Anesthetic Agents & Tech 5

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Anesthetic Agents & Tech 5
2012-03-01 21:51:45
Clinical Practice

Clinical Practice
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  1. What are the three different types of gas anesthesia?
    • halothane
    • isoflurane
    • sevoflurane
  2. Which gas anesthesia do we not use anymore?
  3. When was isoflurane introduced?
  4. Which gas anesthetic is the most widely used?
  5. What class of gas anestheic is isoflurane in?
    halogenated ethers
  6. What are the physical properties of isoflurane?
    • colorless
    • ether-like odor
    • non-irritating to mucous membrane (in debate)
    • heavier than air
    • non-flammable
    • not corrosive to metals
    • dose not react with soda lime
  7. What is the highest vapor pressure precentage isoflurane can get to?
  8. What type of vaporizer do we need to use with isoflurane?
    precision vaporizer
  9. What is solubility coefficient?
    how easy gas gets into blood
  10. What kind of solubility coefficient does isoflurane have?
    very low
  11. How long is induction and recovery using isoflurane?
    rapid (1 - 2 minutes)
  12. What can we use for induction using isoflurane?
  13. Can we change the depth of anesthesia using isoflurane?
    yes - rapidly
  14. What is the rubber solubility of isoflurane?
    very low - does not dissolve into rubber equipment
  15. What is it good to have low rubber solubility?
    anesthesia is not prolonged after vaporizer is turned off
  16. What does MAC stand for?
    minimum alveolar concentration
  17. What is the MAC of isoflurane?
    • higher than halothane or methoxyflurane
    • less potent
  18. At what temperature is isoflurane stable?
    room temperature
  19. Does isoflurane have any preservatives?
  20. What is the margin of safety for isoflurane?
    wider margin of safety than halothane or methoxyflurane
  21. Does isoflurane have a lot of side effects?
    no - few
  22. What are the side effects of isoflurane?
    • little or no: effect on HR, decrease in cardiac output, myocardial depression
    • does not cause arrhythmias
    • vasodilation in deep anesthesia
    • low BP in deep anesthesia
  23. What inhalation anesthetic is the agent of choice for patients with heart problems?
  24. How is isoflurane eliminated?
    through exhalation
  25. Is isoflurane metabolized by the liver or kidneys? Why?
    very little because it has low fat solubility
  26. Because isoflurane is not excreted by the liver and kidneys, it has no what?
    toxic metabolites
  27. Because isoflurane is excreted by exhalation, it is good to use with what kinds of patients?
    • liver problems
    • kidney problems
    • neonates
    • geriatric
  28. Does isoflurane produce good muscle relaxation?
  29. Does isoflurane produce a good analgesic?
  30. What percent and how long do we use isoflurane for mask induction?
    • 4 - 5%
    • 6 - 8 minutes
  31. What percent should we have isoflurane for the maintence period?
    1.5 - 2.5%
  32. What are the physical properties of sevoflurane?
    • clear and colorless
    • sweet, non-pungent odor
    • non-irritating to the respiratory system
    • nonflammable
    • does not corrode metals
    • does react with soda lime and baralyme
  33. What is it called when sevoflurane reacts with soda lime or baralyme?
    compound A
  34. What is the solubility coefficient of sevoflurane?
    very low - lower than isoflurane
  35. What kind of induction does sevoflurane have?
  36. Can we change the depth of anesthesia using sevoflurane?
    yes - rapidly
  37. What kind of recovery does sevoflurane have?
  38. Which anesthetic has a more rapid induction and recovery? Isoflurane or sevoflurane?
  39. What kind of MAC does sevoflurane have?
    higher than isoflurane (even less potent)
  40. What does it mean that sevoflurane is less potent than isoflurane?
    it takes a higher % to maintain anesthesia
  41. What kind of rubber solubility does sevoflurane have?
  42. Does sevoflurane dissolve into rubber parts of the anesthetic equipment?
  43. Is sevoflurane stable?
  44. Does sevoflurane contain any additives or chemical stabilizers?
  45. What effect does sevoflurane have on the cardiovascular system?
    can increase or decrease HR
  46. What happens if we increase the concentration of sevoflurane during maintenance?
    can produce a dose-dependent decrease in blood pressure
  47. What effect does sevolfurane have on the respiratory system?
    depress respiration
  48. Sevoflurane has not been established for dogs with...
    • renal, hepatic, or cardiac problems
    • breeding
    • pregnant
    • lactating
    • neonatals dogs
    • dogs under 12 weeks of age
  49. Do we still use sevoflurane with dogs that have renal, hepatic, cardiac problems, or breeding, pregnant, lactating, neonatals, under 12 weeks of age? Why or why not?
    yes because clinical experience suggests that it is still safe
  50. What can sevoflurane cause?
    malignant hyperthermia (temperature goes up to really high level - 108)
  51. What is compound A?
    produced by interaction of sevoflurane and soda lime or baralyme
  52. What animal does compound A cause nephrotoxicity? Do we still use sevoflurane with this animal? Why or why not?
    • rats
    • no
    • not proven to be a problem in clinical practice
  53. When is compound A more likely to cause renal injury?
    if used for long period at a low flow rate
  54. How do we minimize renal injury with compound A?
    keep fresh gas flow rates (over 1 L/minute, preferable 2 L/minute)
  55. How is sevoflurane excreted?
    • 95% exhaled
    • 5% excreted in urine or taken up in bone
  56. What kind of O2 flow rates should we use for sevoflurane?
    standard or slightly higher standard
  57. What kind of anesthesia circuit do we need to use for sevoflurane?
    any kind
  58. What kind of drugs is sevoflurane compatible with?
    • barbiturates
    • propofol
    • phenothiazines
    • alpha 2 agonists
    • opioids
    • N2O
    • benzodiazepams
    • anticholinergics
  59. Are there any specific premedications we need to use for sevoflurane?
  60. What kind of induction does sevoflurane have?
    very rapid (faster than isoflurane)
  61. For induction, what percent and how long for sevoflurane?
    • 4 - 7%
    • 5 - 7 minutes
  62. For maintenance, what percent of sevoflurane do we use?
    2.5 - 4 %
  63. Describe the recovery using sevoflurane.
    • faster than isoflurane
    • smooth and quiet (goes through stage ll excitement rapidly)