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27 Cards in this Set
- Front
- Back
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What volatiles decrease MAP the least and which ones decrease it the most?
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decrease MAP the least: halothane
decrease MAP the most: des and iso |
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How does ISO, DES and Halothane affect CO?
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ISO and DES: CO is unchanged
halothane: decreases CO |
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How can you attenuate the increased CBF associated with iso and des?
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prior hyperventilation
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How does des affect the airway?
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airway irritation, breath holding, coughing, excessive secretions, laryngospasm
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Why do we heat the desflurane vaporizer?
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due to high vapor pressure(near atmospheric pressure) small changes in liquid temperature or barometric pressure will greatly affect vaporizer output. Heating the vaporizer raises it's partial pressure so the vaporizer can be metered more accurately
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How much isoflurane vapor can be generated by one mL of liquid isoflurane?
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200mL of isoflurane vapor
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How does N2O affect HR, CO, MAP, CBF, PAP?
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increases HR, CO, MAP
increases CBF increases PAP |
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Where in the body will an air bubble expand the rapidest with N20?
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blood(less barriers to diffusion)
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When is N2O contraindicated?
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air embolus(also congenital heart disease), bowel obstruction, COPD-emphysema, cor pulmonale, cardiac dysfxn, eye and ear surgery of certain types, PTX, pneumocephalus, trauma in the presence of head or chest wall trauma
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What does N2O expand faster an air embolus or a PTX?
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air embolus
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Why is halothane beneficial in aortic stenosis or mitral stenosis?
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do not want to increase heart rate or decrease SVR
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Why is isoflurane beneficial with regurgitant cardiac lesions?
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increases HR, decreases SVR
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Rank isoflurane, enflurane and halothane by greatest to least respiratory depression
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Enflurane>halothane>isoflurane
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What do you see on the EEG with halothane and isoflurane and at what dose?
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burst suppression at 2MAC iso and 4MAC halo
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What are some renal manifestations of flouride toxicity?
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polyuria, decreased urine concentrating ability
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How does cold affect induction with volatiles?
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cold increases solubility and slows induction
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How does mainstem intubation affect induction with volatiles?
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for very soluble agents induction is not delayed, for insoluble agents induction is delayed
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How is induction affected in neonates and pregnant patients with volatiles?
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increased ratio of minute ventilation to FRC which accelerates induction
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How does CHF or cirrhosis affect metabolism of volatiles?
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my decrease the magnitude of overall metabolism
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How can halothane be metabolized?
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2 pathways: oxidative(normal pathway)->triflouracetic acid, bromide and chloride; reductive(hepatic hypoxia or obesity)
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What are the blood gas solubilities of the volatile anesthetics?
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des 0.42, N20 0.47, sevo 0.6, iso 1.4, halothane 2.3
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What are the vapor pressures of the volatile anesthetics?
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sevo 160, iso 238, halothane 240, des 665
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if a machine is calibrated at seal level and then taken to higher elevation what happens to the amount of anesthetic delivered?
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vapor pressure remains the same, barometic pressure decreases thus VP/BP increases and the delivered concentration is higher than appears on the dial
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Why do we see frost on the N2O cylinder?
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expansion of fresh gas absorbs heat resulting in frost in the cylinder
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How do you calculate how much N2O is in a cylinder?
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weigh the cylinder 44gms/mole, 22.4 liters/mole
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how do you deal with a tipped anesthetic vaporizer?
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set vaporized at low concentration; flush with oxygen at 10L/min for 30min
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What decreases MAC?
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PaO2<40mmHg, severe hypotension, hypothermia, Hb<4, age, alpha methyldopa, PaCO2>90mmHg, benzos, barbs, cholinesterase inhibitors, chronic amphetamines, narcotics, ketamine, pregnancy, reserpine, guanethidine, clonidine
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