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75 Cards in this Set
- Front
- Back
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what is the brand name for sevoflurane
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ultane
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what type of chemical structure is sevoflurane
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halogenated methyl ethyl ISOPROPYL ether
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what is the vapor pressure of sevoflurane
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170
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what is the odor of sevoflurane like
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*ethereal (ether-like)
*non-pungent |
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how is sevoflurane tolerated by mask
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WELL
-b/c of its non-pungent odor -it is the EASIEST volatile agent to use for mask inductions |
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what is the MAC of sevoflurane in a 30 to 55 y/o
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1.8%
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what is the blood gas partition coefficient of sevoflurane
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.65
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how is sevoflurane in CO2 absorbants stable or unstable
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UNSTABLE
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sevoflurane has a similar vapor pressure to what other IA
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enflurane
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what occurs when sevoflurane degredates in the presence of a strong base (such as CO2 absorbants)
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it forms compound A and trace amts of compund B
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the degredation reaction of sevoflurane occurs when
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with direct contact with soda lime or baralyme (CO2 absorbants)
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the formation of the degredation product sevoflurane is caused by what
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compound A an alkene is formed by the extraction of the acidic proton in the presence of a strong base (KOH)
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what is the formation of the degredation product of sevoflurane similar to with another inhalation agents reaction product
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similar to the reaction that halthane has with CO2 absorbants
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the degree of degredation of sevofluane increases with what
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increasing temperature
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regarding degredation reaction of sevoflurane rxn of Co2 with absorbents is endothermic or exothermic
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exothermic b/c it produces heat
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regarding degredation reaction of sevoflurane which type of absorbents produce more heat
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dry or fresh absorbents
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high flow rates do what to the production of compund A
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decrease the production by reducing re-breathing
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what flows are recommended with sevoflurane
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flows less than 2 are NOT recommended b/c of production of compound A
(need flows greater than 2 with sevo) |
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what affect does metabolic status of the patient have with sevoflurane
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varies the amt of production of compound A
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ventilation will affect the production of compound A how
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resp acidois will increase CO2 & this would increase the temp of the CO2 absorbent therefore increasing production of compound A
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does the concentration of sevoflurane affect compound A production
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YES
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high concentrations compound A does what to rats
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renal injury and death
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when were renal injury and death noted with compound A
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when levels reached 25 to 50 ppm or greater
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there are cases of humans with what type of organ change after administration of sevoflurane
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renal
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organ change occured in humans under what condtions
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renal change occured under conditions of prolonged exposure
-they were dose and time dependent |
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what may not be sensitive enough markers to demonstrate renal dysfunction when looking at compound A effects
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BUN and creatnine serum markers
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what is the most important factor regarding control of compound A
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inspired fresh gas flow
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total exposure of compound A is a product of what
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concentration and time
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with sevoflurane is there significant clinical renal toxicity
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NO
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what is important to remember about flows when using sevoflurane
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DON'T drop flows below 2 l/min secondary to compound A
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what pre-existing condition should sevoflurane be AVOIDED in
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renal dz
(choose iso or des over sevo) |
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what is the relationship between sevoflurane and CBF
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it has the LOWEST increase in CBF
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in 1 MAC concentrations of sevoflurane how much did sevoflurane change CBF and CMR
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*decreased CBF by 38%
*decreased CMR by 39% |
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what is the cranial vessel response to PaCo2 with sevoflurane
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it remains INTACT
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what can be done with sevoflurane if you are doing a craniotomy and see brain protrusion
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can hyperventilate and decrease ICP
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what GENERAL effect does sevoflurane have on the cardiovascular system
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dose related depression
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what effect does sevoflurane have on BP
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dose related decrease
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what effect does sevoflurane have on HR
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*decreased up to 1 MAC
*increase in HR ar 1.5 MAC |
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what is the effect of epi on sevoflurane
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epi induced arrythmogenic effect is equal to isoflurane
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is the baroreceptor reflex intact with sevoflurane
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YES
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if you have a rapid increase in MAC with desflurane what occurs with SNS, HR and MAP
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an abrupt increase
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if you have a rapid increase in MAC with sevoflurane what occurs with SNS, HR and MAP
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*very level SNS
*slight decrease in MAP and even HR |
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what GENERAL effect does sevoflurane have on the respiratory system
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a dose related depression
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what effect does sevoflurane have on PaCo2
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it is increased
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what effect does sevoflurane have as a bronchodilator
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it is the BEST bronchdilator of the IA
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what effect does sevoflurane have on NMB
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potentiates neuromuscular blockers
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with sevoflurane dosage of muscle relaxant should be guided by what
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peripheral nerve stimulator
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what type of inhalation agents are better potentiators of NMB
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ones with lower blood gas solubility coeffients
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does sevoflurane have a cross sensitivity with halothane
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NO
-it is the agent of choice with halothane hepatitis hx |
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what amt of sevoflurane dose is metabolized
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3-5%
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how much trifluroacetic acid does sevoflurane form
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NONE
-it is the one agent that does NOT form it |
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what is the relationship between sevoflurane and TFA antibodies
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it does NOT stimulate anitbodies to TFA
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does sevoflurane cause immune mediated hepatic toxicity
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NO
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sevoflurane is broken down into what metabolic product
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*hexafluroisopropanol (HFIP)
*inorganic fluoride ion |
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how is sevoflurane excreted
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it is congugated with glucorinic acid and excreted in the urine
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what population would HFIP be a concern in and why
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*pediatrics
*b/c they lack UGTs (enzyme) |
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what do UGTs do
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catalyze the transfer of glucoronic acid
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HFIP represents what ion and in what pecentage released in sevoflurane
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*fluorine
*80% |
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what is HFIP a particular concern with
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renal in peds--not being able to concentrate urine
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which agent has more concerns about flouride enflurane or sevoflurane and why
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enflurane--though sevoflurane produces a higher level of fluoride it produces less renal problems b/c of is solubility it is not going to stay around as long
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is sevoflurane a trigger for maligant hyperthermia
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YES
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what is a problem that can occur upon emergence from sevoflurane with pediatric pts
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emergence excitement
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what is emergent excitement
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transient confusional state associated with emergence from GA
(it is excitement/confusion NOT delirium) |
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when does emergent excitement occur
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in the first 10 min of recovery
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when is the peak incidence of
emergent excitement |
in 2-4 y/o
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what agents is emergent excitement associated with
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*sevoflurane
*desflurane (sevo has a higher occurance) |
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what are the etiological factors associated with emergent excitement
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*the IA (des or sevo)
*post-op pain *type of sx *age (2-4 y/o) *pre-op anxiety *underying temperment of pt |
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what adjunct medications have been used to treat emergent excitement
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*mdz
*propofol *clonidine *dexmetatomidine *fentanyl *ketoralac *physostigmine |
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sevoflurane should be used with caution in what type of patient
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pt with renal insufficiency
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what main thing should be done to reduce compound A formation
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use high flow rates with sevoflurane
-use flow rates of AT LEAST 2 l/min or higher |
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does cross sensitivity exist between pts with halothane hepatitis and sevoflurane
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NO
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what type of induction is sevoflurane great for
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mask
-not irritating to the airway |
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what type of airway device is sevoflurane good for
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LMA
-not irritating to the airway |
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what is the cost of sevoflurane
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more expensive than other agents
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why should sevoflurane be used with caution in pediatric pts
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*b/c of increased levels of HFIP
*emergent excitement |
