Inhalation Agents3--Pharm Test 3

Front 1

Do Volatile inhalation agents depress the Autonomic Nervous System? If so, what part(s)?

Back 1

YES; depresses both the SNS and the PNS

Front 2

Which 3 agents inhibit preganglionic sympathetic efferent activity?

Back 2

Halothane, Enflurane and Isoflurane

Front 3

Which 3 agents reduce postganglionic sympathetic nerve activity?

Back 3

Halothane, Enflurane adn Isoflurane

Front 4

Which 3 agents block postsynaptic nicotinic receptors in the stellate ganglion?

Back 4

Halothane, Enflurane and Isoflurane

Front 5

Which 3 aqents induce reductions in norepinephrine release from postganglionic sympathetic nerves?

Back 5

Halothane, Enflurane and Isoflurane

Front 6

Which 3 agents may contribute to depression of reflex vasoconstriction in peripheral blood vessels?

Back 6

Halothane, Enflurane and Isoflurane

Front 7

Does Halothane inhibit the Parasympathetic Nervous System (PNS)?

Back 7

YES

Front 8

TRUE/FALSE: Halothane depresses vagal nerve efferent activity

Back 8

TRUE

Front 9

Halothane inhibits reflex _____ in response to increases in arterial pressure

Back 9

BRADYCARDIA

Front 10

Which 2 IAs have equivalent depression of PNS and SNS?

Back 10

Halothane and Isoflurane

Front 11

Does Halothane depress the baroreceptor reflex control of arterial pressure?

Back 11

YES

Front 12

Does Halothane depress the sympathetic responses to declines in arterial pressure (such as increased HR in response)?

Back 12

YES

Front 13

With Halothane the HR stays stable with increasing MAC concentration; Although the BP is dropping with increasing MAC, HR stays low and stable; what does this mean?

Back 13

the Baroreceptor reflex is NOT intact; Halothane depresses this reflex

Front 14

What effect does Halothane have on myocardial contractility?

Back 14

dose related depression of myocardial contractility

Front 15

Which 2 IAs have a higher dose-related depression of myocardial contractility than Isoflurane?

Back 15

Halothane and Enflurane

Front 16

What effect does Halothane and Isoflurane have on preload and afterload?

Back 16

Halothane and Isoflurane produce beneficial decreases in LV preload and afterload in patients eith heart failure and coronary artery disease

Front 17

What inotropic effect does Halothane produce?

Back 17

Negative inotropic effects

Front 18

What are the negative inotropic effects from Halothane caused by?

Back 18

Alterations in intracellular Ca++

Front 19

The negative inotropic effects of Halothane and Enflurane cause a depression of what?

Back 19

BP

Front 20

Routine BP meds such as Beta Blockers and Calcium channel blockers may increase the _____ of BP depression caused by admin. of Halothane or Enflurane

Back 20

magnitude

Front 21

Although some IAs depress BP, should routine blood pressure medications be continued despite this?

Back 21

YES

Front 22

Does Halothane cause bradycardia or tachycardia?

Back 22

Bradycardia

Front 23

Is Halothane-induced bradycardia more problematic in adults or peds? Why?

Back 23

Peds; because their BP depends on their HR

Front 24

How does Halothane cause bradycardia?

Back 24

Slows the rate of SA node discharge by direct and indirect effects on SA node automaticity; also prolongs AV conduction time and refractoriness

Front 25

What drug should you have ready when giving a Pediatric patient Halothane (due to its bradycardic effects)?

Back 25

Atropine

Front 26

Which IA sensitizes the myocardium to the arrhythmogenic effects of Epinephrine?

Back 26

Halothane

Front 27

Which IA reduces the threshold for atrial and ventricular arrhythmias?

Back 27

Halothane

Front 28

When escalating doses of epinephrine (endogenous or exogenous) is combined with admin. of _____ (IA), PVCs and sustained ventricular tachyarrhythmias are more likely to occur

Back 28

Halothane

Front 29

TRUE/FALSE: When administering Halothane you should avoid the coadmin. of Epinephrine

Back 29

TRUE

Front 30

If patient is to receive Halothane during surgery, why is it important to keep patient calm before/during surgery?

Back 30

to avoid increases in endogenous Epinephrine levels

Front 31

What drug can you give patient pre-op to keep them calm in an attempt to decrease/limit endogenous Epi levels?

Back 31

Versed

Front 32

When administering Halothane, Epinephrine coadmin needs to be avoided or severely limited; if it's necessary to give Epi, what is the recommended concentration and dosage?

Back 32

1:100,000 (0.1 mg/10 minutes)
1:100,000 (0.3 mg/hour)

Front 33

0.5% Lidocaine s.q. given with Epi allows you to ____ the dose of Epi you can safely administer with Halothane. Why?

