90 Questions
Which anesthetic is no longer in use in the US?
Enflurane
Which of the following anesthetics has the highest blood:gas solubility?
Halothane
Which anesthetic is characterized by extreme physical stability and does not require preservatives?
Desflurane
Which anesthetic can cause nephrotoxicity due to the production of inorganic fluoride in the liver?
Isoflurane
Which anesthetic is the least likely to form carbon monoxide?
Halothane
Which anesthetic has the highest MAC (minimum alveolar concentration) awake?
Desflurane
Which anesthetic has the highest potency?
Isoflurane
Which of the following is true about Methoxyflurane?
It is metabolized to inorganic fluoride
Which inhaled anesthetic has the highest resistance to metabolism?
Isoflurane
Which of the following inhaled anesthetics has the lowest solubility in blood?
Desflurane
Which inhaled anesthetic is a structural isomer of enflurane?
Isoflurane
Which inhaled anesthetic has the highest potency?
Methoxyflurane
Which inhaled anesthetic is totally fluorinated methyl ethyl ether?
Desflurane
Which inhaled anesthetic is the preferred choice for rapid awakening?
Sevoflurane
Which gas has the capacity to accumulate in closed spaces and can cause damage by increasing pressure?
Nitrous oxide
Which of the following is true about the Second-Gas Effect?
It reflects the ability of high-volume uptake of one gas to accelerate the rate of increase of the alveolar concentration of a concurrently administered companion gas.
What is the ratio of alveolar ventilation to functional residual capacity (FRC) in neonates compared to adults?
5:1
Which of the following factors influences the rate of rise of the alveolar concentration of anesthetic?
All of the above
What is the estimated time necessary for equilibration of tissues with arterial partial pressure (Pa)?
5 to 15 minutes
Which of the following is true about the impact of changes in alveolar ventilation on the rate of rise of anesthetic concentration?
The impact is greater for more blood soluble anesthetics.
What is the blood:gas partition coefficient for nitrous oxide?
0.46
Which factor affects the rate of rise in partial pressure of anesthetic (PA) during induction?
Cardiac Output (CO)
What effect does a right-to-left shunt have on the rate of induction of anesthesia?
It slows down the rate of induction
Which group of vessels equilibrates rapidly with the partial pressure of anesthetic (Pa)?
Vessel rich group (VRG)
Which factor determines the tissue uptake of inhaled anesthetics?
Tissue solubility, blood flow, and arterial-to-tissue partial pressure difference
What effect does a left-to-right shunt have on the blood going into the lungs?
It increases the partial pressure of the anesthetic in the lungs
What effect does a left-to-right shunt have on the dilutional effects of a right-to-left shunt?
It offsets the dilutional effects
What is the effect of volatile anesthetics that depress cardiac output?
Positive feedback response can occur
What is the impact of a shunt on the partial pressure of anesthetic (Pa)?
It decreases the partial pressure of anesthetic (Pa)
What is the rate of decrease in partial pressure of anesthetic (PA) during emergence compared to the rate of increase during induction?
Faster
Which inhaled anesthetic is a structural isomer of enflurane?
Isoflurane
Which anesthetic can cause nephrotoxicity due to the production of inorganic fluoride in the liver?
Methoxyflurane
Which anesthetic is no longer in use in the US?
Halothane
Which anesthetic is the least likely to form carbon monoxide?
Desflurane
Which gas has the capacity to accumulate in closed spaces and can cause damage by increasing pressure?
Nitrous oxide
What effect does a right-to-left shunt have on the rate of induction of anesthesia?
Decreases the rate of induction
What is the impact of a shunt on the partial pressure of anesthetic (Pa)?
Decreases Pa
Which inhaled anesthetic has the highest blood:gas solubility?
Enflurane
What is the effect of volatile anesthetics that depress cardiac output?
Increase in myocardial contractility
Which anesthetic can form Compound A when reacting with CO2 absorbent?
Sevoflurane
Which inhaled anesthetic is the least likely to form carbon monoxide?
Desflurane
What is the impact of a left-to-right shunt on the dilutional effects of a right-to-left shunt?
Increases the dilutional effects
Which inhaled anesthetic has the highest resistance to metabolism?
Isoflurane
What is the ratio of alveolar ventilation to functional residual capacity (FRC) in neonates compared to adults?
Higher in neonates
Which gas has the highest solubility in blood?
Carbon Dioxide
Which of the following factors influences the rate of rise of the alveolar concentration of anesthetic?
Volume of the external breathing system
What is the estimated time necessary for equilibration of tissues with arterial partial pressure (Pa)?
5 to 15 minutes
Which inhaled anesthetic is characterized by extreme physical stability and does not require preservatives?
Isoflurane
What effect does a right-to-left shunt have on the dilutional effects of a left-to-right shunt?
Increases the dilutional effects
Which anesthetic can cause nephrotoxicity due to the production of inorganic fluoride in the liver?
Halothane
What is the rate of decrease in partial pressure of anesthetic (PA) during emergence compared to the rate of increase during induction?
Slower
Which of the following factors affects the rate of equilibration of volatile anesthetics initiated during cardiopulmonary bypass (CPBP)?
All of the above
What is the impact of a right-to-left shunt on the partial pressure of anesthetic (Pa)?
Decreased Pa and slower induction
Which of the following is true about the impact of a left-to-right shunt on the dilutional effects of a right-to-left shunt?
It offsets the dilutional effects
Which of the following factors determines tissue uptake of inhaled anesthetics?
