Anesthesia Midterm- the actual flashcard worthy stuff 1

kelseyfmeyer's version from 2015-09-27 20:56


Question Answer
CO2- uk and us color?US- grey UK- grey
O2- uk and us color?US- green. UK- white
N2O uk and us color?both blue
Yellowmedical air
whitesuction (IN UK, THIS IS 02)
medical air color... US? UK?US: yellow. UK: black and white
conc in alveoli=conc in brain
O2 filling pressure2000PSI
N2O filling pressure745PSI
filling ratio equationweight of liquid in cyllinder divided by weight of water cyllinder would be able to hold
O2 pipeline pressure58 PSI
Size E tank PSI1900 (680L)
size H tank PSI2,200 (6900L)
calc content of O2 tankO2 gas only, so pressure gauge accurate. so Content is VOLxPRESSURE= L of O2
pressure regulator takes __PSI O2 from tank and makes it __PSI2000, 50
flow meter: measure bobbin from? ball from?bobbin from top, ball from middle
charcoal scavenge system limitation?CHARCOAL DOESNT ABSORB N2O
reservoir bag for cat size?0.5L
reservoir bag for dog size?0.5 to 3L
reservoir bag for horse size?25-30L
soda lime + sevo possibly makes (under poor conditions)Compound A (nephrotoxic) (*change yo lime!)
soda lime + des/en/iso possibly makes (under poor conditions)carbon monoxide (CO) (*change yo lime!)
size of animals for rebreathing system?GREATER THAN 7kg
what's the relation of fresh gas flow and minute volume (volume breathed in one minute) in a REBREATHING system?fresh gas flow is less than minute volume-- this is because you're recycling air so don't need a high FGF
FGF for REBREATHING for INDUCTION? (know units)~40-100 ml/kg/min
FGF for REBREATHING for LOW LOW (basically maintenance)about 20 ml/kg/min
FGF CALCULATIONTidal volume x RR (physiological) x weight x system factor (NOTE: Tidal volume times RR is aka the Vm aka minute volume, so can also be said as minute volume x weight x system factor)
FGF for NON-rebreathing systems is related to the MV (minute volume) how?it's greater than or equal to (not recycling any gas, might need more to clear system in fact)
FGF for NON-rebreathing system if FGF is equal to MV? if FGF is greater than MV?FGF=MV is 200 ml/kg/min. If FGF>MV is 400-600ml/kg/min
REBREATHING system--> HIGH FGF. average amount for horse? small animal? when is high FGF used/how long?usually at start (15-20min) and sometimes at end (faster induction and recovery). SMALL ANIMAL: 2-3L/min. HORSE:8-10L/min
activated charcoal: you must do what and what doesnt it help with?doesnt absorb N2O, need to weigh to determine if spent
pressure provided for machine should be _________ to _________ PSI50-58 PSI
The pressure going to the animal which is on the pressure valve should never exceed ___cmH20 on the pressure dial20
steps for leak testocclude pt end --> close pop off valve --> turn on flow meter to fill reservoir bag until pressure is 30 cmH2O on pressure gauge (watch if pressure starts to go down on gauge) --> squeeze bag till the pressure is at 40 cmH2O (see if pressure starts to go down on gauge) (if no pressure gauge, bag size shouldn't change) --> at end OPEN POP OFF VALVE --> THEN remove your hand from pt end
approx pressure in a tank totally full of O2?2000PSI
in WHICH system do you calc the FGF, and why not the other?calc for the NON rebreathing. don't have to for re-breathing because the flow is less than the minute volume so there's no way you're gonna pop the lungs. Non-re-breathing you CAN pop the lungs, so you need to calc the FGF which wont result in a dead animal
when calc the FGF (once again, for which type breathing system), what's the usual system factor?(non-rebreathing) 2-3 (no units) <---she should give this to us if i remember correctly
calc minute volumetidal volume times RR ( tidal volume is usually 10-15 mLkg^-1 and RR is usually like 12bpm)
uncuffed ET tube in?birds, sm mammals, neonates
to check if right ET tube length?incisors to tip of shoulder
cats and sheep/goats, pigs, rabbits, monkeys lyringospasm, do what?lidocaine spray (just a little) and DONT TOUCH EPIGLOTTIS
