Measurment
When we measure the expiration of the inhalation agents, we assume that this is the concentration where?
Brain
(Concentration) Lungs = Brain
Would you want to reduce or increase your MAC if your patient was a chronic alcoholic?
Of the inhalation agents that are minimally metabolized - list the agents and their respective % that they are metabolized at.
Sevo 5-8%**
N20 + Iso < 1%
Des < 0.1% ("Des" = "decimal")
What happens to the alveolar partial pressure (of the anesthetic) when there is a Right > Left shunt?
Decreases
Which state is known as the "Bee-Hive State"?
Idaho, Michigan, Missouri, Utah, New Hampshire, Nevada, or Wyoming?
Missouri
The level of the anesthesia is equal to the level of ________ _________ of the agent.
Alveolar concentration
Of the volatile agents, which gas will have the fastest onset/offset?
Desflurane (0.42)
*Of ALL inhalation agents, N2O will have the fastest, Des would be the second fastest
At what age would the patient be at higher risk for experiencing emergence delirium?
2 - 5 years old
What happens when... halothane gets partially broken down?
Liver damage (Halothane hepatotoxicity)
During a Left > Right shunt, what happens to the speed of onset?
Slightly speeds up
(a) At what age does MAC peak?
(b) We find that the level decreases as our age increases. At what age does it start to decrease?
(a) 6 months
(b) 40 years old (will decrease ~6-7%/decade after the age of 40)
In regard to rate & rise of alveolar concentration, if the inhalation agent has a low blood/gas solubility - would the rate & rise be faster or slower?
Faster rate & rise (N20, Des)
**Based off of the chart that was in the PowerPoint
In pediatrics, MAC at 6 months of age is ____x higher than a 40 year old.
1.5x higher
What happens when... you add N20 to Iso?
Adding N2O to Iso = helps create a faster onset/offset
T/F: In pediatric patients, having an increased cardiac output would result in a slower onset.
False - Increased CO is negligible to volatile impact
What is the measurement that correlates to 95% of the patient population not moving to noxious stimuli?
1.2 MAC (ED95)
If the inhalation agent has a high potency, will the onset/offset be fast or slow?
Slow
*High potency = lower MAC/High oil/gas = Slow Onset/Offset
Slowest = Isoflurane
If you were administering Desflurane to reach the goals of MAC-Awake, what would the value be?
1.8% Des
Des 6% x 0.3 MAC-Awake = 1.8%
What happens when.... you use inhalation agents instead of TIVA in regard to the concentration of anesthesia?
Inhalation = more accuracy; TIVA = guessing with concentration
**Access to circulation, accurate administration, pharmacokinetic exactness, pharmacodynamics
In a surgical case, you have an obese patient who has been experiencing a longer time than originally anticipated. We would notice an increase in ______ _____.
Depot Effect
You are anesthetizing your patient for a procedure. They are currently at the level of having suppressed recollection and are considered unconscious at the moment. What would be the correct MAC value that would be associated with this?
0.5 MAC - Unconsciousness
MAC - Amnesia: suppresses recollection or explicit memory in 50% of patients
(0.3 MAC =anterograde amnesia. 0.5 = unconsciousness)
Which solubility has properties that correlate with "speed"?
Blood/Gas solubility
(oil/gas = potency)
If you administer Sevoflurane at MAC-BAR, what would the value be?
4% = MAC-BAR
(Sevo - 2% MAC)
What happens to the effect on MAC when.... your male patient presents with HTN and hyperkalemia?
No effect on MAC
*List of factors that don't effect MAC: duration, gender, HTN, metabolic alkalosis, hyper/hypocapnia, & hyper/hypokalemia
When high concentrations of N2O exit the body via the lungs, this can lead to a transient dilution of what?
O2 + CO2 (Normal Gases)
*Solution = Hyperoxygenate prior to extubating