Quiz 6 Flashcards
How do Volatile agents typically decrease MAP? What exceptions?
SVR is decreased
- Halothane decreases MAP by decreased CO
- N2O no change to slight increase in MAP
Starting at concentrations 0.25 MAC, a linear, dose dependent increase in HR is observed - What agent?
Isoflurane or “Forane”
At concentrations ≥ 1 MAC , a linear, dose dependent increase in HR is observed - What agent?
Desflurane
HR does not increase until concentrations >1.5 MAC - what agent?
Sevoflurane
Abrupt increases of _______ and ______ > 1 MAC cause transient circulatory stimulation in the absence of anesthetic adjuncts
Desflurane and Isoflurane
Inhaled anesthetics prolong the QT interval on the electrocardiogram. which specifically? but safe if?
Sevoflurane
on B-Blockers
coronary steal seen more in which agent?
Isoflurane
two distinct periods of protection in Ischemic preconditioning?
- 1-2 hours after the conditioning episode
- 24° later and can last as long as 3 days
Opening of mitochondrial _______-sensitive ________ channels (KATP) is the crucial event that confers the protective activity in Ischemic preconditioning
adenosine triphosphate (ATP)
potassium
_______ increases proportionate to anesthetic depth
PaCO2
Dose related _______ of the respiratory response to increased CO2
blunting
so co2 may have to climb higher than normal to stimulate breathing
______ stimulation to breath comes on sooner, but _______ is a stronger response
Co2
hypoxia
________ displacement of the diaphragm and ________ displacement of the rib cage occur from enhanced expiratory muscle activity. This results in a ________ in FRC
Cephalad
inward
reduction
Most pungent agent?
Desflurane
Least pungent agent?
Sevoflurane
how does the pungency of an agent effect the patient?
- Coughing
- Breath-holding
- Laryngospasm
- Arterial oxygen desaturation
- Asthmatics, smokers, ppl sensitive tosmells
cerebral vasodilatation occurs at concentrations above ____ MAC. Who is this good and not good for?
0.6
good for ischemic pts
not good for ^ICP pts
At concentrations ≥ ___ MAC, __________ effects predominate and cerebral blood flow _________, especially if systemic blood pressure is maintained at awake values.
1
vasodilating
increases
How does N2O differ from others? What to avoid? give what to counter effects?
^CMRO2 (cerebral oxygen consumption)
avoid in cranial injuries
opioids, barbiturates, or propofol
ICP increases with all volatile anesthetics at doses ____ MAC
> 1
Autoregulation is impaired at concentrations ______ MAC
< 1
Volatile anesthetics and nitrous oxide ______ the amplitude and ______ the latency of SSEP in a dose-dependent manner
depress
increase
concentrations of _____ MAC decrease the reliability of motor evoked potentials
0.2-0.3
Avoid in epileptic or hx seizure pts
sevoflurane
which gas has most potentiation of NMBs
Desflurane
causitive agent of hepatic effects?
trifluoroacetate metabolite
________ (trifluoroethyl vinyl ether) is produced from the breakdown of _______ and ________. In animal studies, Compound A is nephrotoxic after prolonged exposure.
Compound A
sevoflurane
halothane
In humans, Compound A exposure significant to cause? Prevention?
transient proteinuria, enzymuria, and glycosuria occurs after prolonged sevoflurane at low fresh gas flows (1L/min).
Keep Sevo to at least 2L of flow or more
N2O administration contraindicated in patients with?
preexisting vitamin B12 deficiency
N2O other risk?
Gas transfer to closed spaces aka Pneumothorax, pneumoperotoneum, pneumocephalus, air emboli, bowel air, eye bubble procedures, inner ear procedures, avoid in craniotomies as well
Gas with highest risk of fire in dessicated CO2 absorber?
Sevoflurane
Which gases produce Carbon monoxide when exposed to dessicated absorbant?
Iso and Des
________ are tempurature compensated vaporizors
Variable bypass
another name for desflurane
suprane
Required vaporizer setting for higher altitude equation =
(desired vaporizer setting at sea level × 760mm Hg)/local barometric pressure (in mm Hg.)
