Inhaled Meds, kays lecture on passing gas
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| General Anesthesia is characterized by: | show 🗑
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| Three Phases of General Anesthesia | show 🗑
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| Meyer-Overton Rule | show 🗑
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| show | Proposes all inhalational anesthetics share a common mechanism of action at the molecular level
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| show | anesthesia occurs when a “critical region” volume is sufficiently changed. Anesthesia binding to sites on cell mem cause an expansion of the bilayer
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| Membrane Hypothesis | show 🗑
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| show | Enhancement of GABA receptor is thought to be a target in the CNS GABA-A & GABA receptors with a alpha-5-sub-unit.
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| Newer theories | show 🗑
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| Stage I | show 🗑
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| show | Delirium with period of excitement, muscle movement, irritability, and pupils dilated, disconjugate gaze, increased RR and HR, risk of laryngospasm
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| show | Surgical plane (target depth), fixed gaze of eyes, constricted pupils and no response to pain
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| show | Overdose, absent or shallow RR, hypotension, profound CV compromise
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| FGF | show 🗑
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| FI: inspired gas concentration | show 🗑
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| show | determined by uptake, ventilation, the concentration effect and second gas effect
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| Fa: arterial gas concentration | show 🗑
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| the more soluble the anesthetic agent is in the blood the ________ the patient becomes anesthetized | show 🗑
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| show | More
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| show | Faster
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| If CO decreases what happens to the alveolar concentration | show 🗑
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| If CO increases what happens to the FA | show 🗑
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| What determines PA-Pv/Partial Pressure difference in Alveolar gas and Venous blood | show 🗑
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| show | Decreased alveolar partial pressure by uptake can be countered by increasing ventilation
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| show | Directly
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| What is it called when "increasing the inspired concentration can increase alveolar concentration" | show 🗑
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| show | Speed
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| show | Declines
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| Second Gas Effect | show 🗑
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| show | increasing ventilation and concentration
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| Ventilation/Perfusion Mismatch will | show 🗑
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| Factors Affecting Wake Up | show 🗑
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| Metabolism/Elimination of gases | show 🗑
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| Respiratory effects of inhaled agents | show 🗑
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| show | All are great bronchodilators by direct action on smooth muscle.Good for bronchospasm.
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| CVS effects of inhaled agents | show 🗑
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| show | All inhaled agents are smooth muscle relaxants. All cause vasodilation(decreased SVR) leading to hypotension except Nitrous Oxide Coronary Dilators--Iso>Sevo=Des Arrhythmias can be induced by the agents, Halothane the worst>enfl>iso>des
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| show | decreased Amplitude, increased Latency
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| show | Increased Cerebral Blood flow, autoregulation of cerebral blood is impairedIncreased ICP due to increased blood flow and induced hypercapnea(prevented by hyperventilation)
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| Intraoperative Awareness risk factors | show 🗑
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| Renal risk factors induced by inhaled agents | show 🗑
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| Liver problems associated with inhaled agents | show 🗑
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| MAC | show 🗑
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| show | because the partial pressure in the aveolus quickly equilibrates with that in the blood and brain because of the brains high blood flow
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| show | MAC is INVERSELY related to POTENCY
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| show | ED95= 1.3 MAC of any volatile anesthetic has been found to prevent movement in 95% of patients
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| What is MAC awake | show 🗑
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| What is MAC BAR | show 🗑
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| show | Hyperthermia Drugs that increase CNS catecholamine levels (monoamine oxidase inhibitors, tricyclic antidepressants, acute cocaine use,Infants (6-12 months)Hypernatremiachronic ethanol abuse
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| show | Hypothermia Preoperative medications and IV anesthetics Neonates and the elderlyPregnancyAlpha-2 blockers, calcium channel blockersacute alcohol ingestion
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| Factors that have no efect on MAC | show 🗑
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| What is compound A | show 🗑
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| show | Increased ETco2, increased heart rate and temperature
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| primary pathophysiologic event in MH | show 🗑
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| What is MH | show 🗑
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| show | Advantages: cheap, very soluble-slow to leave pt, cardio-protective Disadvantages: Solubility-high residual at end of case, risk of awareness, may slow OR turnover, can’t be used for gas inductionBlood:Gas coefficient= 1.4MAC:1.2
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| DESFLURANE(Suprane) | show 🗑
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| SEVOFLURANE(Ultane) | show 🗑
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| Nitrous Oxide (N2O) | show 🗑
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| Cardiac and respiratory effects of Nitrous | show 🗑
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| Disadvantage of Nitrous | show 🗑
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| show | N2O activates methionine synthetase by oxidizing the cobalt in Vit B12 and can affect DNA, spontaneous abortions in women working in the OR/dental offices (Unproven)
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