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23 Cards in this Set
- Front
- Back
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Sevoflurane
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MAC 1.8
B/G 0.65 Vapor Pressure: 160 |
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Isoflurane
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MAC 1.17 (1.2)
B/G: 1.4 Vapor Pressure 240 |
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Desflurane
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MAC 6.6 (6.0 stoelting)
B/G: 0.42 Vapor Pressure: 680 |
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Nitrous Oxide
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MAC 105
B/G: 0.47 Vapor Pressure: 38,770 |
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Enflurane
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MAC: 1.63
B/G: 1.9 Vapor Pressure 173 |
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Halothane
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MAC: 0.75
B/G: 2.4 Vapor Pressure: 243 HIde SEek Halothane & Isoflurane (VP 243 & 240) Sevoflurane & Enflurane (VP 160 & 173) Due the similiarities of VP you can use the same Vaporizers |
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MAC Awake:
MAC BAR: MAC Recall |
.10 X MAC
1.7-2.0 MAC 0.3-0.5 MAC |
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MAC
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Minimum alveolar concentration that prevents movement of 50% patients in response to certain stimulus
MAC is additive |
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Factors that increase MAC
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younger age
chronic ETOH anxiety acute sympathetic increase (cocaine, ephedrine, amphetamines) Hypermetabolic state (Thyroid & high Fever) hyperthermia hypernatremia |
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Factors that decrease MAC
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old age (4-6%% decrease every decade after 40)
pregnancy acute ETOH hypothermi hypoxia (PaO2 38mmHg), hypercarbia sympathetic blockade metabolic acidosis Induced Hypotension (MAP<50mmHg) Hyponatremia Anemia < 4.3ml oxygen/dL blood |
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Uptake Equation (AGENT from lungs to blood)
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Uptake = solubility coeifficient x cardiac output x (P alveoli- P venous)
hence increase solubility increase cardiac ouput and increase gradient between blood and alvoeli all increases uptake Remember things that increase uptake decrease induction (FA/FI --> 1) since high uptake decreases FA |
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Induction (FAST)
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Fast Fa/Fi --> 1 quickly
Fa proportional to PAlveoli= Pblood = Pbrain |
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Volatile Anesthetics (Speed of induction - decreasing order)
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Nitrous Oxide --> Desflurane --> Sevoflurane --> Isoflurane ->Halothane
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what factors increase induction
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high ventilation
lower lipid solubility decrease cardiac output (decrease alveolar blood flow) decrease gradient (alveoli-blood) |
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what can you do speed recovery
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increase FGF
High ventilation high cerebral blood flow low solubility (.42 desflurane) |
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diffusion hypoxia
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During recovery N20 floods alveolus and dilutes the oxygen resulting in hypoxia
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Volatile effects on CMR, ICP, Cerebral Spinal Fluid, Resorption, CBF, EEG
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decrease CMR
increase ICP greater MAC 1 all produce dose-dependent effect on EEG, SEP, and MEP. VEP are more sensitive to Volatile Anesthetics than SEPs |
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Volatile (not nitrous oxide)
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- All relax bronchial smooth muscle
- All decrease ventilatory response to hypercarbia and hypoxia - all decrease minute ventilation - decrease TV - increase RR - all but nitrous potentiate NDMR - all but nitrous relax skeletal muscles - all nitrous oxide triggers for MH - halothane (greatest) - desflurane (less) -nitrous oxide (weak trigger) |
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the dangers of nitrous oxide
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- irreversibly oxidizes Cobalt atom of B12 (decreasing the activity of vitamin B12 dependent enzymes like methionine synthase) affect myelin formation and result in neurological deterioration
-70% results in 50% inactivation of methionine synthase (accumulation of homocysteine) - resulting in birth defects, blindness -inhibits thymidylate synthase (involved in dna synthesis and repair) --> resulting teratogenicity and bone marrow depression taking 4 days to recover - megoblastic anemia (interfere dna synthesis during red blood cell production) - increase incidence of nausea - flammable - increase PVR (contraindicated with those with PHTN) - 35X more soluble in blood than N2 - giving it the ability to diffuse into closed Air Spaces faster than Air ( PTX, venous air embolism, intracranial air, acute GI obstruction, intraocular air, tympanic membrane, blebs, bullae) |
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Volatile and Pregancy
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Uterine Relaxation can be troubling a MAC above 1
use combination of low concentration of VA combined with nitrous oxide Uterine Relaxation may be desired to remove retained placenta |
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National Institute for OSHA recommends
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25 ppm for nitrous oxide
2 ppm for halogenated anesthetics |
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minimal cardiac depressant
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isoflurane
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sensitive to catcholamines
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halothane
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