what parameter can you check on the machine to see if the tube is in the trach and not the eso?END TIDAL CO2 (if up and down, normal, if flat and low, in eso)
if a doc says "get me a ET tube 8" what is the 8 referring to?the INTERNAL DIAMETER
(Clarence says-- and I'm not sure if she cares, but) for a rebreathing system, the high flow is 40-100mg/kl/min. which end of the range is for small animals and which end for large animals?40= large animals and 100= small animals (bc large animals are big and you need to consider cumulative effect)
why must the FGF be higher than the minute volume in the non-rebreathing system?because it needs to be a sufficient amount to carry away the CO2 (bc no soda lime)
is N2O a liquid or gas? think about it in a tank and when it is madeit's the only anesthetic which is packaged as a gas-- HOWEVER, the compression in the tank causes it to become in a liquid state inside. which is why you need to weigh it to determine how much is in there. but it is the only anesthetic that is a gas, not a volatile liquid


Question Answer
which is more irritating to use in induction chamber- sevo or iso?iso more irritating. sevo is less irritating
what is partial pressure?if there is a mix of gases in a container, each gas exerts its own pressure on the walls. So the total pressure is the SUM of all the partial pressures of all the gases in the mix (this is why it's hard to breathe in the mountains- the PP, not the amount of O2 (%), its the partial pressure)
what is SVP? (saturated vapor pressure)maximum possible concentration of molecules in the gaseous phase at a specific temperature (for volatile fluids)
a high SVP is a....less or more volatile agent?high SVP= more volatile
what has the highest SVP (saturated vapor pressure)? Lowest? (know general trend)des is highest
(how do you determine the % concentration of the volatile liquid in the air? <--don't think we need to know)the SVP/atmospheric pressure
vaporizer is needed to ___ inhalational agents to a safe concentrationDILUTE! (their SVPs are usually way higher than what is needed)
what are the boiling points like (order of highest to lowest)Halothane>Sevo=iso>des>N2O
what is noteable about desflurane's boiling point?it's RIGHT AROUND ROOM TEMP (23.5*C) so need a SPECIAL VAPORIZER (also N2O is -89 so will only always be gas)
partition coefficient is the expression of what?soubility
equilibrium refers to when the ___ equilibrate between gas and liquidPARTIAL PRESSURES (conc may be different)
Blood gas partition coefficient is INVERSELY RELATED TO _________?speed of anesthetic induction, recovery, and change of anesthetic depth. (the HIGHER the partition coefficient, the SLOWER the induction, recovery, and change of anesthetic depth)
blood gas partition coefficient (B:G PC) basically represents the...SOLUBILITY. which makes sense as to why it's inversely proportional to speed of induction...because if something is super soluble, it will want to STAY in the blood and not diffuse to the brain, so it'll take more and longer to induce
list the anesthetics in order from highest B:G PC to lowest(longest induction) Halothane>Iso>sevo>des>N2O (fastest induction) (hisdn- same as O:G)
alveoli--> blood depends on what PC?B:G
blood--> brain depends on what PC?B:G and O:G
oil gas partition coefficent is DIRECTLY CORRELATED TO___?POTENCY
list the anesthetics in order from highest oil gas to lowest(most potent) halothane>iso>sevo>des>N2O (hisdn- same as B:G)
how are cardiac output and induction rate related?LOW CO means FASTER induction (blood moving more slowly gives gas more time to diffuse into it)
anesthesia achieved when there is adequate ___, which occurs whenbrain tension (ie, enough concentration in brain). Occurs when equilibrium (remember equi is PP not conc) is alveolus/blood/brain
how can you accelerate "washout" from tissues when inducing recovery?give a high FGF and empty reservoir bag
MAC (what is it?) is the standard index of what?anesthetic potency (MINIMUM alveolar concentration) (basically the min conc that will produce immobility in 50% subjects exposed to painful stimuli)
