmonary HTN

28
Q

Is N2O flammable?

A

No, but it is an O2 source and supports combustion

29
Q

How does N2O affect methionine synthesis?

A

It inhbits (important for B12 and DNA sythesis)

30
Q

What can long term use of N2O lead to?

A

peripheral neuropathy and megaloblastic anemia

31
Q

How does Halothane affect contractility?

A

Halothane has a dose dependent decrease in contractility. Will also decrease BP, CO. SVR and PVR stay normal

32
Q

What gives Halothane its sweet odor?

A

Thymol preservative

33
Q

What effect can Halothane have on children? What do they require preanesthesia?

A

causes Vagal stimulation in children (bradycardia especially > 1 MAC) pretreat with atropine

34
Q

What side effect does Halothane have on the heart?

A

sensitzes the heart to catecholemines, dysrhythmogenic - use epi with caution!

35
Q

Iso and Des are good for inhalation induction (t/f)

A

False, the pungent odor can iritate sensitive airways

36
Q

Will Iso and Des increase HR?

A

yes when rapidly increasing doses (norepi)

37
Q

What is coronary steal syndrome and which agent causes it?

A

normal coronaries dilate and stenotic ones don’t so blood is shunted away from diseased vessels - caused by Iso

38
Q

Does Sevo have a pungent smell?

A

No, makes it a good choice for inhalation induction and children tolerate high levels within significant hemodynamic changes

39
Q

what is a side effect of Sevo you need to look for in children?

A

occasional delirium.

40
Q

How does Sevo form Compound A?

Consequences?

A

Formed with low fresh gas flow, high temps, high agent, dry baralyme, and long cases.
- is nephrotoxic, hepatotoxic, and brain toxic

41
Q

How much fresh gas flow do you need when using Sevo?

A

at least 2 liters/min

GNURS627/Respiration/Physiology for Anesthesa (11 decks)

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