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23 spring anesthesia > Test 1: 12 + 13: inhalant agents > Flashcards

Test 1: 12 + 13: inhalant agents Flashcards

1
Q

vapor pressure of isoflurane

A

240

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2
Q

vapor pressure of sevoflurane

A

160

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3
Q

vapor pressure of desflurane

A

664- very close to sea level pressure

means boiling point very close to room temp, need to be stored at high pressure to keep in liquid form

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4
Q

which inhaled anesthetics have the highest blood gas ratio and what does this mean

A

isoflurane has the highest

takes a longer time to cause change in the body when you change the amount of drug given

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5
Q

what does oil gas ratio mean

A

amount of drug disolved into the lipid/brain= more potent

iso: 91
servoflurane: 50
desflurane: 18
N2O: 1.4

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6
Q

how does generic variable bypass vaporizer work

A

used for iso and sevoflurane

made of bronze- keeps temp constant and therefore vaporization of drug constant

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7
Q

how does desflurane vaporizers work

A

desflurane boils at close to room temp 23.5°C

the vaporizer keeps drug at 39°C and at specific pressure= this allows for rate of vaporization to be constant

injects desflurane vapor into fresh gas stream

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8
Q

inhalant anesthetics cause what in the CNS

A

spinal cord and brain
inhibit sensory processing, nocicpetive signaling and motor response to pain

Brain
hypnosis and amnesia
loss of consciousness
analgesia

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9
Q

how do inhalant drugs work

A

↓ excitatory receptors: inhibit central ACh receptors and NMDA receptors in the brain

stops receptors from opening and sending AP

↑ function of inhibitory receptors: GABA A receptor, glycine, serotonin

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10
Q

MAC

A

minimum alveolar concentration

The anesthetic concentration preventing motor response to a supramaximal noxious stimulus in 50 % of subjects.

Correlates inversely with O/G part. coeff: the more lipophilic the drug the less drug you need to give to cause sedation

agent and species specific

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11
Q

— will decrease MAC valves

A

Increasing age (calmer when older)
Pregnancy (endogenous opioid release)
Hypothermia
Hypotension (MAP< 40 mmHg)
Hypoxemia (PaO2< 38 mmHg)
Hyponatremia
CNS depressant drugs/analgesics

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12
Q

— will increase MAC valve

A
  • Hyperthermia
  • Hypernatremia
  • CNS stimulants
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13
Q

non-anesthetic cerebral effects of iso

A
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14
Q

non-anesthetic cerebral effects of sevoflurane

A
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15
Q

non-anesthetic cerebral effects of desflurane

A
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16
Q

adverse effects of inhaled anesthetics on respiratory system

A

central respiratory depression

↓ tidal volume (iso > sevo, des)
↓RR ( ↑ up to 1 MAC)
↑ PaCO2 Des>Iso = sevo

bronchodilation (iso= sevo>des)

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17
Q

adverse effect of iso on CV system

A
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18
Q

adverse effect of sevoflurane on CV system

A
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19
Q

adverse effect of desflurane on CV system

A

↓CO by ↓Ca into cell

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20
Q

Adverse effect of inhalants on kidney

A

↓ renal blood flow
↓ urine output

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21
Q

adverse effects of inhalants on liver

A

↓ blood flow to liver → ↓ drug metabolism by 50-70%

need to give lower doses of meds

22
Q

adverse effects of inhalants on skeletal muscle

A

↓ muscle tone from ↓ Ca into the cell

Augmentation of neuromuscular
blockade by Non-Depolarizing
Neuromuscular Blockers
(NDNMB)

23
Q

adverse effects of inhalants on fetus

A

↓ blood flow to fetus

24
Q

why use sevoflurane over iso

A

faster induction and faster recovery
no pungent odor
can change depth of med faster
less ↓BP
less respiratory depressant

25
Q

disadvantages of sevo vs iso

A

metabolized in the liver into inorganic fluoride ions

could be cause renal and liver damage in rats: not seen in man, dog or monkey

26
Q

pros and cons of using desflurane

A
  • Requires special vaporizer
  • Irritating to airways
  • Rapid induction & recovery (B/G 0.42; Low Tissue/Blood part. coeff.)
  • Pharmacodynamic profile similar to isoflurane but less cardiac output depressant
  • Basically no metabolism
27
Q

why use nitrous oxide

A

analgesic properties

28
Q

recumbency + inhalant anesthetics cause

A

increased PaCO2 → resp. acidosis and acidemia
hypoxemia
hypotension: tissue hypoperfusion, cardiac arrhythmias, muscle weakness

