Pharm 3/2

Front 1

at what mac do we see impaired cognition

Back 1

0.2

Front 2

Can you get burst suppression with inhalation agents

Back 2

yes

Front 3

does trace gas cause mental impairment

Back 3

no

Front 4

do volatile anesthetics cause prolonged impairment of intellectual function

Back 4

no

Front 5

what do inhalation agents do to CMRO2 and CBF

Back 5

increases CBF and decreases CMRO2
luxury perfusion

Front 6

at what mac do we see burst suppression

Back 6

2 MAC, but will cause hypotension at this dose

Front 7

at one MAC or less what do sevo, iso and des do to CBF

Back 7

do not change it
only need to be concerned with pt that has brain pathology otherwise pt should be able to autoregulate CBF

Front 8

what does nitrous do to CBF and CMRO2

Back 8

increases both but CMRO2 > CBF
reverses neuro protection of other agents

Front 9

which agent do we not use in neuro

Back 9

nitrous oxide

Front 10

net effect on the cerebral vessels depends on what

Back 10

the sum of indirect vasoconstriction(due to decreased CMRO2)
vasodilation (due to the drug)

Front 11

Global blood flow in the brain is usually held constant by what

Back 11

autoregulation

Front 12

how much can we decrease CMRO2 using medications

Back 12

to 40%
or a 60% decrease

Front 13

what causes local control of cerebral blood flow

Back 13

CO2 reactivity

Front 14

why do we usually not see an increase in CBF at 1 MAC

Back 14

because the induction drugs vasoconstrict and the gas vasodilates

Front 15

what can we do to decrease the vasodilation of inhalation agents

Back 15

hyperventilate a little
CO2 around 32-35 will blunt the increase in CBF seen with iso, des and sevo

Front 16

what is the problem with desflurane and ICP?
how do we fix this

Back 16

irritates the airway- SNS stimulation- increased bucking and coughing- increases ICP
blunt the stimulus by giving opiods, propofol, lidocaine

Front 17

what does autoregulation of CBF depend on

Back 17

MAP held constant at 50-150

Front 18

increased MAP does what to CBF

Back 18

vasoconstriction

Front 19

at what MAC values is autoregulation no longer regulated

Back 19

1.5 MAC

Front 20

increased CO2 levels does what to CBF

Back 20

vasodilation

Front 21

where do we keep CO2 levels on neuro pts

Back 21

above 32-35 to maintain adequate blood flow

Front 22

at what MAC do our gases not affect the CO2 reactivity

Back 22

1 MAC

Front 23

what is the only gas that can increase absorption of CSF

Back 23

isoflurane

Front 24

what do volatile agents do to SSEPs

Back 24

increase latency
decrease amplitude
(dose dependent changes)

Front 25

what do we need to know about enflurane

Back 25

shows EEG changes that resemble seizures
triggered at >2 MAC

Front 26

when do we see Sevo with Nitrous causing epileptiform activity in children and are there changes in lactic acid levels seen

Back 26

2 MAC and hypocarbia
no changes in lactic acid levels

Front 27

what agents are best to wake the pts up the fastest

Back 27

less soluble

Front 28

are inhalation agents neuroprotective

Back 28

yes- decreased cellular damage in the face of ischemia- ischemia preconditioning without having the actual ischemia

Front 29

how long does the ischemia preconditioning last and what will stop it

Back 29

24 hrs to 30 days
nitrous will stop the protective effects

Front 30

what are the best agents for ischemia preconditioning

Back 30

iso
sevo

Front 31

what all changes were seen after causing artery occlusion to show that the agents did protect during ischemia

Back 31

smaller decrease in pH
smaller increase in CO2
smaller decrease in O2
fewer neuro cognitive deficits after clamping

Front 32

what do the agents do to the myocardium

Back 32

dose dependent depression

Front 33

what 2 agents will increase HR

Back 33

iso
des
will maintain CO

Front 34

what do we give to combat teh decrease tone and decrease CO seen with inhalation agents

Back 34

fluids

Front 35

what kind of SNS stimulation do we see with nitrous

Back 35

vasoconstriction- increased SVR and PVR
increased right atrial pressure
mydriasis
increased temp

Front 36

what happens when nitrous is given in the presence of opiods

Back 36

myocardial depressant
decreased bp and CO
opiods inhibit teh centrally mediated SNS effects of nitrous

Front 37

which agent has no change on HR or CVP

Back 37

sevo

Front 38

what do the agents do to SVR, and SV

Back 38

decrease

Front 39

what areas get increased blood flow with gases

Back 39

brain
skin
skeletal muscle

Front 40

what areas get decrease in blood flow with gases

Back 40

kidney
liver
stomach

Front 41

what do the gases do to coronary blood flow

Back 41

all cause coronary artery vasodilation

Front 42

which agent can improve collateral circulation to an area of ischemia

Back 42

sevo

Front 43

what is coronary steal syndrome

Back 43

dilating all arteries so that the ones that are occluded are no longer getting preferential blood flow

Front 44

do our agents cause coronary steal syndrome

Back 44

no
only iso if the vessel is >90% occluded

Front 45

what does desflurane do to the HR

Back 45

steep changes can double the HR and MAP- response adapts after a few episodes

Front 46

how can we treat the HR effect with Desflurane

Back 46

fentanyl
esmolol
dexmed

Front 47

can you use des on heart pts

Back 47

yes just protect from tachycardia

Front 48

what happens when we blunt baroreceptors

Back 48

can diminish the ablility of the patients body to identify and correct changes in BP-
wont see the tachycardia we are used to to tell us something is wrong

Front 49

what else can blunt baroreceptors

Back 49

opiods
beta blockers

Front 50

what MAC produces baroreceptor depression

Back 50

1 mac

Front 51

what is the detrimental situation when baroreceptors are blunted

Back 51

a hypovolemic pt