Back 33

Double; because of the cardioprotective effects of Lidocaine

Front 34

Halothane causes what changes in PCO2 above 1 MAC? Why does this occur?

Back 34

slight Increase in CO2; occurs because of the Decrease in TV

Front 35

What effect does Halothane have on TV?

Back 35

Decreases

Front 36

What effect does Halothane have on RR?

Back 36

Increases

Front 37

What net effect does Halothane have on overall minute volume?

Back 37

Fairly stable

Front 38

All IAs depress the response to ______

Back 38

HYPOXIA

Front 39

the depressed response to hypoxia that occurs with IAs can ve overcome by doing what?

Back 39

Stimulating the patient

Front 40

Which IA depresses the response to hypoxia more severely than other IAs without external stimuli?

Back 40

Halothane

Front 41

When administering Halothane to a COPD patient is it good to allow them to ventilate spontaneously or to use mechanical ventilation? Why?

Back 41

Mechanical Ventilation; Halothane depresses the hypoxic drive to breathe (which is what COPD patients depend on); mechanical ventilation would be most appropriate

Front 42

What effect does Halothane have on GFR and renal blood flow?

Back 42

Decreases both

Front 43

Does Halothane decrease or increase urinary output? Why?

Back 43

Decrease; decreased due to decreased CO and decreased BP; autoregulation of renal blood flow is intact

Front 44

What intervention is important when giving Halothane to prevent Halothane-induced decrease in GFR, renal blood flow and decreased urinary output?

Back 44

Give them fluids; pre-op hydration abolishes or attenuates these effects

Front 45

What effect does Halothane have on uterine muscle?

Back 45

relaxes uterine muscle and inhibits contractions

Front 46

Does Halothane rapidly cross the placenta?

Back 46

YES

Front 47

What's a disadvantage for using Halothane alone in a C-section patient? What combo is recommended to use instead?

Back 47

Increases blood loss; use 0.5 MAC of Halothane and 0.5 MAC of N2O

Front 48

While Halothane causes uterine relaxation and can cause excessive bleeding, how can this be useful in a postpartum patient?

Back 48

valuable for uterine relaxation to help remove retained placenta fragments; retained placenta fragments can cause a woman to bleed to death!

Front 49

Halothane undergoes 2 pathways for metabolism; what are they?

Back 49

Reduction (Low O2)
Oxidative (ample O2)

Front 50

When Halothane undergoes the Oxidative metabolic pathway, what is it metabolized to?

Back 50

Trifluoroacetic Acid

Front 51

All Fluorinated Volatile IAs (EXCEPT Sevoflurane) may produce what metabolite?

Back 51

Trifluoroacetic Acid

Front 52

Trifluoroacetic acid is detected in the urine for how long?

Back 52

Many days

Front 53

In genetically susceptible patients, an antigen is formed that provokes the formation of antibodies to the Trifluoroacetic Acid metabolite of Halothane; this sensitivity reaction is called what?

Back 53

"Halothane Hepatitis"

Front 54

Which fluorinated IA is the only one that will NOT produce the Trifluoroacetic Acid metabolite?

Back 54

Sevoflurane

Front 55

Trifluoroacetic Acid cross sensitivity may occur between which 3 fluorinated IAs?

Back 55

Halothane, Enflurane and Isoflurane

Front 56

Which fluorinated IA is the least metabolized IA and therefore the least likely to cause hepatic damage?

Back 56

Desflurane

Front 57

First reports of liver damage associated with Halothane occurred in _____ (year)?

Back 57

1958

Front 58

What's the incidence of the "mild form" of "Halothane Hepatitis?" The severe form?

Back 58

Mild form=1:5
severe form=1:10,000

Front 59

The mild form of Halothane Hepatitis causes what kind of necrosis? The severe form?

Back 59

Mild form=Focal Necrosis
Severe Form=Massive Hepatic Necrosis

Front 60

The mild form causes mild elevation of what liver enzymes?

Back 60

ALT, AST

Front 61

The severe form of Halothane Hepatitis causes a marked elevation of what liver enzymes?

Back 61

ALT, AST, Bilirubun, Alkaline Phosphatase

Front 62

What is the mortality rate of the severe form of Halothane Hepatitis?

Back 62

50%

Front 63

Is Halothane a potential triggering agent for Malignant Hyperthermia?

Back 63

YES

Front 64

Which agent has replaced Halothane as an induction agent for children in the U.S?

Back 64

Sevoflurane

Front 65

Pro-arrhythmic potential has been confirmed with the use of Halothane; how would you treat Halothane-induced dysrythmias?

