Inhaled anesthetics do not generally provide __________ but do produce immobility and amnesia.
A) Sedation
B) Analgesia
C) Euphoria
D) Muscle relaxation
B) Analgesia
…with the exception of nitrous oxide, inhaled anesthetics do not provide any significant analgesia.
Slide 3
Which of the following is an exception among inhaled anesthetics in terms of increasing skeletal muscle tone?
A) Isoflurane
B) Desflurane
C) Nitrous oxide
D) Sevoflurane
C) Nitrous oxide
-Inhaled anesthetics either do not affect, or in some cases lower skeletal muscle tone EXCEPT Nitrous oxide
Slide 3
Inhaled anesthetics produce immobility primarily through actions on:
A) The cerebral cortex
B) The spinal cord
C) Peripheral nerves
D) The brainstem
B) The spinal cord
Slide 3
Inhaled anesthetics are thought to produce anesthesia by enhancing __________ channels and attenuating __________ channels.
A) Inhibitory, excitatory
B) Excitatory, inhibitory
C) Potassium, calcium
D) Sodium, chloride
A) Inhibitory, excitatory
..whether or not this occurs through direct binding or membrane alterations is not known
Slide 3
What does the Minimum Alveolar Concentration (MAC) of an inhaled anesthetic represent?
A) The dose required to produce analgesia in 50% of patients during surgical incision
B) The alveolar concentration at which 50% of patients do not show a motor response to a surgical incision
C) The concentration that results in sedation for 50% of patients during surgery
D) The concentration that prevents any response in 100% of patients
B) The alveolar concentration at which 50% of patients do not show a motor response to a surgical incision
..MAC of an inhaled anesthetic is the alveolar (or end- expiratory)concentration at which 50% of patients will not show a motor response to a standardized surgical incision
Slide 3
Approximately what percentage of patients will not show a motor response to a surgical incision at 1.3 MAC of an anesthetic?
A) 50%
B) 80%
C) 95%
D) 99%
D) 99%
Slide 3
What does a MAC of 1.2 indicate in terms of patient response to a surgical incision?
A) 50% of patients will respond
B) 95% of patients will respond
C) 95% of patients will not respond
D) 99% of patients will not respond
C) 95% of patients will not respond
Slide 3
Which inhaled anesthetic is described as an airway irritant, requiring a special heated vaporizer, and is particularly expensive?
A) Sevoflurane
B) Isoflurane
C) Desflurane
D) Nitrous oxide
C) Desflurane
slide 7
Why is Desflurane often considered suitable for obese patients?
A) It has a high lipid solubility.
B) It is metabolized primarily by the liver.
C) It has a low solubility
D) It is the cheapest inhaled anesthetic.
C) It has a low solubility
..absorbs quick, and goes away quick
Slide 7
What is a notable disadvantage of Desflurane as an anesthetic agent?
A) It has a long onset and offset.
B) Increased heart rate.
C) It has high blood solubility
D) It causes significant nephrotoxicity in humans.
B) Increased heart rate.
slide 7
Sevoflurane is commonly used in pediatric induction because it is:
Select 2
A) Very cheap
B) Longer emergence time
C) An airway irritant that requires a special vaporizer
D) Non-irritating to the airway
E) Not commonly used in humans
F) Quick emergence
D) Non-irritating to the airway
F) Quick emergence
Slide 7
What is a potential concern associated with the use of Sevoflurane based on animal studies?
A) Nephrotoxicity in rats
B) Neurotoxicity in humans
C) Cardiovascular instability
D) Hepatotoxicity in rats
A) Nephrotoxicity in rats
…not proved in humans
Slide 7
Which of the following are potential concerns or considerations when using Sevoflurane?
Select 2
A) It may cause emergence delirium in pediatric patients.
B) Needs a special heated vaporizer
C) It is very irritating to the airway.
D) It may linger longer in obese patients.
E) The most expensive
A) It may cause emergence delirium in pediatric patients
D) It may linger longer in obese patients.
fat:blood coefficient is 47.5:1 higher than all except halothane
…good for pediatric induction though and very commonly used
Slide 7
Which of the following are true statements about Isoflurane?
Select 2
A) It is relatively inexpensive
B) It has a low lipid solubility
C) It is ideal for cases where quick extubation is desired.
