Inhalation Anesthetics

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Author:
tsbatiste
ID:
263389
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Inhalation Anesthetics
Updated:
2014-03-14 19:34:28
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VTHT Anesthesia Surgery
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Description:
Inhalation gases and induction
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  1. This gas is not often used in veterinary medicine and cannot be used alone due to its very high minimum alveolar concentration.
    Nitrous Oxide
  2. This gas anesthetic is no longer used due to irritation to mucous membranes and its explosive nature.
    Diethyl ether
  3. These anesthetic gases are collectively known as halogenated compounds:
    • "DISH EM"
    • Desflurane
    • Isoflurane (Aerrane-h,)
    • Sevoflurane
    • Halothane
    • Enflurane
    • Methoxyflurane (Metofane)
  4. This value is the ability of a volatile liquid in a gas form to be absorbed by the body
    Solubility Coefficient
  5. Another name for the Solubility Coefficient
    Partition Coefficient
  6. A high partition coefficient means:
    more uptake in blood and tissues resulting in delay in alveolar concentration
  7. A lower the partition coefficient means:
    The gas will reach the nerves faster
  8. List the gas by Partition Coefficients from lowest to highest:
    • Nitrous Oxide
    • Sevoflurane
    • Isoflurane
    • Halothane
    • Diethyl ether
    • Methoxyflurane
  9. What percentage of total cardiac output consumption does the vessel rich tissue group uptake?
    75%
  10. Tissues in the vessel rich group:
    • brain
    • heart
    • kidneys
    • liver
    • spleen
    • intestines
  11. What percentage of total cardiac output consumption does the muscle rich tissue group uptake?
    20%
  12. Tissues in the muscle rich group:
    • skeletal muscles
    • skin
  13. What percentage of the total cardiac output consumption does the vessel poor group uptake?
    5%
  14. Tissues in the vessel poor group
    • bone
    • tendon
    • ligament
    • fat
  15. Define MAC:
    the anesthetic concentration required to prevent gross muscular movement in response to painful stimuli in 50% of a tested population
  16. MAC
    Minimum Alveolar Concentration
  17. General concentration range for surgical anesthesia
    1.2 to 1.5 MAC
  18. Which gas anesthetic has the highest MAC (and is therefore considered the weakest gas)?
    Nitrous Oxide (188-200% d, 150% c)
  19. Which gas anesthetic has the lowest MAC (and is therefore considered the strongest gas)?
    Methoxyflurane (0.23-0.30% d, 0.23% c)
  20. List the gases by MAC values from lowest to highest
    • Methoxyflurane
    • Halothane
    • Isoflurane
    • Enflurane
    • Sevoflurane
    • Diethyl ether
    • Desflurane
    • Nitrous Oxide
  21. 3 methods of elimination of anesthetic gases from the body
    • 1. Lungs
    • 2. Other routes
    • 3. Biotransformation by the liver
  22. 3 factors of uptake and elimination of anesthetic gases from the lungs
    • 1. Pulmonary ventilation
    • 2. Blood flow
    • 3. Partition Coefficient
  23. What form are anesthetic gas in when eliminated by the lungs?
    Largely unchanged (not "metabolized")
  24. What other routes are anesthetic gases eliminated in small amounts?
    • Skin
    • Milk
    • Mucous membranes
    • Urine
  25. Which enzyme system is responsible for metabolizing anesthetic gases in the liver?
    hepatic microsomal enzyme system
  26. What are the toxic intermediate metabolites of gas anesthetic biotransformation?
    • Fluoride ions
    • Bromide ions
  27. List the liver metabolism of anesthetic gases:

    Methoxyflurane:
    Halothane:
    Enflurane:
    Isoflurane:
    Sevoflurane:
    • 50%
    • 20%
    • 2.5%
    • 0.25%
    • 0.25%
  28. List factors that affect MAC
    "PACCT"

    • Pregnacy
    • Age - older needs less gas
    • CNS drugs - depress inhalation
    • Concurrent illness
    • Temperature - lower temps reduce MAC
  29. Veterinary proprietary name for Methoxyflurane
    Metafane (Pitman-Moore)