Back 65

Treat with Lidocaine

Front 66

Chemically, Ethrane (Enflurane) is an _____.

Back 66

Ether

Front 67

Why is it important NOT to hyperventilate a patient on Ethrane (Enflurane)?

Back 67

Decreasing PaCO2 < 30 torr causes SEIZURE activity

Front 68

Administering Ethrane above ____ MAC concentrations can cause seizure activity

Back 68

above 2 MAC

Front 69

If patient on Ethrane (Enflurane) has seizure activity and they are at a MAC concentration above 2, what do you do?

Back 69

Treat by decreasing MAC, returning to normocarbia

Front 70

Does increasing MAC of Enflurane (Ethrane) lead to electrical silence (EEG)?

Back 70

NO; can't depress electrical activity of the brain like you can with other agents

Front 71

With Ethrane admin. is autoregulation of Cerebral Blood Flow (CBF) completely intact?

Back 71

NO; however increases in BP/MAP cause SMALLER increases in brain perfusion than with Halothane admin

Front 72

With Ethrane admin, autoregulation of CBF stays relatively normal and stable until approx. what MAC?

Back 72

0.6 MAC

Front 73

What effect does Ethrane (Enflurane) have on CSF production and absorption?

Back 73

Increased rate of production and decreased absorption

Front 74

Because Ethrane increases production and decreases absorption of CSF, what effect does this most likely have on ICP?

Back 74

May increase ICP

Front 75

What 3 factors increase ICP with Ethrane admin?

Back 75

increase in CBF, seizure activity, and increased CSF production

Front 76

What factor decreases ICP with Ethrane admin?

Back 76

LOW MAP

Front 77

Enflurane depresses the Myocardium to a greater extent than which 2 other IAs?

Back 77

Halothane and Isoflurane

Front 78

Enflurane (Ethrane) has what effect on PaCO2?

Back 78

Greatly increases PaCO2;

Front 79

Because Enflurane greatly increases the PaCO2 level in the patient, is it a good drug to chhose for a patient who is going to breathe spontaneously?

Back 79

NO

Front 80

What effect does Enflurane have on TV?

Back 80

Decreases TV

Front 81

What effect does Enflurane have on RR?

Back 81

Increases

Front 82

What effect does Enflurane have on Minute Ventilation?

Back 82

Decreases

Front 83

Metablism of Enflurane produces what kind of an ion?

Back 83

Inorganic Fluoride ion

Front 84

Even low fluoride ion concentrations have been associated with a 25% decrease in maximum urine _____ ability

Back 84

Concentrating

Front 85

Because Enflurane metabolizes into a fluoride ion, what effect does this have on renal function?

Back 85

May temporarily alter renal function

Front 86

Should you administer Ethrane to patients with pre-existing renal disease?

Back 86

NO; may be harmful

Front 87

Which IA produced the highest serum Fluoride concentrations when metabolized which is why we no longer use it anymore due to its harmful renal effects?

Back 87

Methoxyflurane (Penthrane)

Front 88

Does Ethrane produce dose-related skeletal muscle relaxation or rigidity? How?

Back 88

Relaxation; depresses NM function

Front 89

Does admin of Ethrane potentiate or inhibit muscle relaxants?

Back 89

Potentiate

Front 90

Because Ethrane produces good muscle relaxation, its use may be adequate for what type of surgery?

Back 90

Abdominal

Front 91

Usage of Muscle Relaxants allows the dose of Ethrane to be _____.

Back 91

Decreased (synergistic)

Front 92

Ethrane has a lower incidence of liver damage due to its low degree of ______.

Back 92

Biodegration

Front 93

Which IA, Halothane or Ethrane, has a higher degree of biodegration?

Back 93

Halothane

Front 94

Which IA has the highest incidence of biodegration and therefore the highest incidence of liver damage?

Back 94

Halothane

Front 95

How is Ethrane metabolized (which pathway)?

Back 95

Oxidative metabolism

Front 96

What percentage of Ethrane is metabolized?

Back 96

2.5%

Front 97

Although Ethrane is not used in the U.S. anymore, why is it often used in 3rd world countries?

Back 97

It's CHEAP

Front 98

Structurally, Isoflurane is very similar to which other IA with only one difference? What is that difference?

Back 98

Similar to Desflurane; the Cl- atom in Isoflurane is replaced by a Fluorine atom in Desflurane

Front 99

Chemically, what is Forane (Isoflurane) called?

Back 99

a Halogenated methyl, ethyl ether

Front 100

Isoflurane (Forane) is an isomer of what other IA?

Back 100

Enflurane (Ethrane)

Front 101

Is Isoflurane flammable?

Back 101

NO

Front 102

Does Forane (Isoflurane) have a preservative?

