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Anesthesia Pharmacology > Volatile agents > Flashcards

Volatile agents Flashcards

1
Q

Desflurane (Suprane)

Class/ Category, use, MOA (how many florunes)

A

Class: volatile agent
use: maintenance of general anesthesia
MOA: unknown

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2
Q

Desflurine

MAC (adult)

A

6.6%

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3
Q

Desflurane

Blood: gas

A

0.42

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3
Q

Desflurane

CV effects

A

-Dose-dependent ↓ MAP (via ↓ SVR)
-Dose-dependent ↓ contractility
-Dose-dependent ↓/↔ CO
-↑ HR 5-10% from baseline, even at low concentrations (Des > Iso)
-Rapidly increased concentration → ↑ SNS and RAAS activity → ↑ MAP and HR*

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3
Q

Desflurane

% metabolism

A

0.02

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3
Q

Desflurane

vapor pressure

A

669

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4
Q

Desflurane

Pulm effects

A

-Dose-dependent ↑ RR
-Possible apnea at 1.5-2 MAC
-↓ Vt, ↓ MV
-↑ PaCO2, ↓ ventilatory response to PaCO2
-May promote bronchoconstriction, especially in smokers

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5
Q

Desflurane

CNS effects

A

-↓ CMRO2, ↑ CBF, ↑ CBV
-↑ ICP (especially if space-occupying lesion)
-Maintains CBF autoregulation up to 1 MAC
-Dose-related EEG changes; burst suppression at > 1.2 MAC

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6
Q

most pungent PIA and what does it cause

A

Desflurane
-promotes airway irritation, salivation, breath holding, coughing, or laryngospasm when > 6% given to awake patient

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7
Q

Degradation in a ____ CO2 absorber produces ______
(in what order of VA)

A

Desiccated, CO
Des>Iso»Sevo

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8
Q

signs of CO poisoning (carboxyhemoglobinemia)

Desflurane

A

↓ SpO2, mixed gas or Enflurane reading on gas analyze

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9
Q

T or F provides skeletal muscle relaxation

desflurane

A

True

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10
Q

Dose-Dependent potentiation of ____ by ____-____%

Order of volatile agents

A

NMBs by 30-40%
Des>Iso>sevo

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11
Q

Desflurane is a ____trigger and may be undesirable in pts with ____

A

MH, CAD

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12
Q

Des required vaporizor

A

Tec 6

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13
Q

Desflurane boiling point

A

22.8 C

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14
Q

Tec 6 heated to____, pressurized to ____

A

39C, 2 atm (1500psi)

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15
Q

What volatile agent requires vaporizor with power

A

Desflurane

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16
Q

T/F Isoflurane is MH trigger

A

true

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17
Q

Sevoflurane

Class/ Category, use

A

-volatile inhaled agent
-inhalation induction; maintenance of general anesthesia

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18
Q

Sevoflurane

MAC (adult)

A

2%

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19
Q

Sevoflurane

Blood:gas

A

0.65

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20
Q

Sevoflurane

% metabolism

A

2-5

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21
Q

Sevoflurane

Vapor pressure

A

157

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22
Q

Sevoflurane

CV effects

A

-Dose-dependent ↓ MAP (↓ SVR)
-Dose-dependent ↓ CO (at 1-1.5 MAC)
-Dose-dependent ↓ contractility
-↑ HR at 1-1.5 MAC

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23
Q

Sevoflurane

Pulm effects

A

-Dose-dependent ↑ RR
-Apnea at 1.5-2 MAC
-↓ Vt, ↓ MV
-↑ PaCO2, ↓ ventilatory response to PaCO2
-Promotes bronchodilation

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24
Q

Sevoflurane

CNS effects

A

-↓ CMRO2, ↑ CBF (for up to 4 hrs after stopping), ↑ CBV
-↑ ICP
-No alteration of CBF autoregulation
-Dose-related EEG changes, burst suppression at > 1.2 MAC
-Possible proconvulsant effect at high concentrations (1.5-2 MAC)

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25
Q

List 4 things different about Sevo (than Des/Iso)

A

-non-pungent
-minimal odor
-sweet-smelling
-least/no airway irritation

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26
Q

Degradation in desiccated CO2 absorber produces _______ rxn leading to ____and ____

A

exothermic, fire, carbon monoxide

27
Q

When sevo breaks down in CO2 absorber can cause what? with what side effect

A

Compound A, nephortoxicity

28
Q

how to prevent compound A (MAC hours, FGF, and LPM)

A

Exposure should NOT exceed 2 MAC hours at FGF 1-2 LPM, increase FGF >2LPM after 2 MAC hours

