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Pharmacology > Sevo > Flashcards

Sevo Flashcards

1
Q

Increase or decrease MAC

  • temperature
  • age
  • benzos, opiates, alpha 2 agonists
A

Decreases

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2
Q

Adding 1% N2O decreases MAC by what

A

1%

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3
Q

ETOH use acute and chronic effect on MAC

A

Acute = decreased MAC

Chronic = increased MAC

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4
Q

MAC awake of Sevo

A

0.6%

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5
Q

MAC BAR Sevo

A

3%

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6
Q

MAC intubation Sevo

A

4%

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7
Q

Sevo MAC

A

2%

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8
Q

Alveolar concentration =

A

Brain Concentration

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9
Q

Sevo BGP

A

0.69

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10
Q

Low solubility of sevo facilitates what

A

Rapid elimination

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11
Q

Rate of decrease of ET concentrations following termination of anesthesia

A

Rate of elimination

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12
Q

To hasten emergence of volatile anesthetic

A
  • Oxygen
  • Ventilate more
  • turn off sooner
  • high FGF (decreases reinspiration)
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13
Q

Is Sevo an airway irritant

A

NO

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14
Q

Sevo Vapor pressure

A

197

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15
Q

Is Sevo soluble in water

A

Yes

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16
Q

Sevo BGPC

A

0.69

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17
Q

Sevo OGPC

A

53.9

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18
Q

MAC highest for Sevo at what age?

How different from other volatiles

A

Highest in newborns

  • others around 1 year
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19
Q

Lower CO =

A

Faster to go to sleep

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20
Q

Primary factor determining FA/FI

A

BGPC

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21
Q

Sevo uptake factors

A

Solubility X CO X alveolar to venous partial pressure

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22
Q

Tissue uptake depends on

A
  1. Tissue solubility
  2. Tissue blood flow
  3. Arterial to tissue anesthetic partial pressure difference
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23
Q

VRG gets how much CO?

% of body mass

A

10% body mass

75% of CO

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24
Q

Muscle % of body mass

% of perfusion received

A

50% body mass

19% CO

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25
Q

Fat % of body mass

% of CO

A

20%

6% CO

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26
Q

VPG is what % body mass

Get what % of CO

A

20% mass

0% CO

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27
Q

VRG equilibrates with Sevo in how much time

A

4-8 minutes

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28
Q

How long until sevo equilibrates in muscle and skin

A

2-4 hours

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29
Q

Sevo equilibration in fat takes how long

A

30 hours

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30
Q

Durations of sevo anesthesia affects

A

Recovery times

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31
Q

Residual gases in anesthetic circuit can affect

A

Recover times

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32
Q

Sevo emergence correlates with

A

Fall in alveolar concentration

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33
Q

Sevo and retrograde amnesia

A

No retrograde amnesia (not remembering what happened before given)

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34
Q

Sevo and long term impairment of intellectual function and mental function

A

Can cause long term development impairment

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35
Q

Sevo and ICP

A

Potential to increase in pt with space occupying lesion

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36
Q

Ketamine and long term intellectual impairment

A

Does cause

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37
Q

Sevo at _____ increases frequency and voltage of EEGs

A

<0.4 MAC

<0.8%

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38
Q

Counteract increased ICP with what

A

Hyperventilation

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39
Q

Goal of ETCO2 fro hyperventilation

A

25- 35

Correlate with blood gas

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40
Q

CMRO2 decreases at what MAC of sevo

A

0.4 MAC.

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41
Q

At what MAC value does sevo begin to maximally suppress CMRO2

A

..

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42
Q

As sevo dose approaches 1 MAC what happens to EEG

A

Frequency decreases and maximum voltage occurs

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43
Q

Sevo causes burst suppression on EEG at

A

1.5 MAC

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44
Q

EEG activity ceases at what MAC of sevo

A

2 MAC

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45
Q

Does Sevo produce convulsive activity on EEG

A

Does not

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46
Q

Does sevo suppress convulsive activity

A

Yes

47
Q

Sevo an evoked potential monitoring

A

Cause dose dependent decrease in amplitude and increased latency of evoked potentials

48
Q

Sevo effect on

  • cerebral vasodilation
  • cerebral vascular resistance
  • CBF
A
  • increased vasodilation
  • decreased resistance
  • increased CBF
49
Q

Sevo and ICP

A

Increases ICP

50
Q

How to decrease tendency of sevo to increase ICP

A

Hyperventilate decreasing PaCO2 to 30

51
Q

Sevo and BP r/t what

A

Decreased MAP rt decreased SVR

52
Q

Sevo and increased HR begins at what MAC

A

1.5 MAC

53
Q

Increased loss of body heat with sevo caused by

A

Increased cutaneous blood flow

54
Q

Is there potentiation of NMB’s with volatile agent administration

A

YES

55
Q

Sevo and RAP

A

Does not significantly alter RAP

56
Q

Sevo and PVR

A

No effect on PVR

57
Q

Sevo and doses of epi

A

Does not alter dose of epi needed

58
Q

HR decrease more with

A

Spontaneous ventilation as opposed to mechanical ventilation

59
Q

Abrupt increase in iso and des cause what to BP and HR

Why

A

Transient increases in HR and BP r/t increased SNS and RAA

60
Q

Sevo and contractility of myocardium

A

Decreases in normal and failing cardiac muscle

61
Q

Sevo produces dose dependent effect on

A
  • pattern of breathing
  • ventilatory response to CO2
  • ventilatory response to arterial hypothermia
  • airway resistance
62
Q

