chapter 11. quiz 5. Effects of Volatile Anesthetics on Cerebral Blood Flow
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Questions and Answers

What is the primary mechanism by which volatile anesthetics affect cerebral blood flow?

  • Enhanced autoregulation
  • Direct effect on vascular smooth muscle (correct)
  • Increased cerebral metabolic rate
  • Reduction in intracranial pressure

    • At 0.5 MAC of volatile anesthetics, what is the effect on cerebral blood flow?

  • Increased due to vasodilatory activity
  • Enhanced autoregulation
  • Unchanged
  • Decreased due to cerebral metabolic rate suppression (correct)

    • What happens to autoregulation with larger doses of volatile anesthetics?

  • It is abolished (correct)
  • It becomes pressure passive
  • It is enhanced
  • It remains unchanged

    • How does the CBF/CMR ratio change with increasing doses of volatile agents?

    <p>Increases</p> Signup and view all the answers

    Which volatile anesthetic leads to the greatest vasodilating potency?

    <p>Halothane</p> Signup and view all the answers

    What is the clinical consequence of administering volatile anesthetics in terms of cerebral perfusion and intracranial pressure?

    <p>Increased cerebral blood flow (CBF) leading to higher ICP</p> Signup and view all the answers

    At 1 MAC of volatile anesthetics, what is the effect on cerebral blood flow?

    <p>Unchanged</p> Signup and view all the answers

    At 1.5 MAC of volatile anesthetics, what is the effect on cerebral blood flow?

    <p>Increased due to vasodilatory activity</p> Signup and view all the answers

    What effect does 1 MAC halothane have on cerebral blood flow when maintaining mean arterial pressure (MAP) at 80 mm Hg?

    <p>Increases by 191%</p> Signup and view all the answers

    How does 1.2 MAC of enflurane affect cerebral blood flow (CBF)?

    <p>Increases CBF by 45%</p> Signup and view all the answers

    Which of the following statements is true regarding sevoflurane at 1 MAC?

    <p>Decreases CBF by 50% and CMR by 50%</p> Signup and view all the answers

    What is the primary mechanism through which xenon exerts its anesthetic effect on cerebral blood flow?

    <p>Noncompetitive antagonism of NMDAR</p> Signup and view all the answers

    What effect does sevoflurane have on cerebral blood volume (CBV) at a reduced cerebral blood flow (CBF)?

    <p>Maintains CBV</p> Signup and view all the answers

    Which volatile anesthetic shows both an increase in cerebral blood flow (CBF) and a decrease in cerebral metabolic rate (CMR) at 1.1 MAC?

    <p>Isoflurane</p> Signup and view all the answers

    At what MAC does the occurrence of EEG suppression typically happen with isoflurane, desflurane, and sevoflurane?

    <p>1.5 - 2 MAC</p> Signup and view all the answers

    Which volatile anesthetic requires concentrations greater than 4 MAC to achieve EEG suppression?

    <p>Halothane</p> Signup and view all the answers

    What occurs with additional halothane administration above 4 MAC, according to the text?

    <p>Further reduction in CMRo2</p> Signup and view all the answers

    Which volatile anesthetic results in slightly less suppression of CMR compared to isoflurane?

    <p>Desflurane</p> Signup and view all the answers

    What effect does additional isoflurane above 6% end-tidal concentration have on CMR?

    <p>No change in CMR</p> Signup and view all the answers

    What effect does propofol have on regional cerebral blood flow (CBF) and regional cerebral blood volume (CBV)?

    <p>Decreases both CBF and CBV</p> Signup and view all the answers

    How does cerebral blood volume (CBV) respond to changes in PaCO2?

    <p>Decreases with hypocapnia and increases with hypercapnia</p> Signup and view all the answers

    In comparison to the change in cerebral blood flow (CBF), how does the change in cerebral blood volume (CBV) respond to alterations in Paco2?

    <p>CBV changes are less than CBF changes</p> Signup and view all the answers

    Which anesthesia results in greater cerebral blood volume (CBV) compared to propofol or pentobarbital?

