Podcast
Questions and Answers
What is the preferred inhaled anesthetic for inhalation induction?
What is the preferred inhaled anesthetic for inhalation induction?
- Sevoflurane (correct)
- Xenon
- Nitrous oxide
- Desflurane
Which of the following is true about the volatile anesthetics and triggering MH (Malignant Hyperthermia)?
Which of the following is true about the volatile anesthetics and triggering MH (Malignant Hyperthermia)?
- Nitrous oxide and xenon trigger MH
- Sevoflurane does not trigger MH
- Only desflurane triggers MH
- All volatile agents trigger MH in a susceptible patient (correct)
How do the volatile anesthetics affect cerebral blood flow and cerebral metabolic rate of oxygen consumption (CMRO2)?
How do the volatile anesthetics affect cerebral blood flow and cerebral metabolic rate of oxygen consumption (CMRO2)?
- Decrease both cerebral blood flow and CMRO2
- Increase both cerebral blood flow and CMRO2
- Decrease cerebral blood flow and increase CMRO2
- Increase cerebral blood flow and decrease CMRO2 (correct)
What effect do the volatile anesthetics have on evoked potential monitoring?
What effect do the volatile anesthetics have on evoked potential monitoring?
What is the main effect of 0.5 MAC of an inhaled anesthetic?
What is the main effect of 0.5 MAC of an inhaled anesthetic?
Which factor does NOT increase MAC?
Which factor does NOT increase MAC?
What is the main difference between MAC-awake and MAC-BAR?
What is the main difference between MAC-awake and MAC-BAR?
Which inhaled anesthetic is least pungent and produces the least airway irritation?
Which inhaled anesthetic is least pungent and produces the least airway irritation?
Which agent results in NO CHANGE in CSF resorption?
Which agent results in NO CHANGE in CSF resorption?
What effect do Isoflurane, Desflurane, and Sevoflurane have on CMRO2 and EEG?
What effect do Isoflurane, Desflurane, and Sevoflurane have on CMRO2 and EEG?
Which anesthetic agent is associated with an improvement in cognitive recovery over isoflurane?
Which anesthetic agent is associated with an improvement in cognitive recovery over isoflurane?
At what concentration range does the shift to increasing frequencies occur on EEG when using N2O?
At what concentration range does the shift to increasing frequencies occur on EEG when using N2O?
Which type of evoked potential monitoring is least affected by volatile agents?
Which type of evoked potential monitoring is least affected by volatile agents?
In terms of hemodynamics, what effect do volatiles have on blood pressure?
In terms of hemodynamics, what effect do volatiles have on blood pressure?
How do isoflurane and desflurane affect heart rate compared to sevoflurane?
How do isoflurane and desflurane affect heart rate compared to sevoflurane?
Which anesthetic agent may slightly prolong the QT interval?
Which anesthetic agent may slightly prolong the QT interval?
Which organ system experiences sensitization to catecholamines under halothane?
Which organ system experiences sensitization to catecholamines under halothane?
In terms of contractility, how do volatile agents impact cardiac patients with ejection fraction (EF) less than 40%?
In terms of contractility, how do volatile agents impact cardiac patients with ejection fraction (EF) less than 40%?
Which volatile anesthetic has the highest blood solubility?
Which volatile anesthetic has the highest blood solubility?
What is the most potent currently available volatile anesthetic?
What is the most potent currently available volatile anesthetic?
Which volatile anesthetic has the lowest blood solubility?
Which volatile anesthetic has the lowest blood solubility?
What is the primary metabolic byproduct of desflurane in a dry CO2 absorber?
What is the primary metabolic byproduct of desflurane in a dry CO2 absorber?
Which volatile anesthetic has the least airway irritation?
Which volatile anesthetic has the least airway irritation?
Which volatile anesthetic results in an extremely rare incidence of immune-mediated hepatitis?
Which volatile anesthetic results in an extremely rare incidence of immune-mediated hepatitis?
Which volatile anesthetic has the lowest potency?
Which volatile anesthetic has the lowest potency?
Which gas is odorless to sweet smelling but supports combustion?