All of the above
Which group of vessels equilibrates rapidly with the partial pressure of anesthetic (Pa)?
Vessel-rich group (VRG)
What is the estimated equilibration time of the vessel-rich group (VRG) in neonates compared to adults?
Faster in neonates
What is the rate of decrease in the partial pressure of anesthetic (PA) during emergence compared to the rate of increase during induction?
Faster during emergence
Which of the following anesthetics has the highest blood:gas solubility?
Enflurane
Which of the following anesthetics is characterized by extreme physical stability and does not require preservatives?
Desflurane
Nitrous oxide is the first halogenated hydrocarbon.
False
Halothane enhances the arrhythmogenic effects of epinephrine.
True
Methoxyflurane has a high lipid solubility, resulting in prolonged induction and recovery.
True
Enflurane is metabolized to inorganic fluoride and stimulates the central nervous system.
True
Desflurane is a totally fluorinated methyl ethyl ether.
True
Sevoflurane has low solubility in blood, facilitating rapid induction of anesthesia.
True
Desflurane is 1/5 as potent as isoflurane.
True
True or false: Isoflurane has a higher MAC than enflurane?
True
True or false: Isoflurane is stored in amber-color bottles with thymol added as a preservative?
False
True or false: Halothane is no longer in use in the US?
True
True or false: Sevoflurane has the highest blood:gas solubility?
False
True or false: Nitrous oxide is harmful to the environment?
False
True or false: The rise and fall in alveolar partial pressure precedes that of other tissues?
True
True or false: The concentration effect results from the rate of rise of the alveolar concentration of anesthetic?
True
True or false: Increasing the inspired concentration of an anesthetic increases both the alveolar concentration and its rate of rise.
True
True or false: A higher concentration of anesthetic disproportionately increases the alveolar concentration, even with the same pulmonary uptake.
True
True or false: The Second-Gas Effect refers to the ability of high-volume uptake of one gas to accelerate the rate of increase of another gas.
True
True or false: The Second-Gas Effect specifically pertains to nitrous oxide.
True
True or false: Increased alveolar ventilation promotes the input of anesthetic to offset uptake, resulting in a more rapid rate of increase in alveolar concentration.
True
True or false: The rate of increase in partial pressure of anesthetic in the alveoli is inversely related to the solubility of the anesthetic in blood.
True
True or false: The rate of increase in partial pressure of anesthetic in the alveoli is influenced by the solubility of the anesthetic in blood as well as the volume of the external breathing system.
True
True or false: Cardiac Output (CO) influences the uptake of inhaled anesthetics and therefore affects the partial pressure in the pulmonary artery (PA).
True
True or false: The impact of a right-to-left shunt is more pronounced with less soluble inhaled anesthetics compared to more soluble ones.
True
True or false: Left-to-right shunts occur with arteriovenous fistulas, septal defects, or volatile anesthetic-induced increase in cutaneous flow.
True
True or false: The presence of a right-to-left shunt results in a dilutive effect that leads to a decreased arterial partial pressure (Pa) and slower induction.
True
True or false: The equilibration time of the vessel-rich group (VRG) in neonates is more rapid compared to adults due to a greater fraction of cardiac output (CO) reaching the VRG and less solubility in neonatal tissues.
True
True or false: The rate of decrease in partial pressure of anesthetic (PA) during emergence is faster than the rate of increase during induction.
True
True or false: Continued uptake from the vessel-poor group results in a continued alveolar-to-venous partial pressure difference (A-vD) for several hours.
True
True or false: The rate of decrease in arterial partial pressure (Pa) during recovery from anesthesia is depicted by the rate of decrease in partial pressure of anesthetic (PA).
True
True or false: More soluble agents have a slower rate of decrease in partial pressure of anesthetic (PA) during recovery compared to less soluble agents.
False
Study Notes
Overview of Inhaled Anesthetics
- Nitrous oxide, diethyl ether, and chloroform were the earliest inhaled anesthetics used in the 19th century.
- Fluroxene, introduced in 1950, was the first halogenated hydrocarbon anesthetic.
- Halothane, introduced in 1956, had the side effect of enhancing the arrhythmogenic effects of epinephrine.
- Methoxyflurane, introduced in 1960, had high lipid solubility, resulting in prolonged induction and recovery, but also had hepatic and nephrotoxicity.
- Enflurane, introduced in 1973, was metabolized to inorganic fluoride and stimulated the central nervous system.
- Isoflurane, introduced in 1981, was a structural isomer of enflurane and was resistant to metabolism.
- Desflurane, introduced in 1992, was a totally fluorinated methyl ethyl ether.
- Sevoflurane, introduced in 1994, was a totally fluorinated methyl isopropyl ether with low solubility in blood, facilitating rapid induction and recovery.
- Providers preferred sevoflurane and desflurane over isoflurane due to their faster awakening properties, despite factors like airway irritation, stimulation of the sympathetic nervous system, and higher cost.
- Factors that affect the cost of inhaled anesthetics include price, vapor pressure, fresh gas flow, and solubility of the agent.
- Desflurane is less potent than isoflurane, requiring a smaller amount to sustain an equivalent minimum alveolar concentration (MAC).
- Sevoflurane has a greater MAC compared to isoflurane, requiring a larger amount to sustain an equivalent MAC.
- Inhaled anesthetics like nitrous oxide are commonly administered with opioids or other volatile anesthetics in general anesthesia, providing analgesic effects.
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