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69 Cards in this Set
- Front
- Back
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what type of chemical structure is desflurane
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a halogenated methyl ethyl ether
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what is the trade name for desflurane
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suprane
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desflurane has the same chemical structrure as what other IA?
with what exception? |
*isoflurane
*Fl atom replaces Cl atom on the alpha carbon |
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desflurane shares many properties with what other IA
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isoflurane
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what are the differences of desflurane from isoflurane
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*increased vapor pressure (669)
*decreased solubility *increased MAC |
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what is the blood gas solubility coefficient of desflurane
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0.45
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what is the fat blood solubility coefficient of desflurane
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27
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what is the MAC for 31-65 y/o for desflurane
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6.6%
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what is the MAC for 18-30 y/o for desflurane
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7.25%
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desflurane has a decreased or increased resistance to metabolism
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INCREASED
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desflurane has what type of peak TFA concentrations
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LOWER
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what is the anesthetic TFA (mcgM) of halothane
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500
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what is the anesthetic TFA (mcgM) of isoflurane
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5
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what is the anesthetic TFA(mcgM) of desflurane
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< 0.5
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what does desfluranes anesthetic TFA mean
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its reading(<0.5) means there is less metabolite to stimulate halothane hepatitis
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is desflurane stable or unstable
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stable
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is desflurane reactive with sunlight or soda lime
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NO
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is desflurane reactive with metals
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NO
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what type of odor does desflurane have
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pungent
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is desflurane recommended for mask inductions
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NO
-pungent odor -laryngospasms -irritating to airway |
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with desflurane what are CMR and CBF
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CMR is decreased and CBF is increased
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with desflurane what can you do to control CBF
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hyperventilate
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desflurane has what effect on EEG that is dose related
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decrease in EEG
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is there sz activity noted with desflurane
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NO
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what type of neuro test is desflurane "perfect" for
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the "wake up" test
-with herring rod placement -b/c of low b/g solubility coefficient can titrate fast |
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if you abruptly increase the MAC of desflurane what happens to MAP
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it abruptly increases but subsides to below awake value within 5 min
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if you abruptly increase the MAC of desflurane what happens to HR
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it abruptly increases but it does NOT return to awake values
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with desflurane what occurs with PaCo2
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at less than 1 MAC there is a slight increase in PaCo2 but at > than 1 MAC there is a profound increase in PaCo2
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deflurane has what effect on the respiratory system
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dose dependent depression
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desflurane has what effect on resp rate
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dose dependent INCREASE
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deflurane has what effect on Vt and minute volume
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decreases them
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what is desfluranes effect on bronchomotor tone
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it is the LEAST desirable for asthmatics
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is defluane an airway irritant
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YES
-causes coughing, breath holding and larygospasm |
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what type of pt should desflurane be used in caution with (r/t airway)
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SMOKERS
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what type of airway device may desflurane NOT be the best choice for
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LMA
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does desflurane potentiate NMB
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YES
-it is the best IA at potentiating NMB |
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what is the order from most to least potentiation for IA and NMB with the following agents
(desflurane, halothane, isoflurane, sevoflurane) |
des > sevo > iso > halo
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what 2 IA potentiate NMB the best and why
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the 2 with the lowest b/g solubility coefficients (desflurane and sevoflurane) b/c they can move very quickly into the NMJ
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what effect does desflurane have on serum creatinine and BUN
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no change
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what effect does desflurane have on liver function tests
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no change
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how much is desflurane metabolized
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minimum to none (0.01%)
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what type of organ toxicity does desflurane have
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no evidence of any
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is desflurane a trigger for malignant hyperthermia
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YES
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how much of Hgb is normally bound to CO
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1%
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in a smoker how much Hgb is bound to CO
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10%
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which IA poses the greatest concern for CO toxicity
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desflurane
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what type of poisoining has been reported with IA
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CO
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will desflurane produce any CO in baralyme
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YES-quite a bit
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high levels of CO2 lead to what
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neurological problems
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at what percent of CO bound to Hgb can lead to death
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50%
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can any IA produce CO
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YES
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how might an IA produce CO
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interaction with strong bases in relatively dry carbon dioxide (CO2) absorbents
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what are the factors that influence the level of CO production with IA
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*choice of anesthetic agent
*inspired anesthetic concentration *type, temp & degree of dryness of CO2 absorbent |
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out of the following agents (desflurane, enflurane, halothane, isoflurane, sevoflurane) what is the order in which they are likely to produce CO
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D > E & I w/ negligible S & H
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what factor makes the production of CO more likely to happen with IA agents
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a HIGHER concentration
(so desflurane having a higher concentration is more likely to produce CO) |
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what clinical significance does CO toxicity have
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LITTLE regardless of agent
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what are the guidelines to minimize or eliminate CO
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*use fresh absorbent
*use soda lime instead of baralyme *avoid tech that dehydrate Co2 absorbent *as a last resort CO2 absorbent can be rehydrated |
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how would you avoid dehydrating the CO2 absorbent
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by using fresh gas flows
(this is more ecomomical and limits absorbent dessication) |
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how can absorbent be rehydrated
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by adding approx 1 cup (230 ml) of water per 1.2 kg of absorbent (standard canister)
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what are some new absorbents on the market and what is different about them
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*amsorb
*dragersorb free -they don't contain Na+ or K+ hydroxide |
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what is the recommedation for economical delivery with desflurane
(how many L/min and for how many mins) |
*6 L/min for 10 mins
*4L/min for 20 mins *2 L/min for 30 mins |
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for equilibration with the vessel rich group how many liters per min is required and for how long
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6 L/min for 10 min
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for the muscle rich group how many L/min is required for equilibration and for how long
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4 L/min for 10 min
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what benefits does economical delivery provide
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*decreased dessication of absorbent
*keeps pt warmer with lower flows (b/c not losing as much humidity thru the lungs) |
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how should levels of desflurane be changed (titration rate) and why
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induce and change levels of des SLOWLY to avoid unacceptable tachycardia
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what is washout like with desflurane
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EXTREMELY fast
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with the washout characteristic of desflurane what should the provider anticipate/do
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*anticipate EARLY analgesic needs (give opioid at end of case)
*reverse muscle relaxants EARLY |
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what should be remembered about desflurane and its effect on the airway
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it is an airway irritant
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what is desflurane good for
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*very good for wake up test
*good for sx on the obese secondary to low solubility |