29
Q

inhalant anesthetics cause vaso—-, inhibition of the — nervous system and — stress hormone release

A

vasodilation

ANS: negative-inotropic effect, ↓ of autonomic CV reflexes

increased

even though negative inotrope, CO stays similar cause vasodilation balances it out, when at normal levels

30
Q

why use PIVA for anesthesia

A

use combo of injectable and inhalants with analgesics or NM blockers

  • can reduce dose needed for each drug
  • decrease adverse effects
  • more rapid recovery
31
Q

the use of balanced anesthesia will do what to PaCO2 and MAP

A

will decrease PaCO2= better respiratory function

will increase MAP= better perfusion

32
Q

reduction in MAC is cause

A
  • reduced stress response
  • inhibition of intraoperative nocicpetion: improved analgesia and recovers faster
  • improved overal perianesthetic outcome
33
Q

how to monitor balanced anesthesia

A
  • Palpebral reflexes less suppressed
  • Hemodynamic parameters (esp. arterial blood pressures (ABP)) often closer to physiological values
  • Plane of anesthesia appears often light despite no response to surgical stimulation

Indicators of light anesthesia in case of ketamine CRI
* Rapid nystagmus
* Sudden rises in HR, ABP, RR, skeletal muscle tone

34
Q

factors that affect uptake, distribution and elimination of inhaled anesthetics

A

physical properties: gradient of anesthetic partial pressures
chemical properties: solubility in blood vs tissues
Physiological factors: RR and CO

35
Q

distribution into muscle of IA will determine —.

A

how long stays in system, when pt will wake up

Desflurane faster then ISO and Sevo

36
Q

change in the amount of IA med that machine is turned to →brain

A
37
Q

Every change in concentration of IA in the CNS follows changes in the PP in the —

A

alveolar gas mixture and arterial blood

(brain follows changes in dose of inhaled anesthetic)

38
Q

factors affecting inspired gas concentration

A

fresh gas flow rate (↑FGF = ↑rate of induction)
volume of breathing circuit (dead space)
absorption (tubing of machine can absorb some of the med

39
Q

factors affecting alveolar concentration of IA

A

Delivery via circuit
machine setting

alveolar ventilation
(↑ ventilation= ↑ delivery)

pulmonary uptake: blood/gas solubility coefficient (B/G)
↑ solubility= ↓ rate of induction
blood and tissue act as sponge

pulmonary blood flow
(↑ the blood flow the slower the induction)
not relavant anymore

tissue uptake
tissue solubility, blood flow and partial pressure difference between arterial blood and tissue

40
Q

how does pulmonary uptake affect alveolar concentration of IA

A

pulmonary uptake: blood/gas solubility coefficient (B/G)
↑ solubility= ↓ rate of induction
blood and tissue act as sponge

pulmonary blood flow
(↑ the blood flow the slower the induction)
not relavant anymore

tissue uptake
tissue solubility, blood flow and partial pressure difference between arterial blood and tissue

41
Q

if the blood gas solubility coefficient is high what happens to rate of induction

A

lowers
blood and tissue act like a sponge

42
Q

the higher the pulmonary blood flow the — the rate of induction of anesthesia

A

slower

with modern IA drugs almost irrelevant

43
Q

the higher the tissue uptake the — the rate of induction

A

slower

(a) Tissue solubility of anesthetic agent
(b) Tissue blood flow
(c) Partial pressure difference between arterial blood and tissues

44
Q

factors affecting arterial concentration of IA gas

A

VQ mixmatch

deadspace
intrapulmonary shunting

45
Q

alveolar gas delivery is dependent on

A
  • concentration and partial pressure
  • ventilation rate
46
Q

IA alveolar gas uptake is due to

A

blood gas solubility
pulmonary (alveolar) blood flow
tissue uptake

47
Q

IA inspired gas is based on

A

FGF rate
absorption by breathing circuit
volume of breathing circuit

48
Q

arterial concentration of IA is dependent on

A

V/Q mixmatch

49
Q

how to cause rapid induction of IA

A

give higher dose 1-4 MAC depending on the med

50
Q

which IA has the longest recovery time and why

A

sevoflurane (has higher amount that dissolves into muscle)

sevo ≃iso > des > nitro

23 spring anesthesia (40 decks)

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