Back 102

NO

Front 103

Is IV induction with Isoflurane (Forane) more or less rapid than Halothane and Ethrane?

Back 103

More rapid

Front 104

What is the major problem with performing a mask induction with Forane?

Back 104

It's irritable to the airway, therefore causing slower inductions (ppl cough, hold their breath,etc; they don't breathe it in as readily)

Front 105

Recovery with Isoflurane (Forane) is more or less rapid than Enflurane?

Back 105

more rapid

Front 106

Recovery with Isoflurane (Forane) is more or less rapid than Halothane?

Back 106

Less rapid

Front 107

Why is recovery with Halothane more rapid than with Isoflurane (Forane)?

Back 107

due to Halothane's extensive metabolism

Front 108

What effect does 1 MAC of Isoflurane (Forane) have on EEG spikes?

Back 108

decreases the amplitude and increases the latency of EEG spikes

Front 109

What effect does 1.5 MAC of Isoflurane (Forane) have on the EEG?

Back 109

burst suppression and decreased latency

Front 110

What effect does 2 MAC of Isoflurane (Forane) have on the EEG?

Back 110

Isoelectric activity (flat line)

Front 111

Does Isoflurane (Forane) interfere with evoked potentials?

Back 111

YES (at >1 MAC)

Front 112

What is beneficial about Isoflurane (Forane) producing isoelectric activity (on the EEG)?

Back 112

Beneficial because it decreases the cerebral CMRO2 (o2 demand)

Front 113

With Isoflurane (Forane) a MAC of 0.6-1.1 produces what kind of change to the CBF?

Back 113

No change

Front 114

Isoflurane (Forane) increases CBF by about 19% at what MAC?

Back 114

1.1 MAC

Front 115

All agents may increase ICP but effects are attenuated by decreasing what?

Back 115

PCO2

Front 116

Which IA requires you to hyperventilate simultaneously with induction (to decrease PCO2 and ICP)?

Back 116

Isoflurane (Forane)

Front 117

Which IA requires PREVIOUS hyperventilation (to decrease PCO2 and ICP)?

Back 117

Halothane

Front 118

Which agent should you NOT hyperventilate at all because decreasing the PCO2 can actually cause seizures?

Back 118

Ethrane (Enflurane)

Front 119

Because autoregulation of CBF is impaired with Halothane admin, as MAP increases, CBF _____.

Back 119

Increases

Front 120

Autoregulation of CBF is intact with Isoflurane (Forane) at 1 MAC; this means as MAP increases, CBF is prevented from _____.

Back 120

Increasing

Front 121

Does increased CBF always mean increased Cerebral Blood Volume (CBV)?

Back 121

NO

Front 122

What effect does Isoflurane (Forane) have on CSF production and reabsorption?

Back 122

No change in production, increased reabsorption

Front 123

Although it has not been proven, it is said that Isoflurane (Forane) is ______ and the agent of choice in neurosurgical cases

Back 123

neuroprotective

Front 124

Why is Isoflurane (Forane) considered "neuroprotective?" How is it protective?

Back 124

Isoflurane (Forane) does not cause major disturbances in Cerebral O2 balance during hypotension (due to autoregulation)

Front 125

Increasing MAC of IAs typically does what to BP?

Back 125

Decreases

Front 126

What effect does Isoflurane (Forane) have on SVR at 1 MAC?

Back 126

decreases it significantly (<80% of normal)

Front 127

True/False: Isoflurane peripheralizes circulation to skin, muscle, etc

Back 127

TRUE

Front 128

Isoflurane peripheralizes blood flow to skin; what effect does that have on the patient's temp?

Back 128

drops the patient's temp

Front 129

With Isoflurane (Forane), as BP drops, HR increases; this means the Baroreceptor reflex is ______.

Back 129

Intact

Front 130

Isoflurane (Forane) has a mild _____(receptor) agonist effect; this leaves CO virtually intact and stable

Back 130

Beta agonist

Front 131

With Isoflurane, CO and CI are _____.

Back 131

Stable

Front 132

Are arrhythmias common with Isoflurane (Forane)?

Back 132

NO

Front 133

Why are arrhythmias uncommon with Isoflurane (Forane)?

Back 133

Less sensitivity of the heart to Epinephrine than Halothane and Enflurane

Front 134

Because Isoflurane produces less cardiac sensitivity to Epinephrine, how much more of an Epi dose can you give with Isoflurane than Halothane?

Back 134

May triple the dose of Epinephrine with Isoflurane

Front 135

Enflurane produces a cardiac sensitivity to Epinephrine that is somewhere between Halothane and Isoflurane; How much more of an Epi dose can you give with Enflurane than Halothane?