Pattern of breathing with sevo

A

Increased RR, decreased TV, increased deadspace

63
Q

Sevo produces apnea

A

Bw 1.5-2 MAC

64
Q

Pre- existing lung disease and ventilatory depressant effects of sevo

A

Worsens vent depression

65
Q

As duration of sevo anesthesia increases, ventilatory effects

A

Decrease

66
Q

Sevo interferes with what during spontaneous breathing

A
  • intercostal muscle function

- resulting in loss of chest wall stabilization

67
Q

Best way to treat hypoxemia and hypercarbia with pt breathing sevo

A

Put on vent or squeeze bag more

68
Q

Sevo effect on smooth muscle related to what

A

Relaxant effects r/t decrease in vagal nerve control

69
Q

Which decreases airway resistance more iso or sevo

A

Sevo

70
Q

Best for inhalation inductions

A

Sevo

71
Q

Sevo to what for inhalation induction

A

8%

72
Q

Sevo and metabolism of drugs

A

Drug metabolism decreased

73
Q

Sevo metabolism and liver

A

No effect

74
Q

Sevo and renal blood flow, GFR, UOP

A

Dose dependent decreases

75
Q

How to decrease reduction in renal function

A

Pre-hydrate

76
Q

Safety of sevo and ESRD

A

Not established

77
Q

Sevo metabolism rate

A

3-5%

78
Q

Sevo and skeletal muscle relaxation

A

Produces relaxation

79
Q

Sevo effect on NMD

A

Dose dependent enhancement of NMB effect

80
Q

Is sevo triggering agent for MH

A

YES

81
Q

Sevo degredation enhanced by

A

Higher absorbent temps

High sevo concentration

Low FGF

Desiccated CO2 absorbent

82
Q

Sevo depredation via path 1

A

Deflourination pathway: - Loss of hydrogen fluoride to form compound A

  • results from extraction of acidic proton in presence of strong base
  • KOH or NaOH form Compound A from sevo
83
Q

Concentration of degradents is ____________ to FGF rate

A

Inversely proportional

84
Q

Temp increase of absorbent is determined by what

A

Quantity of CO2 absorbed

85
Q

Quantity of CO2 absorbed by absorbent depends on

A
  • FGF in circuit
  • Pt metabolic rate
  • pt ventilation
86
Q

Minimum FGF to prevent compound A formation

A

2 liters

87
Q

Concentration of Compound A in circuit increases with what

A
  • concentration of sevo given

- duration of sevo anesthesia

88
Q

Second pathway of Sevo depredation

A
  • occurs in presence of desiccated CO2 absorbent and dissociation of sevo to HFIP and formaldehyde
  • formaldehyde can degrade to methanol and formate
  • formate can form carbon monoxide
  • methanol can form Compound B
89
Q

HFIP

A

Inactive and rapidly cleared by liver eliminated in urine

90
Q

Fluoride ion concentration influenced by

A
  • duration of anethesia
  • sevo concentration used
  • composition of anesthetic gas mixture
91
Q

Sevo metabolism rate

A

3-5%

92
Q

CO2 absorbent containing _________ and _________ produce much higher concentration in Compound A concentration from sevo

A

KOH

NaOH

93
Q

Absorbent containing neither KOH or NaOH and produces lower concentration of Compound A

A

Absorb

94
Q

Incidence of post op agitation with sevo

A

Greater with sevo than with other volatile agents

95
Q

Sevo produces what effect on uterine smooth muscle contractility and blood flow

Don’t give more than _____

A

Decreases

Don’t give more than 1 MAC

96
Q

Sevo and placenta

A

Easily crosses placenta but quickly exhaled by newborns

97
Q

Sevo and K+

Most vulnerable

A

Rarely ass with increase in K+

Duchesse muscular dystrophy more vulnerable

98
Q

Sevo and total body O2 requirements

A

Reduces requirement

99
Q

Solubilization of sevo may cause

A

Redistribution of membrane lateral pressures surrounding ion channels

100
Q

Sevo and CBF autoregulation

A

Does not alter

101
Q

Sevo produces ______________ in cerebral metabolic oxygen requirements.

Maxes out when ____________

A
  • dose dependent decrease

- isoelectric EEG obtained

102
Q

Abrupt increases in iso and des may cause ___________ in HR and BP r/t _______

A

Transient increase due to increased SNS and Renin angiotensin activity

103
Q

sevo minimally __________ myocardial contractility in normal and failing cardiac muscle

A

Decrease

104
Q

Sevo and RR

A

Dose dependent increase in RR

105
Q

Apne threshold with sevo

A

Apnea threshold 3-5mmHg less than PaCO2 in spontaneous breathing

106
Q

Sevo is metabolized by ________ to _______

A

Cytochrome P-450 to HFIP with release of inorganic fluoride and CO2

107
Q

How much sevo metabolized

A

5%

108
Q

Peak inorganic fluoride concentrations occur ________ and return to baseline _____

A

Within 2 hours

Within 48 hours from end of sevo admin

109
Q

Post op agitation and sevo

A

Incidence is greater with sevo than other volatile agents

110
Q

Sevo and uterine smooth muscle contractility and blood flow

Effect minimal at ____ and significant at ____

A

Decreases

0.5 MAC significant at 1 MAC

111
Q

Sevo _______ cross placenta.

A

Easily crosses

Quickly exhaled by newborn

112
Q

Sevo and MH

A

Less than halothane but greater trigger than nitrous

113
Q

Sevo and total body oxygen requirements

A

Decreases

Pharmacology (6 decks)

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