    <p>Isoflurane</p> Signup and view all the answers

    What effect does 1 minimum alveolar concentration (MAC) of sevoflurane have on regional cerebral blood flow (CBF) and regional cerebral blood volume (CBV)?

    <p>Decreases regional CBF but does not affect CBV</p> Signup and view all the answers

    Which of the following best describes the effect of volatile anesthetics on carbon dioxide responsiveness?

    <p>CO2 responsiveness is well maintained</p> Signup and view all the answers

    Which volatile anesthetic is mentioned in the text as potentially causing less impairment of autoregulatory response to increasing blood pressure?

    <p>Sevoflurane</p> Signup and view all the answers

    Which statement accurately describes the effect of volatile anesthetics on cerebral blood flow (CBF) when maintaining mean arterial pressure (MAP)?

    <p>CBF is preserved up to lower MAP values</p> Signup and view all the answers

    How does autoregulation of cerebral blood flow respond to increasing arterial blood pressure during anesthesia with highly cerebral vasodilatory anesthetics?

    <p>Autoregulation is impaired</p> Signup and view all the answers

    In a patient with a large mass and compressed basal cisterns, what anesthetic technique is advised until the cranium and dura are open?

    <p>Predominantly IV technique</p> Signup and view all the answers

    What effect does isoflurane have on cerebral blood flow (CBF) when introduced under thiopental anesthesia?

    <p>Significantly increases CBF</p> Signup and view all the answers

    Which drug administration or disease process justifies caution in the use of volatile anesthetics due to decreased cerebral metabolic rate (CMR)?

    <p>Traumatic brain injury</p> Signup and view all the answers

    What happens when volatile agents are introduced after prior propofol anesthesia?

    <p>Significant increase in CBF</p> Signup and view all the answers

    Under what circumstances does isoflurane not cause a significant increase in CBF?

    <p>When CMR is slightly reduced by morphine</p> Signup and view all the answers

    What effect does the introduction of volatile anesthetics have on cerebral blood flow (CBF) when cerebral metabolic rate (CMR) has been maximally suppressed?

    <p>Significant increase in CBF</p> Signup and view all the answers

    How do modest reductions in cerebral blood flow (CBF) typically correlate with changes in cerebral blood volume (CBV) according to the text?

    <p>Modest reductions in CBF may not necessarily be accompanied by reductions in CBV.</p> Signup and view all the answers

    In patients with normal intracranial compliance, what effect do volatile anesthetics have on cerebral hemodynamics?

    <p>Volatile anesthetics have modest effects on cerebral hemodynamics.</p> Signup and view all the answers

    How does hypocapnia influence the increase in intracranial pressure (ICP) induced by isoflurane administration according to the text?

    <p>Hypocapnia mitigates the increase in ICP.</p> Signup and view all the answers

    What is the clinical implication of administering volatile anesthetics to patients with abnormal intracranial compliance?

    <p>Volatile anesthetics increase CBV and ICP.</p> Signup and view all the answers

    How does hyperventilation typically affect isoflurane-induced increases in intracranial pressure (ICP) in patients with intracranial tumors?

    <p>Hyperventilation has no effect on the isoflurane-induced increases in ICP.</p> Signup and view all the answers

    What effect do volatile anesthetics have on intracranial pressure (ICP) in experimental investigations of cerebral injury according to the text?

    <p>Volatile anesthetics significantly increase ICP.</p> Signup and view all the answers

    What is the impact of administering nitrous oxide (N2O) alone on cerebral blood flow (CBF) and intracranial pressure (ICP)?

    <p>Increase in CBF, CMR and ICP</p> Signup and view all the answers

    How does the presence of intravenous (IV) anesthetics affect the cerebral vasodilating effect of Nitrous oxide (N2O)?

    <p>Attenuates or inhibits the effect</p> Signup and view all the answers

    What is the impact of administering 50% N2O during barbiturate anesthesia in patients with intracranial tumors and poor compliance?