Back 135

May double the dose of Epinephrine with Enflurane (Ethrane)

Front 136

In a normal, awake patient, a decrease in HR, Preload or Afterload, or a negative inotropic state causes coronary (vasoconstriction or vasodilation)? This is due to metabolic ______.

Back 136

Vasoconstriction; metabolic autoregulation

Front 137

Metabolic autoregulation causes coronary vasoconstriction secondary to a decrease in HR, Preload, Afterload, negative inotropic state, etc; what is the overall purpose of this metabolic autoregulatioin?

Back 137

to decrease myocardial oxygen consumption (MVO2) and to decrease myocardial O2 supply

Front 138

Which non-IA drug causes "Coronary Steal Syndrome?"

Back 138

Adenosine

Front 139

Does Isoflurane (Forane) cause Coronary "Steal" Syndrome?

Back 139

NO

Front 140

Which 3 IAs are used for anesthesia cardiac pre-conditioning (preconditions heart and protects against prolonged myocardial ischemia)?

Back 140

Isoflurane, Sevoflurane and Desflurane

Front 141

What effect does Isoflurane have on HR?

Back 141

Will increase HR

Front 142

With Isoflurane, what is the only hemodynamic parameter that is significantly related to ischemia?

Back 142

Tachycardia

Front 143

Because Isoflurane can cause tachycardia which can cause myocardial ischemia, what drug should you give to prevent this ischemia?

Back 143

Beta1-antagonists (Beta Blockers)

Front 144

True/False: In patients predisposed to myocardial ischemia, it is important to make sure they continue their heart medications prior to surgery

Back 144

TRUE

Front 145

What effect does Isoflurane have on PaCO2?

Back 145

Increases

Front 146

What effect does Isoflurane have on TV?

Back 146

Decreases

Front 147

What effect does Isoflurane have on RR?

Back 147

increases

Front 148

What effect does Isoflurane have on minute ventilation?

Back 148

Decreases

Front 149

Isoflurane depresses respiratory system (due to increased PaCO2) more or less than Halothane and N2O?

Back 149

More

Front 151

Which IA has the worst bronchodilator properties and should be avoided in asthmatics?

Back 151

Desflurane

Front 152

Which 2-drug combination is very bad to admin. to asthmatics because of their poor bronchodilator properties?

Back 152

Thiopental + N2O

Front 153

PaCO2-induced respiratory depression is greater or less with Isoflurane alone than with Isoflurane + N2O?

Back 153

Greater with Isoflurane alone

Front 154

Using Isoflurane with muscle relaxants allows you to ____ the dose of the muscle relaxants (than if used alone)

Back 154

decrease

Front 155

Isoflurane is minimally metabolized; what % is metabolized?

Back 155

<0.2%

Front 156

Isoflurane is metabolized by what metabolic pathway?

Back 156

Oxidative pathway

Front 157

Isoflurane is metabolized into Trifluoroacetic Acid; what is important about this?

Back 157

Need to be aware of cross-sensitivity (Halothane, Enflurane and Isoflurane)

Front 158

Does Isoflurane produce any renal dysfunction? Why or why not?

Back 158

NO; because so little of it is metabolized there are only an insignificant amount of Fluoride ions produced

Front 159

Is Isoflurane nephrotoxic?

Back 159

NO

Front 160

What effect does Isoflurane have on Renal Blood Flow (RBF), GFR and Urinary output?

Back 160

Decreases all

Front 161

Why is RBF, GFR and urinary output decreased with Isoflurane?

Back 161

due to decreased BP and a subsequent decrease in perfusion to the kidneys

Front 162

What effect does Isoflurane have on the Liver?

Back 162

Increases hepatic blood flow (O2 supply to the Liver is greater with Isoflurane than Halothane)

Front 163

In general, Isoflurane (Forane) is NOT hepatic toxic; what is the one case where it could be?

Back 163

with cross sensitivity reactions(in patients who are genetically susceptible)

Front 164

What are the major general advantages of Isoflurane (Forane)?

Back 164

CV stability, Ischemic preconditioning, Lack of sensitization of the heart to circulating catecholamines (Epi), Limited biodegration, decreased hepatorenal toxicity, good muscle relaxation properties, no CNS excitatory effects

Front 165

What is the major disadvantage of Isoflurane (Forane)?

Back 165

Not good for mask induction due to irritation to the airways

Front 166

There is only one major difference between the chemical structure of Desflurane and Isoflurane. Otherwise they are identical. What is it?

Back 166

Isoflurane has an ethyl group with a Cl- atom on the alpha carbon; Desflurane's same ethyl group has a Fluorine atom on the alpha carbon

Front 167

What is the chemical classification of Desflurane (Suprane)?