29
Q

what does Sevo metabolize into and what is a potential concern

A

inorganic fluoride, nephrotoxic

30
Q

T/F Sevo does NOT cause skeletal muscle relaxation

31
Q

T/F Sevo has risk factor for emergence delrium

32
Q

T/F Sevo is not MH trigger

33
Q

Isoflurane

Class/ Category, use

A

volatile inhaled agent, maintenance of general anesthesia

34
Q

Isoflurane

MAC

35
Q

Isoflurane

Blood:gas

36
Q

Isoflurane

% Metabolism

37
Q

Isoflurane

Vapor Pressure

38
Q

Isoflurane

CV effects

A

-Dose-dependent ↓ MAP (↓ SVR)
-Dose-dependent ↓ contractility
-Dose-dependent ↓/↔ CO
-↑ HR 5-10% from baseline, even at low concentrations (Des > Iso)
-Rapidly increased concentration → ↑ SNS and RAAS activity → ↑ MAP and HR

39
Q

Isoflurane

Pulm effects

A

-Dose-dependent ↑ RR up to 1 MAC (ceiling effect)
-↓ Vt, ↓ MV
-↑ PaCO2, ↓ ventilatory response to PaCO2
-Bronchodilator

40
Q

Isoflurane

CNS effects

A

-↓ CMRO2, ↑ CBF,↑ CBV
-↑ ICP
-Maintains CBF autoregulation up to 1 MAC
-Dose-related EEG changes, burst suppression at > 1.5 MAC, isoelectric at 2 MAC
-Anticonvulsant properties, does not evoke seizures

41
Q

Describe coronary steal syndrome and what VA is associated

A

-diversion of blood from myocardial bed with limited or inadequate perfusion to a bed with greater perfusion

-Isoflurane

42
Q

Isoflurance is less ____than ____ and can cause_____

A

Pungent, Des, airway irriation

43
Q

Nitrous Oxide (N2O)

class/ category, use, MOA

A

-Inorganic inhaled agent
-adjuvant for general anesthesia/ sedation/ analgesia
-NMDA antagonist

44
Q

Nitrous Oxide

MAC

45
Q

Nitrous Oxide

Blood:gas

46
Q

Nitrous Oxide

% metabolism

47
Q

Nitrous Oxide

Vapor pressure

A

38,770 mmhg/ 745psi

48
Q

Nitrous Oxide

CV effects

A

-↑/↔ BP
-↑ CO
-↔ SVR
-↑ SNS activity

49
Q

Nitrous Oxide

Pulm effects (5)

A

-↑ RR (equal or more than PIAs),
-↓ Vt (less than PIAs)
-No change or ↑ PaCO2 (less than PIAs)
-↑ PVR
-Lacks bronchodilator effect

50
Q

Nitrous Oxide

CNS effects

A

-↑ CMRO2,↑ CBF,↑ CBV
-↑ ICP

51
Q

Nitrous Oxide is a good choice for what patient population

and when?

A

Obstetrics (3rd trimester)

52
Q

Odorless to sweet smelling inhaled agent

A

Nitrous Oxide

53
Q

Nitrous Oxide is non-flammable but is still a fire risk because?

A

supports combustion

54
Q

____activity of Vit B12 dependent enzymes by irreversibly oxidizing the cobolt atom, which effects ____ and ____ synthetase

A

Nitrous oxide decreases, methionine, thymidylate

55
Q

T/F Nitrous Oxide can cause spontaneous abortion/ fetal effects/ cogential abnormalities

55
Q

May cause bone marrow suppression and neurological disturbances

A

Nitrous oxide

56
Q

What can Nitrous oxide do to air filled spaces and causes risk for what?

A

-expands airfilled spaces, ↑ pressures, high-volume absorption into gas-filled spaces 34x faster than N2 can escape

-risk for expansion of air-filled spaces, emboi

57
Q

What can occur when discontinuing nitrous oxide

A

Diffusion hypoxia for 1-5 min following discontinuation may transiently lower alveolar O2 and CO2 concentration

58
Q

Which inhaled agen can increase risk of PONV, and after how long

A

nitrous oxide, >6 hours

59
Q

which trimesters is N2O contraindicated

A

first and second

60
Q

List potential toxicity from expansion of gas-filled spaces from N2O

A

-Emphysema, pneumothorax, pneumocephalus, middle ear surgery, air embolus, bowel obstruction

61
Q

T/F N2O used in tympanoplasty

62
Q

T/F-Increased ICP and cerebral ischema can be caused by N2O

63
Q

relative contraindications for nitrous oxide

A

Pulm HTN, foreign body aspiration, thoracic anesthesia

64
Q

which inhaled agents do not cause MH

A

N2O and Xe

65
Q

Which inhaled agent has modest acute analgesic effect

A

Nitrous oxide

66
Q

Which inhaled agent does not provide skeletal muscle relaxation (potentiation of NMBs)

A

Nitrous oxide

67
Q

what does nitrous oxide do when combined with volatile agents

A

reduces MAC of volatile agents

68
Q

T/F nitrous oxide promotes uptake of second gas

Anesthesia Pharmacology (7 decks)

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