  30. Human proprietary name for Methoxyflurane
    Panthrane
  31. Why is Methoxyflurane no longer used today?
    No longer available in the US
  32. What was the only system that methoxyflurane could be used?
    Vaporizer In Circuit (VIC)
  33. VOC
    Vaporizer Outside the Circuit
  34. Another name for VIC system
    Wick
  35. Another name for VOC
    Precision Vaporizer
  36. Proprietary names for Halothane
    • Halothane - Abbot Laboratories
    • Fluothane
  37. Halothane approved species
    • Dog
    • Cat
    • non-food animals
  38. Gas anesthetics that can trigger Malignant Hyperthermia
    • Halothane
    • Isoflurane
    • Sevoflurane
  39. Which gas reduces tear production in horses by 60%
    Halothane
  40. What is the common effect of all gas anesthetics that prevents their use in head trauma patients
    They increase the cerebral blood flow and intracranial pressure
  41. This was the first of the "Fast Induction-Fast Recovery" Halogenated compound
    Halothane
  42. Human proprietary names for Isoflurane
    • Forane
    • Aerrane
  43. Veterinary Proprietary Names (MFR) of Isoflurane
    • IsoFlo (Abbot)
    • Iso-Thesia (Vetus Animal Health)
  44. List the common anesthetic gases in order of induction/recovery rate, quickest first:
    • Sevoflurane
    • Isoflurane
    • Halothane
  45. Human proprietary name for sevoflurane
    Ultane
  46. Veterinary proprietary name (MFR) for sevoflurane
    SevoFlo (Abbot Laboratories)
  47. Approved species for Sevoflurane
    Dogs
  48. What has been reported when sevoflurane is used with a desiccated CO2 absorbent?
    Excessive heat in the respiratory circuit
  49. List the 4 main precautions when using Halogenated gas anesthetics
    • 1. Avoid use in head trauma/brain tumor cases due to increase cerebral flow and intracranial pressure
    • 2. Avoid use in patients susceptible to Malignant Edema
    • 3. Must be monitored closely
    • 4. Avoid exposure to pregnant staff members
  50. Proprietary name for Desflurane
    Suprane
  51. What compound is substituted by fluorine in Desflurane gas?
    chlorine
  52. Why is desflurane not commonly used in veterinary medicine?
    • 1. very pungent
    • 2. requires electrically heated vaporizer
  53. Proprietary name for Enflurane
    Ethrane
  54. Despite it being very stable, why is enflurane not used often in veterinary medicine?
    Expense
  55. What would a concentration of 50% nitrous oxide do when combined with other anesthetic gases?
    It lowers the MAC of the other anesthetic gases which can be considered when finances are tight.
  56. Advantages of Modern Inhalation Gases:
    • "CARE"
    • 1. Can alter anesthetic depth quickly
    • 2. Always good muscle relaxation
    • 3. Rapid induction/recovery
    • 4. Elimination primarily by lungs
  57. Disadvantages of Modern Inhalation Gases:
    • "CAGE"
    • 1. Complex equipment needed
    • 2. Always some level of cardio-respiratory depression
    • 3. Gases exposure to personnel
    • 4. Expensive
  58. 3 disadvantages of sevoflurane vs. isoflurane
    • 1. Can produce an increase in serum inorganic fluoride ion concentration
    • 2. Can increase post-surgical BUN and creatinine values = nephrotoxicity
    • 3. Can produce excessive heat when used with a desiccated CO2 absorbent
  59. 4 methods of induction
    • Intravenous
    • Intramuscular
    • Oral
    • Inhalant Gas
  60. Ketamine hydrochloride dosage
    0.1mL/lb (canine) but not more than 4mL/animal
  61. Acetylpromazine maleate dosage when used with Propofol
    0.05 - 0.20 mg/lb
  62. 4 main differences between IV and IM induction:
    • 1. IM cannot be given to effect
    • 2. IM dose is 2-3 times IV dose
    • 3. IM takes longer to reach the brain
    • 4. IM increases recovery time due to increased induction time
  63. Manufactures of Ketamine Hydrochloride
    • Ketaset/Vetalar - Pfizer
    • Ketalar - Abbot Laboratories
    • Keta-thesia - Vetus Animal Health
    • Vetamine - generic
    • Ketaject - human product
  64. Veterinary Ketamine dosage strength
    100mg/mL
  65. Human Ketamine strength
    50mg/mL
  66. Approved species for Ketamine
    • Cats
    • sub-human primates
  67. Ketamine method of action
    inhibits GABA receptors
  68. Which reflexes do not abolish when Ketamine HCL is used alone?
    • Laryngopharyngeal
    • Pinnal
    • Pedal
  69. Why must an anticholinergic be used with Ketamine HCL?
    Ketamine causes hypersalivation
  70. Uses of Glycopyrrolate
    • 1. antisialagoue
    • 2. prevent/treat bradycardia due to vagal reflexes
    • 3. treat diarrhea/bladder spasms
    • 4. antidote for organophosphate poisoning
  71. Oral route for Induction
    Not generally an option for basal anesthetic but can be sprayed into the mouth of a fractious animal
  72. Two drugs that can be used orally to produce a level of consciousness in a fractious animal to be approached for proper induction of anesthesia:
    • Ketamine
    • Innovar-Vet
  73. Manufacturers of fentanyl
    • Duragesic - Janssen Pharmaceutica
    • gen Fentanyl - Abbott Laboratories
  74. Species approved for fentanyl
    no veterinary species
  75. Onset of effect for fentanyl (duragesic) patches
    12-24 hours
  76. Duration of effect for fentanyl (duragesic) patches
    • dog: 3 days
    • cat: 5 days
  77. List the 4 strengths of fentanyl (duragesic) patches
    25, 50, 70, 100 mcg/hr
  78. For mask induction to be feasible, the inhalant must have what type of partition coefficient?
    Low
  79. Why might a mask induction be used?
    Critically ill, pediatric or geriatric patients may not be able to tolerate parental methods due to renal/liver insufficiencies
  80. Drawbacks of mask induction
    • 1. personnel exposed to waste gases
    • 2. fear causes catecholamine release which may predispose patient to cardiac arrythmias and hypotension
    • 3. difficult to use mucous membrane, crt and ocular indicators because of mask
    • 4. increased oxygen usage
  81. Species in which chamber induction is appropriate
    • feline
    • lagomorphs
    • lizards
    • rodents
  82. How do you know the chamber is the correct size for the patient?
    It is large enough for the patient to lie down with neck extended
  83. According to McKelvey, the anesthetist has two major tasks during surgery:
    • 1. Ensure vital signs remain within limits
    • 2. Maintain the patient at the appropriate anesthetic depth
  84. List the parameters to be monitored:
    • Pulse strength and blood pressure
    • Palpebral reflex
    • Respiratory rate and depth
    • Oxygenation and SpO2
    • Oxygen Flow Rate
    • Fluid administration
    • Mucous membrane and capillary refill time
    • Anesthetic gas flow rate
    • Temperature
    • Heart Rate
  85. What does monitor mean?
    "To warn"
  86. How often should vital signs be checked?
    3-5 minutes
  87. This term refers to those parameters that indicate the response of the patients homeostatic mechanisms to anesthesia
    Vital Sign
  88. This term refers to an involuntary response to a stimulus
    Reflex
  89. What is the purpose of monitoring vital signs and reflexes?
    To determine anesthetic depth
  90. Give 5 reasons for a drop in blood pressure:
    • General anesthesia
    • Pre-anesthesia like acetylpromazine that  produces hypotension in blood vessels
    • Depth of anesthesia
    • Hypovolemia (blood/fluid loss)
    • Dehydration (blood/fluid loss)
  91. List the vital signs
    • Heart rate and rhythm
    • Blood pressure
    • Capillary Refill time
    • Mucous membrane color
    • Respiratory Rate/depth
    • Thermoregulation
  92. What percentage does tidal volume decrease under anesthesia?
    25%
  93. Which opioids commonly produce panting?
    • Fentanyl (Duragesic)
    • Hydromorphone (Dilaudid)
  94. Normally expiration takes how long with respect to inspiration?
    Twice as long
  95. When is temperature loss the greatest during general anesthesia?
    The first 20 minutes
  96. List factors that contribute to temperature loss:
    • 1. Wet skin
    • 2. No shivering
    • 3. Reduce metabolic rate
    • 4. Vasodilation due to anesthetics
    • 5. Open cavity
  97. List side effects of reduced temperature in an anesthetized patient:
    • 1. prolonged recovery
    • 2. slow liver enzyme metabolism of the anesthetics
    • 3. Bradycardia
    • 4. Decreased MAC
    • 5. Painful shivering
    • 6. Decreased anti-cholinergic effectiveness
    • 7. Increased O2 requirement
  98. 2 methods to decrease heat loss
    • 1. Circulation hot water heating pads
    • 2. Forced air warming devices
  99. 2 Forced Air Warming devices
    • 1. Bair Hugger (Gaymar)
    • 2. Hot Dog Warming System (Augustine Biomedical)
  100. List the reflexes monitored
    • 1. Jaw Tone (Muscle reflex)
    • 2. Pedal
    • 3. Palpebral
    • 4. Pinnal
    • 5. Pupillary Light Reflex
    • 6. Corneal Reflex
    • 7. Pupil Size (except with anticholinergics)
    • 8. Response to surgical stimuli
    • 9. Heart and respiratory rate
  101. Palpebral reflex can still be seen at the surgical level when these drugs are used:
    • 1. Barbiturates
    • 2. Methoxyflurane (Metafane)
  102. When is the Pedal reflex normally lost?
    During induction
  103. What situation is the Pinnal reflex particularly useful?
    Determines when a cat given ketamine HCL anesthetic level (diminishes at the end of Stg 3 p1)
  104. Which reflex is generally the last reflex to abolish and when is it finally absent?
    Corneal, stage 3 plane 4
  105. At what rate should the patient be left on oxygen after surgery?
    1 minute/hr of surgery
  106. Length of recovery depends on:
    • 1. Type of anesthetic used
    • 2. Length of anesthesia
    • 3. Condition of the patient (hypothermia/organ dysfunction
    • 4. Route of administration
  107. List the stages of recovery that should be followed:
    • 1. Look for the swallowing reflex to return
    • 2. Remove tube (be sure it is uncuffed first)
    • 3. Place animal in sternal recumbency
    • 4. Leave on maintenance fluids until told otherwise

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