Back 167

Halogenated methyl ethyl ether

Front 168

Desflurane (Suprane) has an increased resistance to metabolism; because of this it has a higher/lower peak concentration of Trifluoroacetic Acid?

Back 168

Lower

Front 169

Rank Halothane,Isoflurane and Desflurane in order from greatest to least concentration of Trifluoroacetic Acid produced from metabolism

Back 169

Halothane (500),
Isoflurane (5),
Desflurane (<0.5)

Front 170

Is Desflurane reactive or non-reactive in sunlight?

Back 170

Non-reactive

Front 171

Is Desflurane reactive or non-reactive in soda lime?

Back 171

Non-reactive

Front 172

Is Deflurane reactive or non-reactive with metals?

Back 172

Non-reactive

Front 173

Does Desflurane have a pleasant or a pungent odor? Is this good or bad for mask inductions?

Back 173

Pungent odor; not recommended for mask inductions (like Isoflurane)

Front 174

Other than the pungent odor of Desflurane, what's another reason Desflurane is not recommended for mask inductions?

Back 174

Can cause Laryngospasms

Front 175

What effect does Desflurane have on CBF and CMRO2?

Back 175

Increases CBF and decreases CMRO2

Front 176

Does Desflurane produce any seizure activity?

Back 176

NO

Front 177

What kind of EEG changes does Desflurane produce?

Back 177

Dose-related decreases

Front 178

What type of test is Desflurane good to be used for during procedures such as Harrington Rod placement where the patient needs to answer questions about their status, etc?

Back 178

The Wake-up Test

Front 179

Why is Desflurane a good drug to use for the wake-up test?

Back 179

Its low solubility coefficient allows them to wake up quickly and be put under quickly

Front 180

What effect does Desflurane have on HR?

Back 180

Increases

Front 181

What effect does Desflurane have on MAP? How does this compare to Isoflurane?

Back 181

Increases MAP; increases MAP more than Isoflurane does

Front 182

What effect does Desflurane (Suprane) have on PaCO2?

Back 182

Increases

Front 183

What effect does Desflurane have on TV?

Back 183

Decreases

Front 184

What effect does Desflurane have on RR?

Back 184

Increases

Front 185

What effect does Desflurane have on minute ventilation?

Back 185

fairly stable minute ventilation until 1 MAC and then decreases

Front 186

True/False: Desflurane is the most desirable agent to use for an asthmatic

Back 186

False; it's the least desirable agent to use in asthmatics due to it's lack of brochodilator effect

Front 187

Is Desflurane an airway irritant?

Back 187

YES

Front 188

What occurs (symptoms) due to Desflurane being an airway irritant?

Back 188

Patient coughing, breath-holding and Laryngospasm

Front 189

What population should you be cautious with when administering Desflurane due to its airway irritant properties?

Back 189

Smokers

Front 190

Is it good to administer Desflurane to a patient with an LMA? Why or why not?

Back 190

NO; Laryngospasm can occur

Front 191

Because Desflurane is an airway irritant, it should not be started in a smoker until what occurs first?

Back 191

ET tube is in place

Front 192

Rank Desflurane, Sevoflurane, Isoflurane and Halothane in order from greatest to least ability to potentiate muscle relaxation?

Back 192

Des>Sevo>Iso>Halo

Front 193

The 2 IAs with the lowest blood/gas solubility coefficients (Desflurane and Sevoflurane) are the best at potentiating muscle relaxation; why is this?

Back 193

decreased blood/gas solubility coefficients allows these agents to move quickly into the NMJ

Front 194

Does Desflurane produce any change in serum creatinine or BUN (or any other significant renal effects)?

Back 194

NO

Front 195

Does Desflurane produce any change in liver function tests?

Back 195

NO

Front 196

What percentage of Desflurane is metabolized?

Back 196

Minimum to none--0.01%

Front 197

With Desflurane is there any evidence of organ toxicity?

Back 197

NO

Front 198

Is Desflurane a trigger for malignant hyperthermia?

Back 198

YES

Front 199

True/False: All inhaled anesthetics produce some CO (Carbon Monoxide).

Back 199

TRUE

Front 200

Rank Desflurane, Enflurane and Isoflurane in order from greatest to least production of CO in Baralyme CO2 Absorbent

Back 200

Desflurane>Enflurane>Isoflurane

Front 201

Which 2 IAs produce about the same amount of CO in Soda lime CO2 absorbent?

Back 201

Desflurane and Enflurane

Front 202

What percentage of Hgb is bound with CO in nonsmokers?

Back 202

1%

Front 203

What percentage of Hgb is bound with CO in smokers?

Back 203

10%

Front 204

What percentage of Hgb bound with CO causes death?