Which gas is odorless to sweet smelling but supports combustion?
What is the primary concern associated with Nitrous Oxide postoperatively?
What is the primary concern associated with Nitrous Oxide postoperatively?
Which volatile anesthetic is associated with dose-dependent nephrotoxicity in rats but appears safe in humans even at low fresh gas flows?
Which volatile anesthetic is associated with dose-dependent nephrotoxicity in rats but appears safe in humans even at low fresh gas flows?
What is the primary property of Xenon that distinguishes it from other volatile anesthetics?
What is the primary property of Xenon that distinguishes it from other volatile anesthetics?
Which statement about the Minimum Alveolar Concentration (MAC) is correct?
Which statement about the Minimum Alveolar Concentration (MAC) is correct?
Which anesthesia for cesarean section shows transient depression following general anesthesia?
Which anesthesia for cesarean section shows transient depression following general anesthesia?
What is a long-term effect of neonatal or early childhood exposure to anesthetics in humans?
What is a long-term effect of neonatal or early childhood exposure to anesthetics in humans?
What contributes to renal injury in rats based on the text?
What contributes to renal injury in rats based on the text?
What is the FDA recommendation for fresh gas flow concerning sevoflurane in humans?
What is the FDA recommendation for fresh gas flow concerning sevoflurane in humans?
Which volatile agent undergoes ~ 5% metabolism and increases fluoride concentration?
Which volatile agent undergoes ~ 5% metabolism and increases fluoride concentration?
What is the primary inhalation induction agent used in pediatrics according to the text?
What is the primary inhalation induction agent used in pediatrics according to the text?
Which agent provides relaxation of skeletal muscle during anesthetic maintenance?
Which agent provides relaxation of skeletal muscle during anesthetic maintenance?
What is a benefit of volatile agents for anesthetic maintenance according to the text?
What is a benefit of volatile agents for anesthetic maintenance according to the text?
Which agent is noted for easy and rapid titration of depth of anesthesia during maintenance?
Which agent is noted for easy and rapid titration of depth of anesthesia during maintenance?
What is the main cost driver of indirect costs in pharmacoeconomics?
What is the main cost driver of indirect costs in pharmacoeconomics?
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?
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?
Long-term effects of neonatal or early childhood exposure to anesthetics in humans are well understood and definitive answers have been found.
Long-term effects of neonatal or early childhood exposure to anesthetics in humans are well understood and definitive answers have been found.
Volatile anesthetics have been shown to cause accelerated neuronal apoptosis in rodents.
Volatile anesthetics have been shown to cause accelerated neuronal apoptosis in rodents.
The long-term effects of exposure to volatile anesthetics have been extensively studied in humans and conclusive results are available.
The long-term effects of exposure to volatile anesthetics have been extensively studied in humans and conclusive results are available.
Sevoflurane undergoes significant metabolism, leading to the production of renal concentrating injury.
Sevoflurane undergoes significant metabolism, leading to the production of renal concentrating injury.
Halothane is primarily used in adults for inhalation induction due to its high pungency and low acceptance.
Halothane is primarily used in adults for inhalation induction due to its high pungency and low acceptance.
Desflurane has the lowest blood solubility among the volatile anesthetics.
Desflurane has the lowest blood solubility among the volatile anesthetics.
Sevoflurane inhalation induction can be used in both pediatric and adult populations with equal success rates.
Sevoflurane inhalation induction can be used in both pediatric and adult populations with equal success rates.
The primary metabolic byproduct of desflurane in a dry CO2 absorber is carbon dioxide.
The primary metabolic byproduct of desflurane in a dry CO2 absorber is carbon dioxide.
Volatile agents are known to cause a decrease in cerebral blood flow and cerebral metabolic rate of oxygen consumption (CMRO2).
Volatile agents are known to cause a decrease in cerebral blood flow and cerebral metabolic rate of oxygen consumption (CMRO2).
Low-flow or closed circuit anesthesia has been associated with decreased Compound A production.
Low-flow or closed circuit anesthesia has been associated with decreased Compound A production.
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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