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19 Cards in this Set
- Front
- Back
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NITROUS OXIDE
CNS EFFECTS |
not potent but great analgesic
35% = max analgesia 75% = 50% pts unaware of their surroundings 60% and over = Increase in CBF and ICP |
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HALOTHANE
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MAC % 0.75
BLOOD GAS COEFF. 2.5 VAPOR PRESSURE 243 |
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ISOFLURANE
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MAC % 1.2
BLOOD GAS 1.4 VAPOR PRESSURE 240 |
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FORANE (ISOFLURANE)
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ADV. cheap, very soluble, slow to leave patient, cardio-protective
DISADV. Solubility high, req more skill to use (timing), risk of awareness, may slow OR turnover, not to be used for induction |
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SEVO (SEVOFLURANE)
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ADV. non pungent, good for induction, less SNS activation, cardioprotective, used with N2O to decrease need for SEVO, quicker wake up
DISADV. cost, solubility, compound A |
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DESFLURANE
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MAC % 6.0
BLOOD GAS 0.45 V.P. 681 |
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SUPRANE (DESFLURANE)
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ADV. Insoluble, fast on fast off, easy to use, fast OR turnover, low residual, pt more awake after less hangover feel
DISADV. pungent, cost, SNS stimulation, careful with irritable airways, asthma, smokers, req special vaporizer |
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RESP EFFECTS OF I.A.
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good for bronchospasm
most are airway irritants esp des decrease TV increase RR minute ventilation decrease chemoreceptor response to CO2 blunted all great bronchodilators by direct action on smooth muscle |
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FACTORS AFFECTING WAKE UP
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agent used
length of procedure age, mental status obesity- airway obstruction, sleep apnea |
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CV EFFECTS OF I.A.
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baroreceptors preserved
all cause CV depression, which in turn cause increase rate of concentration rise halo = enf > des >iso >sevo Des > Iso initial tachycardia Halothane decrease HR Sevo = Enf neutral CO fairly well preserved Des and Iso > Sevo |
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MORE CV EFFECTS OF I.A.
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all smooth muscle relaxants
all vasodilate and decrease SVR (except N2O) coronary dilators Iso > Sevo = Des arrhythmias - Halo worst > Enf > Iso > Des ***potentiates catecholamine arrhythmias sensitizes heart to epi |
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CNS EFFECTS OF I.A.
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Increase CBF, autoregulation of cerebral blood impaired
Increase ICP ventilatory responses blunted (could be sleep apnea, narcotics, benzos) EEG decrease amplitude, increase latency |
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INTRAOPERATIVE AWARENESS
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estimated 0.15 % of all cases
R.F. age, gender, substance abuse 1. paralytic use 2. type of surgery 3. poor machine maintenance |
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KIDNEY I.A. EFFECTS
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transient usually return to normal after stopping anesthesia
dose dependent decrease in renal blood flow, GFR, urine output SEVO potential compound A |
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LIVER EFFECTS
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most cause transient LFT's
Halothane 1:10,000 usually mult exposure |
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MH
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Fulminant hypermetabolic state of skeletal muscle induced by I.A. and sux
***release of Ca from sarcoplasmic reticulum Ryanodine receptor First sign usually increasing ETCO2. -> increase HR increase in temp late sign |
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SEVO
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MAC % 2.0
B.G. 0.65 V.P. 160 |
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N2O
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only inorganic gas in clinical use
colorless, pleasant smell, not explosive, not flammable used in combo with I.A. or O2 BG coeff. 0.47 not resp irritant good for induction cheap, low solubility |
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N2O
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minimal CV effects
Increase RR, decrease TV, reduced ventilatory response to CO2, decreased hypoxic drive not trigger for MH Major drawback is diffusion into closed air spaces space will expand increase volume or pressure or both careful on long case with ETT |