Back 204

50%

Front 205

What factor produces more CO?

Back 205

interaction with strong bases in relatively dry carbon dioxide (CO2) absorbents

Front 206

What 3 factors influence the level of CO production?

Back 206

Choice of anesthetic agent, inspired anesthetic concentration, and type, temperature and degree of dryness of the CO2 absorbent

Front 207

What are some simple ways you can minimize or eliminate CO?

Back 207

Use fresh absorbent, Use Soda Lime instead of Baralyme, avoid techniques that dehydrate the CO2 absorbent

Front 208

Dehydrating CO2 absorbent increases CO production, so avoiding techniques that dehydrate the CO2 absorbent is critical; what are 2 ways you can avoid dehydrating the CO2 absorbent?

Back 208

Use low gas flows or (as a last resort) rehydrate absorbent by adding approx. 1 cup of water (230 ml) per 1.2 kg of absorbent (i.e. standard cannister)

Front 209

What are two new absorbents that are now being used (which have a lower incidence of dehydration and CO production)?

Back 209

Amsorb and DragerSorb Free

Front 210

As an "economical delivery method", how much flow of gas and for how long would you administer it to equilibrate the VRG?

Back 210

6L/minute for 10 minutes

Front 211

As an "economical delivery method", how much flow of gas and for how long would you administer it to equilibrate the muscle group?

Back 211

4L/minute for 20 minutes

Front 212

As an "economical delivery method", how much flow of gas and for how long would you administer it to decrease the incidence of absorbent dessication (drying out)?

Back 212

2L/minute for 30 minutes

Front 213

With Desflurane, is wash-out fast or slow?

Back 213

Extremely fast (has low solubility coefficient)

Front 214

Because wash-out with Desflurane is extremely fast, what are 2 very important things to remember regarding patient comfort?

Back 214

Anticipate early analgesic needs;
Reverse muscle relaxants early

Front 215

Why is Desflurane good to use for obese patients?

Back 215

low solubility coefficients--won't hang out in the fat as a reservoir

Front 216

How should you administer Desflurane to avoid unacceptable tachycardia?

Back 216

Induce and change levels slowly

Front 217

What chemical classification does Sevoflurane (Ultane) belong to?

Back 217

Halogenated methyl isopropyl ether

Front 218

What type of odor does Sevoflurane have?

Back 218

"Ethereal;" Non-pungent

Front 219

True/False: The odor of Sevoflurane is well tolerated by mask

Back 219

TRUE

Front 220

Is Sevoflurane stable or unstable in CO2 absorbents?

Back 220

Unstable

Front 221

What is the major degradation product of Sevoflurane when Sevo comes into contact with Soda lime or Baralyme and CO2 absorbent?

Back 221

Compound A

Front 222

What chemical classification is "Compound A?" (major degradation product of Sevo)

Back 222

Alkene

Front 223

Which other IA (other than Sevo) has a similar degradation reaction as Sevo when comes in contact with CO2 absorbents and therefore is not stable in Soda lime CO2 absorbents?

Back 223

Halothane

Front 224

How is Compound A formed from Sevoflurane?

Back 224

By the extraction of the acidic proton in the presence of a strong base (KOH) to form an alkene (Compound A)

Front 225

The degree of degradation of Sevoflurane to Compound A increases with (increasing or decreasing) temperature

Back 225

Increasing

Front 226

The chemical reaction of CO2 with absorbents is endothermic or exothermic?

Back 226

Exothermic (heat is produced)

Front 227

Dry (or fresh) absorbents produce (more or less) heat?

Back 227

More heat

Front 228

Increased temperature increases degradation of Sevoflurane and production of Compound A; the temperature increase depends on what factors?

Back 228

fresh gas flow in breathing circuit, metabolic status of the patient, ventilation and concentration of Sevoflurane

Front 229

Why is it good to use a high flow rate when admin. Sevoflurane?

Back 229

High flow rates decrease the production of Compound A by reducing re-breathing

Front 230

Are flows of <2L recommended with Sevoflurane admin?

Back 230

NO

Front 231

What do high concentrations of Compound A cause (in rats)? At what concentrations?

Back 231

Cause renal injury and death; occurred when levels reached 25-50 ppm or greater

Front 232

Cases of humans with renal changes occurred after Sevoflurane admin (Compound A); Under what conditions did these renal changes occur?

Back 232

Prolonged Sevoflurane exposure

Front 233

While "renal changes" have been demonstrated in humans after Sevoflurane admin, a large number of studies were done which demonstrated no change in BUN and Creatinine levels after Sevo admin; why could this be?

Back 233

may not be sensitive enough markers to demonstrate renal dysfunction

Front 234

What's the most important factor in determining how much Compound A a patient will inspire?