is MAC directly or inversely related to potency?INVERSELY. That is to say, the HIGHER the MAC, the lower the potency
relation direct or inverse for... B:G, O:G, MAC?B:G= INVERSE to solubility. O:G= DIRECT for potency. MAC=INVERSE to potency
**list the anesthetics in order of HIGHEST MAC to lowest(LEAST POTENT) N2O>des>sevo>iso>halo (most potent) (hisdn backwards. lol)( the most potent Nuthatch does swim in hell)
FI= fractional inspired(innhaled) ET= end tidal(exhaled)...which of these represents the amount in the brain?ET (compared to the MAC)
some stuff that DECREASES MAC(this means to make anesthetic more potent) sedatives/analgesics/injectable anesthetics, N2O, older animals, hypothermia, preg, severe hypoxemia (PaO2<40), severe hypercapnea (PaCO2>90), concurrent illness
how does N2O affect MAC?nec mac, which means giving N2O inc potency of what you're giving
how much does N2O affect the CV system?minimally
fastest inducer and recoverer?N2O
you need to mix O2 with NO2 or you will cause hypoxia. what's the minimum proportion of O2 you need in the mix?not less than 1/3 O2....and the MAC of N2O is like 200%, with at least 50% needed to see an affect.
explain "second gas effect" and which anesthetic this usually is referring toN2O! when N2O is given with another anesthetic gas, it speeds up the initial intake of that other gas. This is because of N2O's diffusibility and HIGH partial pressure gradient (basically, the gases like to move together, so the anesthetic gas follows the N2O)
why must you be careful with N2O in particular situations? (what situations?)N2O DIFFUSES INTO GAS FILLED SPACES! (rumen, stomach during GDV, closed pneumothorax, ocular sx) and then N2O DIFFUSES FASTER than it can leave... leads to EXPANSION of this air-filled cavity
explain diffusion hypoxia, what gas this happens with, and what you must doN2O diffuses rapidly!! because of this, after administration of gases is stopped, the N2O rapidly diffuses into the alveoli and then it DILUTES THE O2 in the alveoli. this runs you the risk of hypoxia. Therefore, provide O2 for 10min after turning off N2O
what are the benefits of N2O?second gas affect (faster induction with anesthetic gas), MAC sparing, ANALGESIA
what are the disadvantages of N2O?low potentcy, diffusion into gas-filled spaces, potential for hypoxia, drug abuse, environmental impact (worst for environment)
why do we care about the fact halothan is preserved with 0.01% thymol?can make knobs sticky
CV affects of halothane?depresses myocardial contractility --> reduces CO, SV, MAP (cardiac output, stroke volume, and mean arterial pressure) is also ARRYTHMOGENIC (sensitizes myocardial conduction to catecholamines)
most potent anesthetic that isnt halo?iso
which anesthetic is metabolized the most?halo
which anesthetic creates compound A, and when is this most likely to happen?sevo, with low flow gas (nephrotoxic compound)
which anesthetic needs a special vaporizer, and why?DESFLURANE, because it's super volatile bc it's boiling point is 23.5*C which is like room temp (vaporizer requires special elec. power and heats des to 39*C, and it is pressurized)
What is malignant hyperthermia? who does it happen in most commonly? what can trigger this condition?a potentially life-threatening myopathy what is a heritable dz (hyperthermia, mm fasciculation, tachycardia). humans>PIGS>horses+dogs>cats. It can be triggered by all 4 current volatile agents (and depolarizing NM blockers)
what drug can you use to tx malignant hyperthermia?dantrolene (dan is too hot for his own good)
(not sure how important) recommended trace limits in the US?25ppm Nitrous Oxide, 2ppm any halogenated anesthetic agent (UK= 100ppm N2O, 50 iso, 10 halo)
risks to ppl exposed to N2O?miscarriage and dec fertility if exposed to high N2O conc
which anesthetic can rarely cause hepatitis?halothane (hepatic necrosis and death from immune mediated rxn, previous exposures to traces might predispose)
which anesthetic might cause alzheimers?iso

Recent badges