51 Questions
What is the preferred inhaled anesthetic for inhalation induction?
Sevoflurane
Which of the following is true about the volatile anesthetics and triggering MH (Malignant Hyperthermia)?
All volatile agents trigger MH in a susceptible patient
How do the volatile anesthetics affect cerebral blood flow and cerebral metabolic rate of oxygen consumption (CMRO2)?
Increase cerebral blood flow and decrease CMRO2
What effect do the volatile anesthetics have on evoked potential monitoring?
Can cause unpredictable effects on evoked potential monitoring
What is the main effect of 0.5 MAC of an inhaled anesthetic?
Loss of self awareness and recall
Which factor does NOT increase MAC?
Gender
What is the main difference between MAC-awake and MAC-BAR?
Alveolar concentration that opens eyes to command vs. blunts adrenergic response
Which inhaled anesthetic is least pungent and produces the least airway irritation?
Sevoflurane
Which agent results in NO CHANGE in CSF resorption?
Nitrous oxide
What effect do Isoflurane, Desflurane, and Sevoflurane have on CMRO2 and EEG?
Decrease CMRO2 consistent with EEG decrease
Which anesthetic agent is associated with an improvement in cognitive recovery over isoflurane?
Sevoflurane
At what concentration range does the shift to increasing frequencies occur on EEG when using N2O?
30-70%
Which type of evoked potential monitoring is least affected by volatile agents?
Subcortical monitoring
In terms of hemodynamics, what effect do volatiles have on blood pressure?
Dose-related decrease
How do isoflurane and desflurane affect heart rate compared to sevoflurane?
Isoflurane and Desflurane increase heart rate, Sevoflurane does not change it
Which anesthetic agent may slightly prolong the QT interval?
Desflurane
Which organ system experiences sensitization to catecholamines under halothane?
Myocardium
In terms of contractility, how do volatile agents impact cardiac patients with ejection fraction (EF) less than 40%?
No change in contractility
Which volatile anesthetic has the highest blood solubility?
Halothane
What is the most potent currently available volatile anesthetic?
Isoflurane
Which volatile anesthetic has the lowest blood solubility?
Desflurane
What is the primary metabolic byproduct of desflurane in a dry CO2 absorber?
Carbon monoxide
Which volatile anesthetic has the least airway irritation?
Sevoflurane
Which volatile anesthetic results in an extremely rare incidence of immune-mediated hepatitis?
Desflurane
Which volatile anesthetic has the lowest potency?
Desflurane
Which gas is odorless to sweet smelling but supports combustion?
Nitrous oxide
What is the primary concern associated with Nitrous Oxide postoperatively?
Inactivation of Vitamin B12
Which volatile anesthetic is associated with dose-dependent nephrotoxicity in rats but appears safe in humans even at low fresh gas flows?
Sevoflurane
What is the primary property of Xenon that distinguishes it from other volatile anesthetics?
Low blood solubility
Which statement about the Minimum Alveolar Concentration (MAC) is correct?
It is measured at atmospheric pressure.
Which anesthesia for cesarean section shows transient depression following general anesthesia?
General anesthesia
What is a long-term effect of neonatal or early childhood exposure to anesthetics in humans?
Behavioral changes
What contributes to renal injury in rats based on the text?
Sevoflurane
What is the FDA recommendation for fresh gas flow concerning sevoflurane in humans?
> 2 L/min fresh gas flow after 2 MAC hours
Which volatile agent undergoes ~ 5% metabolism and increases fluoride concentration?
Sevoflurane
What is the primary inhalation induction agent used in pediatrics according to the text?
Sevoflurane
Which agent provides relaxation of skeletal muscle during anesthetic maintenance?
Volatile agents
What is a benefit of volatile agents for anesthetic maintenance according to the text?
Provide some protection from ischemic injury
Which agent is noted for easy and rapid titration of depth of anesthesia during maintenance?
Volatile agents
What is the main cost driver of indirect costs in pharmacoeconomics?
PACU time
Which type of induction technique with high inspired concentration of sevoflurane provides rapid loss of consciousness but does not ensure adequate depth of anesthesia for airway instrumentation?
1-2 breath technique
Long-term effects of neonatal or early childhood exposure to anesthetics in humans are well understood and definitive answers have been found.
False
Volatile anesthetics have been shown to cause accelerated neuronal apoptosis in rodents.
True
The long-term effects of exposure to volatile anesthetics have been extensively studied in humans and conclusive results are available.
False
Sevoflurane undergoes significant metabolism, leading to the production of renal concentrating injury.
False
Halothane is primarily used in adults for inhalation induction due to its high pungency and low acceptance.
False
Desflurane has the lowest blood solubility among the volatile anesthetics.
True
Sevoflurane inhalation induction can be used in both pediatric and adult populations with equal success rates.
False
The primary metabolic byproduct of desflurane in a dry CO2 absorber is carbon dioxide.
False
Volatile agents are known to cause a decrease in cerebral blood flow and cerebral metabolic rate of oxygen consumption (CMRO2).
False
Low-flow or closed circuit anesthesia has been associated with decreased Compound A production.
False
Study Notes
Inhaled Anesthetics
- There are different types of inhaled anesthetics, including volatile agents (halothane, isoflurane, desflurane, sevoflurane) and gases (nitrous oxide, xenon)
Organ System Effects
Neurophysiology
- Volatile anesthetics produce predictable effects on evoked potential monitoring, varying by type of monitor
- They increase cerebral blood flow and decrease cerebral metabolic rate for oxygen (CMRO2)
- They produce a dose-dependent decrease in compensatory autonomic nervous system responses
Circulatory
- Volatile anesthetics produce a dose-dependent decrease in blood pressure, secondary to relaxation of vascular smooth muscle
- They trigger a cascade of intracellular events similar to a brief ischemic period, resulting in some degree of protection from ischemia for the myocardium and potentially other organ systems
Pulmonary
- Inhaled agents produce a dose-dependent decrease in minute ventilation and subsequent increase in PaCO2
- They relax airway smooth muscle, reducing airway resistance
- Desflurane is unique in producing an increase in sympathetic nervous system outflow despite decreasing blood pressure
- Nitrous oxide causes less decrease in minute ventilation and increase in PaCO2 compared to volatile agents
Hepatic
- Volatile agents reduce hepatic blood flow to some extent, with desflurane reducing it by ~30%
- Sevoflurane appears to provide organ protection following ischemic injury
Neuromuscular
- Volatile anesthetics produce direct relaxation of skeletal muscle, with a pronounced effect at >1 MAC
- They potentiate the effect of neuromuscular blockers, with a 30-40% reduction in rocuronium requirement
- Malignant hyperthermia is a rare but life-threatening reaction to volatile anesthetics and succinylcholine
Chronic Exposure
- NIOSH has set exposure limits for volatile anesthetics (2 ppm) and nitrous oxide (25 ppm)
- The volatile anesthetics have not been shown to produce teratogenicity or carcinogenicity in humans
Maternal and Fetal Effects
- Volatile anesthetics produce a dose-dependent decrease in uterine smooth muscle tone, reducing contractility and frequency of contractions
- At >1 MAC, uterine atony may be a problem, but brief uterine relaxation can be beneficial in certain situations
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