D) Not used very often
E) Used the most often
A) It is relatively inexpensive
D) Not used very often
slide 7
Isoflurane is very lipid-soluble, leading to a __________ emergence, making it suitable for cases where extubation is not expected.
A) Quick
B) Longer
C) Abrupt
D) Slow but unpredictable
B) Longer
(Ex: Sick ICU patient going to stay on a ventilator)
slide 7
Nitrous oxide is known to be an effective __________, allowing it to be used to reduce the required dose of primary anesthetic agents.
A) Muscle relaxant
B) Hypnotic
C) Amnestic
D) Analgesic
D) Analgesic
NOT a solo anesthesia gas. Used as an adjunct.
Slide 7
In which of the following situations might the use of nitrous oxide be contraindicated or not recommended?
Select 2
A) Neurosurgical procedures
B) Procedures involving open body cavities
C) The need for high doses of Nitrous
D) Pediatric dental procedures
A) Neurosurgical procedures
C) The need for high doses of Nitrous N/V at higher doses
Not recommended for procedures involving closed body cavities (e.g., bowel surgery)
Slide 7
What Factors increase Anesthetic Requirements. Select 5
1. Chronic ethanol (ETOH)
2. Acute ethanol (ETOH)
3. Infant (highest MAC at 6 months)
4. Elderly patients
5. Red hair
6. Hyperthermia
7. Hypothermia
8. Anemia (Hgb < 5 g/dL)
9. Hypercarbia
10. Pregnancy
11. Hyponatremia
12. Hypernatremia
13. Hypoxia
- Chronic ETOH
- Infant (highest MAC at 6 mo.)
- Red hair
- Hyperthermia
- Hypernatremia
All the rest decrease Anesthetic Requirements
Slide 8
Anesthetic gases are preferred in clinical anesthesia due to which of the following reasons?
Select 2
A) Quick adjustment in patient sedation level
B) Limited to no metabolism
C) High metabolism
D) They have wide therapeutic window
A) Quick adjustment in patient sedation level
B) Limited to no metabolism
Titratable: Working on the very steep part of the dose response curve.
Very potent: They do have a narrow therapeutic window.
slide 8
Which of the following benefits of anesthetic gases allow for precise dosing and patient monitoring?
Select 2
A) Speed of onset
B) Low potency
C) Ability to measure exhaled gases to assess brain levels
D) High metabolism requirements for adjustment
A) Speed of onset
C) Ability to measure exhaled gases to assess brain levels
Available Measure: Watching what the patient breaths in and out tells us what is in the patients brain.
Slide 8
What law describes the movement of gas from ventilator into lungs?
Boyles: at a constant temperature pressure and volume of gas are inversely proportional
(as PPV begins, bellows contract –> pressure increases within ventilator and circuit –> anesthetic gases flow from high pressure to low pressure (lungs)) –> also via concentration gradient
Diffusion of gas depends on (3)
Partial pressure gradient of the gas
Solubility of the gas
Thickness of the membrane (premature babies have thick pulm cap membranes)
MAC awake
0.3-0.5
MAC BAR (blunts autonomic refexes)
1.7-2.0
no increase in HR or BP
-
Anesthesia Gas44
-
Induction Agent: Propofol34
-
Induction Agent: Etomidate20
-
Induction Agent: Ketamine27
-
Induction Agent: Dexmedetomadine24
-
Narcotics: Morphine8
-
Narcotics: Hydromorphone7
-
Narcotics: Fentanyl8
-
Narcotics: Meperidine7
-
Narcotics: Sufentanil / Sufenta9
-
Narcotics: Remifentanil11
-
Narcotics - Agonist/Antagonist5
-
Opioid Antagonist - Naloxone / Narcan8
-
Benzodiazepines18
-
Flumazenil / Romazicon8
-
N/V Agents22
-
Paralytics: Succinylcholine / Anectine24
-
Paralytics: Cisatracurium / Nimbex11
-
Paralytics: Vecuronium / Norcuron9
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Paralytics: Rocuronium / Zemuron11
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Reversal of Paraytics17
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Glycopyrrolate / Robinul6
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Sugammadex12
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Mir: ACLS Meds30
-
Dosing2
-
Rescue Drugs66
-
Extra from first 2 ppts in spring29
-
Preoperative medications65
-
Adjuncts18