    <p>Negligible effect on CBF and ICP</p> Signup and view all the answers

    Which effect does administering Nitrous oxide (N2O) with IV agents such as barbiturates, benzodiazepines (BNZ), narcotics, or propofol have on its cerebral vasodilating effect?

    <p>Attenuates or completely inhibits the effect</p> Signup and view all the answers

    What should be considered when administering Nitrous oxide (N2O) in circumstances where intracranial pressure (ICP) is persistently elevated or the surgical field is persistently tight?

    <p>Avoid using N2O</p> Signup and view all the answers

    How does the simultaneous administration of IV anesthetics affect the cerebral vasodilation induced by Nitrous oxide (N2O)?

    <p>Reduces the vasodilating effect of N2O</p> Signup and view all the answers

    The most dramatic increases in ICP or CBF occurred when N2O was administered

    <p>when was administered alone</p> Signup and view all the answers

    How does the concentration of inhaled drug correlate with the vasodilating effect of N2O?

    <p>The effect is exaggerated at higher concentrations.</p> Signup and view all the answers

    What impact did administering 50% N2O to healthy volunteers have on cerebral blood volume (CBV)?

    <p>No significant alteration in CBV.</p> Signup and view all the answers

    When N2O was added to a background of 1 MAC sevoflurane anesthesia, what effect did it have on cerebral blood volume (CBV)?

    <p>Had no effect on CBV.</p> Signup and view all the answers

    What do the data presented in the text suggest about the relationship between N2O and cerebral blood volume (CBV)?

    <p>N2O moderately affects CBV.</p> Signup and view all the answers

    Which muscle relaxant is mentioned as having the most rapid onset time in the text?

    <p>Rocuronium</p> Signup and view all the answers

    What does the text suggest can be used to rapidly reverse a profound neuromuscular blockade (NMB)?

    <p>Sugammadex</p> Signup and view all the answers

    In which instances should doses of metocurine, atracurium, and mivacurium be limited ?

    <p>limited to ranges not associated with hypotension</p> Signup and view all the answers

    What was observed regarding intracranial pressure (ICP) after the administration of succinylcholine to nonparalyzed, ventilated neurosurgical patients in the ICU?

    <p>No change in ICP</p> Signup and view all the answers

    How can succinylcholine-induced increases in ICP be prevented based on the text?

    <p>With deep anesthesia</p> Signup and view all the answers

    What is the primary mechanism of action of Nondepolarizing muscle relaxants and effect on ICP?

    <p>Release of histamine leading to increased cerebral blood flow (CBF)</p> Signup and view all the answers

    Which muscle relaxant has the highest potency as a histamine releaser according to the text?

    <p>D-Tubocurarine</p> Signup and view all the answers

    Which muscle relaxant is least likely to have a significant effect on cerebral physiology?

    <p>Vecuronium</p> Signup and view all the answers

    What is the likely clinical significance of histamine release by muscle relaxants?

    <p>Increased risk of cerebral vasodilation with large doses</p> Signup and view all the answers

    What is the effect of cisatracurium compared to other muscle relaxants in terms of histamine release?

    <p>Least potent among all muscle relaxants mentioned</p> Signup and view all the answers

    WHICH anesthetic drug increase secretion and no effect on absorption ?

    <p>Desflurane</p> Signup and view all the answers

    WHICH anesthetic drug increase absorption and no effect on secretion ?

    <p>Isoflurane</p> Signup and view all the answers

    WHICH anesthetic drug increase absorption and decrease secretion ?

    <p>Etomidate</p> Signup and view all the answers

    WHICH anesthetic drug decrease absorption and increase secretion ?

    <p>Enflurane</p> Signup and view all the answers

    WHICH anesthetic drug decrease absorption and secretion ?

    <p>Halothane</p> Signup and view all the answers

    How do tight junctions in the brain affect the pore size between endothelial cells?

    <p>Decrease the pore size to 8 Å</p> Signup and view all the answers

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