Back 234

Inspired fresh gas flow is most important factor

Front 235

Should we avoid using Sevoflurane in a patient with preexisting renal disease?

Back 235

YES

Front 236

What effect does Sevoflurane have on CBF and CMRO2?

Back 236

Increases CBF (the least among the Volatile IAs) and decreases CMRO2

Front 237

Which IA increases CBF the LEAST among the volatile IAs?

Back 237

Sevoflurane

Front 238

What's interesting about the effect Sevoflurane has on CBF and CMRO2 at 1 MAC?

Back 238

decreases CBF by 38% and CMRO2 by 39% (coupled)

Front 239

True/False: With Sevoflurane admin, the cranial vessel response to PaCO2 is impaired?

Back 239

False; it is intact (you can hyperventilate patient, bringing CO2 and ICP down)

Front 240

Sevoflurane produces what general cardiovascular effect?

Back 240

dose related depression

Front 241

What effect does Sevoflurane have on BP?

Back 241

dose related decrease

Front 242

What effect does Sevoflurane have on HR?

Back 242

up to 1 MAC, decreased;
at 1.5 MAC, increased (baroreceptor reflex is intact)

Front 243

What effect does Sevoflurane have on MAP?

Back 243

MAP is decreased until approx. 1.5 MAC and then it levels out (or slightly increases); baroreceptors are intact

Front 244

The Epinephrine induced arrhythmogenic effect of Sevoflurane is equivalent to which other IA?

Back 244

Isoflurane

Front 245

What general effect does Sevoflurane have on the respiratory system?

Back 245

Dose related depression

Front 246

What effect does Sevoflurane have on PaCO2?

Back 246

Increases

Front 247

True/False: Sevoflurane is the best bronchodilator and the best IA to use in asthmatics

Back 247

TRUE

Front 248

Does Sevoflurane potentiate NM blockers?

Back 248

YES

Front 249

Because Sevoflurane potentiates NM blockers (muscle relaxants), the dosage of Muscle relaxants should be guided by a ____ ____ _____

Back 249

Peripheral Nerve Stimulator

Front 250

Sevoflurane is the next best drug to ____ for NM Blocker potentiation

Back 250

Desflurane

Front 251

What percentage of Sevoflurane dose is metabolized?

Back 251

3-5%

Front 252

Does Sevoflurane form Trifluoroacetic Acid?

Back 252

NO

Front 253

Since Sevoflurane does not form Trifluoroacetic Acid, what 3 things also do not occur?

Back 253

Does not stimulate antibodies to TFA, does not cause immune mediated hepatic toxicity, and no cross-sensitivity with Halothane

Front 254

What are the 2 metabolic products of Sevoflurane?

Back 254

Hexafluoroisopropanol (HFIP) and Inorganic Fluoride ion

Front 255

How is Hexafluoroisopropanol (HFIP) metabolized?

Back 255

Conjugated with Glucuronic acid and excreted in the urine

Front 256

HFIP (metabolic product of Sevo) represents ____% of Fluorine released from Sevoflurane metabolism; what is the problem with this?

Back 256

80%; worry about renal not being able to concentrate urine in Pediatrics (Peds lack UGT enzymes necessary to catalyze the transfer of glucuronic acid)

Front 257

Why are we more concerned about Enflurane and renal insufficiency than Sevoflurane and renal insufficiency?

Back 257

Because Enflurane has a higher solubility coefficient than Sevoflurane (stays around longer)

Front 258

Is Sevoflurane a potential trigger for Malignant Hyperthermia?

Back 258

YES

Front 259

What is a problem with Sevoflurane upon emergence (particularly in Peds)?

Back 259

Emergent Excitement

Front 260

Describe "Emergent Excitement"

Back 260

Transient confusional state associated with emergence from GA

Front 261

Emergent Excitement is not to be confused with what other similar condition that occurs after Ketamine admin?

Back 261

Emergence Delerium

Front 262

When does Emergent Excitement typically occur?

Back 262

Within the 1st 10 minutes of recovery

Front 263

The peak incidence of Emergent Excitement occurs in what age of children?

Back 263

2-4 year olds

Front 264

What 2 IAs are associated with emergent excitement?

Back 264

Sevoflurane and Desflurane (esp. Sevoflurane)

Front 265

List the etiological factors of emergence excitement

Back 265

IA, Post-op pain, type of surgery, age (typically 2-4 year olds), preoperative anxiety, underlying temperament, adjunct medications

Front 266

What are the 2 main conditions to be cautious about when admin. Sevoflurane to Pediatrics?

Back 266

Increased levels of HFIP, and Emergent Excitement