Chapter 8- Review Exam #2

Front 1

What is Sevo's MAC%, Blood/Gas PC at 37C, and oi/gas PC at 37C?

Back 1

mac- 2, BG - 0.6, OG- 50

Front 2

What is Iso's MAC%, Blood/Gas PC at 37C, and oi/gas PC at 37C?

Back 2

mac-1.15, BG-1.4, OG-99

Front 3

What is N20 MAC%, Blood/Gas PC at 37C, and oi/gas PC at 37C?

Back 3

mac- 105, BG- 0.47, OG- 1.4

Front 4

What is Des MAC%, Blood/Gas PC at 37C, and oi/gas PC at 37C?

Back 4

mac- 5.8, BG- 0.42, OG- 18.7

Front 5

What are 6 factors influencing absorption?

Back 5

1. Ventilation
2. Uptake into the blood
3. CO
4. Solubility in the blood
5. Alveolar to venous blood PP difference
6. Concentration and 2nd gas effect

Front 6

Level of anesthesia is related to?

Back 6

alveolar concentration

Front 7

PP in the lungs is same as?

Back 7

the PP in the brain

Front 8

What are 2 factors that affect uptake early in anesthetic administration?

Back 8

drug solubility in the rubber and plastic machine parts and total machine liter flow

Front 9

Could rubber, plastic components, ventilator and absorbent slow administration at the beginning? for how long?

Back 9

yes, after 15 minutes it ceases

Front 10

What gases are potential triggers for MH?

Back 10

all except for nitrous

Front 11

What do you do if you have a suspected MH pt?

Back 11

1. Flush machine with 100% O2 at 10L/min for at least 20 min
2. Replace breathing circuit and canister
3. Drain or inactivate vaporizers

Front 12

What does the blood gas solubility coefficient indicate?

Back 12

the speed of uptake and eliminiation

Front 13

What does blood/gas solubility reflect?

Back 13

the proportion of anesthetic that will be soluble in the blood, bind to blood components, and not readily enter the tissues (blood phase), versus the fraction that will leave the blood and quickly diffuse into tissues (gas phase)

Front 14

The more soluble the agent, the?

Back 14

(higher coefficient) the SLOWER the brain and spinal cord uptake and slower induction

Front 15

Do more soluble or less soluble drugs stay in the blood in greater proportion?

Back 15

more soluble drugs, and less of the drug is released in the early/rapid uptake phase of induction.

Front 16

Iso has b/g solubility of 1.4 or 1.4:1, what does that mean?

Back 16

Therefore 1.4 more stays in the blood than goes to the tissues.

Front 17

The lower the blood/gas solubility, the?

Back 17

faster the rise in lung concentration.

Front 18

Anesthetic agents move?

Back 18

down a concentration gradient

Front 19

Does uptake of the anesthetic gas slow during the procedure?

Back 19

yes

Front 20

What is the ventilation effect?

Back 20

The faster and more deeply a patient is ventilated the faster the patient losses consciousness and emerges at the end

Front 21

What hinders inhalational agent administration?

Back 21

V/Q deficits or poor lung function

Front 22

Which gases are more affected by VQ deficits and poor lung function?

Back 22

Rapid acting (low blood/gas coef) drugs

Front 23

What is overpressuring or the concentration effect? More effective for?

Back 23

(1) A higher concentration is necessary during the first few minutes than during maintenance to speed initial uptake
-More effective the more soluble the anesthetic (slower)
-Less effect on the fast agents

Front 24

What is the second gas effect?

Back 24

Simultaneous administration of a slow agent (iso) with a fast agent (nitrous) in high concentrations can speed onset
(a) The uptake of the slower agent is increased
(b) The faster the speed of the slower gas the less pronounced the effect is, for example it is less effective with sevo and des

Front 25

The oil/gas solubility coefficient is an indicator of ?

Back 25

potency

Front 26

The higher the solubility the more potent the drug due to?

Back 26

higher lipid solubility

Front 27

Of the current agents, what is the most potent?

Back 27

iso, nitrous oxide is the least

Front 28

What two factors are at play with OG solubility?

Back 28

speed of delivery to tissues (blood/gas solubility) and efficiency of access to target tissues (oil/gas solubility)

Front 29

In the cardiovascular system what two major things influence the uptake and distribution?

Back 29

(1) Majority of blood leaving the lungs is normally distributed to the vital organs aka vessel rich group or central compartment before the muscle and fat areas
(2) During induction, increases in cardiac output slow onset

Front 30

The longer the agent is given the greater the?

Back 30

saturation of all the body compartments

Front 31

With increases in cardiac output what type of agent is more affected?

Back 31

The more soluble the agent (slower) the greater the effect

Front 32

Does increased output remove more agent from the lungs?

Back 32

yes, so slower the onset

Front 33

What is the perfusion to the VRG?

Back 33

75 mL/min/100g

Front 34

What is the perfusion to the muscle?

Back 34

3 mL/min/100g

Front 35

What is the perfusion to the fat?

Back 35

3 mL/min/100g

Front 36

What is the perfusion to the vessel poor group?

Back 36

0

Front 37

What is the distribution of cardiac output?

Back 37

VRG- 75%, muscle- 19%, fat- 6%

Front 38

What is the body weight of the groups?

Back 38

VRG-10%, msucle- 50%, fat- 20%, VPG- 20%

Front 39

What agents are least metabolized and do not result in toxicity from metabolism?

Back 39

Nitrous, Des, Iso

Front 40

What agent is metabolized?

Back 40

sevo-

Front 41

What is the average metabolism of each agent?

Back 41

Sevoflurane 3-6%
Nitrous Oxide < 1%
Iso &lt; 1%
Des &lt; 0.1%

Front 42

What factors affect emergence?

Back 42

all the factors that affect induction

Front 43

Leaves the tissues via?

Back 43

via the blood, then exits through the lungs

Front 44

T or F. Anesthetics redistribute out more uniformly than the onset

Back 44

True

Front 45

The longer the agent is administered, the?

Back 45

slower the emergence

Front 46

Differences during emergence exist when?

Back 46

during the final 20% of elimination

Front 47

Diffusion Hypoxia

Back 47

When high concentrations of a fast (insoluble) anesthetic like nitrous are given and the drug exits quickly through the lungs it is replaced by less soluble nitrogen in air and may transiently dilute respiratory gases such as oxygen and Carbon dioxide

Front 48

Nitrous oxide is how many times more soluble than nitrogen?

Back 48

34

Front 49

Sevo reacts with the absorbent, what increases the reaction?

Back 49

heat, and FGF < 2L/min

Front 50

What type of absorbent is less reactive?

Back 50

Ambsorb

Front 51

The uptake of agents in children is? due to?

Back 51

faster than in adults, higher ventilation per weight

Front 52

Peds have a higher ___ per weight.

Back 52

CO

Front 53

Will the higher CO slow uptake?

Back 53

This will slow output slightly but is minimal due to the increased CO to the vessel rich group in children and infants

Front 54

What other factor in children affects uptake?

Back 54

a lower muscle mass that allows more agent to accumulate in the vital organs, and promotes uptake to the brain

Front 55

How is the MAC affected in a child?

Back 55

higher

Front 56

Anesthetics appear to be _____ soluble.

Back 56

less

Front 57

What two agents are associated with delerium emergence?

Back 57

des and sevo

Front 58

What has been found to decrease delerium emergence?

Back 58

fentanyl or precedex

Front 59

What two drugs have been found not to decrease delerium emergence?

Back 59

propofol and versed

Front 60

What effect does obesity have on anesthesia?

Back 60

emergence may be slower b/c of deposition of anesthetics in fat