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Definition
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Term
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Definition
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Term
| Does cyclosporines increase or decrease MAC? Does this mean you need more or less of the inhaled agent? |
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Definition
| cyclosporines INCREASE MAC = INCREASE DRUG REQUIREMENTS. Cyclosporine is an immunosuppresant drug for transplants that targets T helper cells. |
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Term
| At what age will the patient have the highest MAC requirement |
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Definition
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Term
| Red heads need more MAC because of what in their system |
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Definition
| increase levels of pheomelanin-production. |
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Term
| Patients on MAOis, Tricyclics, SSRIs will need more or less MAC for volatile agents? Why? |
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Definition
| NEED MORE! INCREASE MAC/INCREASE VOLATILE AMOUNT. B/c these drugs for depression treat depression by increasing central catecholamine levels. |
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Term
| Pregnancy..increases or decreases MAC |
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Definition
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Term
| Lithium will increase or decrease MAC |
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Definition
| DECREASE. ANTIPYSCHOTICS ARE ADDITIVE TO SEDATION |
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Term
| A PaO2 of __ will have no effect on MAC |
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Definition
| PaO2 > 38 has no effect on MAC |
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Term
| A CO2 of __ will have no effect on MAC |
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Definition
| CO 15-95 will not effect MAC |
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Term
| Cardiopulmonary bypass will do what to MAC |
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Definition
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Term
| Can High or low potassium levels affect MAC? |
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Definition
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Term
| Does duration of anesthesia affect MAC |
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Definition
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Term
| MAC AWAKE is what percentage of MAC |
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Definition
| MAC Awake is 1/3 of MAC. BUT CANNOT MAKE MEMORIES |
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Term
| Mac Aware is what percentage of MAC |
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Definition
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Term
| Does MAC Awake or MAC Aware able to make memories |
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Definition
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Term
| What is the MAC at which 95% of patients will not move in response to stimulus |
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Definition
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Term
| a patient with hypothyroid disease will have a increase or decreasse in mac |
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Definition
| NO EFFECT. Thyroid whether high or low has no effect on MAC |
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Term
| a patient on sevo for 10 hours will have a lower or higher MAC requirement than a person on SEVO for 1/2 hour. |
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Definition
| NO DIFFERENCE. BOTH WILL HAVE SAME MAC |
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Term
| What is the MAC BAR for Sevo |
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Definition
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Term
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Definition
| MAC at which you block autonomic resposne to stimulil. |
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Term
| an addition of ___ mcg/kg of fentanyl will decrease MAC BAR to? |
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Definition
| 1.5-3 mcg/kg of fentanyl decreases MAC BAR to 0.4-0.63 MAC |
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Term
Blood gas solubility for:
1. Desflurane
2. Nitrous
3. Sevo
4. Isoflurane |
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Definition
1. Desflurane: 0.42
2. Nitrous: 0.47
3. Sevo: 0.59
4. Isoflurane: 1.4 |
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Term
| if a gas is being uptaked in the alveoli at a large rate then will the onset be increased or decreased. |
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Definition
| UPTAKE = BAD. More uptake means more volatile in blood and less in brain |
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Term
| describe the second gas effect |
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Definition
| When using nitrous + volatile. Nitorus is absorbed much more readily and result in alveolar collapse due to loss of gas. Now with a smaller size of alveolar space your monitors falsely register the volatile as being a larger % in this smaller space. |
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Term
| overpressure in relation to inhaled anesthetic means |
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Definition
| you crank up the gas so that you increase the concentration gradient to casue a fast onset of action. |
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Term
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Definition
Uptake = lamda x Q x Pa - Pv
------
P
P = barometric pressure
Q = perfusion
Lamda = B:G coefficent
Pa = alveolar pressure |
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Term
how do the following affect induction time for inhaled anesthetics
1. FRC |
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Definition
Increased FRC means larger bucket to fill with gas. Means slower induction. Ex would be COPD patients
Decrease FRC in paturients or neonates or large abdominal tumors pushing up on diagphram means faster onset. Bucket is smalelr and filled up more quickly. |
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Term
| What type of shunt has an effect on induction of inhaled anesthetics |
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Definition
| R to L shunt will decrease induction time. |
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Term
| is cardiac output directly or indirectly related to agent uptake into the blood |
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Definition
| directly related. So higher the cardiac output then larger amount uptaked into blood. Greater uptake = slower induction. |
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Term
| what does the meyer-overton theory explain |
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Definition
| the correlation between lipid solubility of inhaled anesthetics and its MAC |
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Term
| O:G is proprotional or inverse to MAC |
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Definition
| INVERSE!!!! Higher the O:G then lower the MAC. So higher the O:G means more lipid soluble means more potenet. More potenet means the MAC will be lower. |
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Term
| What is the O:G of sevo and nitrous |
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Definition
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Term
| Which coefficent predicts emergence times from anesthesia |
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Definition
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Term
What is the tissue:gass coefficent for
1. Nitrous
2. Desflurane
3. Sevo
4. Iso |
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Definition
1. Nitrous - 1.22
2. Desflurane - 35
3. Sevo - 99
4. Iso - 110 |
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Term
| Per guedel's chart the amnesia stage I ends when |
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Definition
| Ends with loss of consciousness seen by loss of eyelid reflex |
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Term
| Stage II delirium / excitment is characterized by |
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Definition
1. breath-holding
2. struggling
3. vomiting
4. laryngospasms |
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Term
| what do the eyes look like during stage II |
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Definition
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Term
| what do eyes look like during surgical anesthesia Stage III |
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Definition
1. pupillary constriction
2. central gaze |
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Term
| Stage IV anesthesia is characterized by |
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Definition
1. apnea
2. pupils are dilated and non-reactive
3. hypotension leading to complete CV collapse
4. TOO DEEP |
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Term
| All inhaled agents do what to brain |
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Definition
| decrease EEG and decrease CMRO2. But increase in CBF and Increase ICP. |
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Term
| Which volatile may actually increase EEG and can preciptiate seizures at high doses |
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Definition
| SEVO. That's one of the reasons why we don't use it during SSEP monitoring. |
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Term
| What is the best gas for limiting increaases in CBF |
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Definition
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Term
| which gas has the most likely ability to cause EEG stimulation at high doses |
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Definition
| SEVO is the biggest culprit |
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Term
| Which volatile effects SVR the most |
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Definition
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Term
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Definition
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Term
| the dose limit for exogenous epi for a patient on volatiles is |
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Definition
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Term
| do our volatiles sensitize the myocardium to effects of exogenous and endogenous catecholamines? |
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Definition
| NO. Sevo, iso and des DO NOT Sensitize the myocardium. |
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Term
| Why do patients on volatiles have decrease TV |
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Definition
| due to loss of accessory muscles of respiration |
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Term
| at a MAC of ? We see a markedly depressed response of the body to hypoxia. This is due to depression of what part of our brain by volatiles and Nitrous |
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Definition
| CArotid body is depressed. At mac 1.1. |
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Term
| all volatiles interfere with heaptic drug clearnace via what two mechanisms |
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Definition
1. reduction of heaptic blood flow
2. suppression of metabolizing enzymes |
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Term
| sevo when it reacts with ___ can produce compound A |
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Definition
| Sevo reacting with soda lime in the circuit forms compound A. Therefore it is a degradation product from co2 absorber not a metabolite. |
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Term
| why avoid NO2 in immunocomprised people |
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Definition
1. causes megaloblastic changes
2. agranulocytosis
3. impedes hematopoiesis |
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