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Induction of unconsciousness, muscle relaxation, and analgesia.
Halothane, isoflurane, and sevoflurane.
Desflurane.
N2O
N2O
It is given as an inhaled muscle relaxant. It is never used alone as an anesthetic.
Minimum Alveolar Concentration - the concentration at which 50% of patients will not respond to standard stimulus.
It varies from agent to agent.
It can't be used alone as an anesthetic because its MAC is too high.
Fever, amphetamines, withdrawl from [sedatives or] alcohol.
Alcohol, sedatives, anemia, pregnancy, [withdrawl from amphetamines].
Blood solubility of agent, alveolar blood flow, and partial pressure difference b/w alveoli and venous blood.
Slower, because gas partition coefficient is higher so high arterial tension is reached slowly.
Because it has negative effects on the laryngeal reflex.
By augmenting ventilation and increasing concentration of the major agent.
It diffuses so quickly into the blood that it creates a partial vacuum, increasing the relative concentration of the other agent.
Crawford W. Long.
Oliver Wendell Holmes.
Because of the danger of explosions.
Children with small veins and uncooperative patients.
Low flow vaporizer (<10%; varied by MAC of agent).
High flow flowmeter (e.g. for N2O + O2 to "wash out" lungs).
Inspired gas concentration; dependent on gas flow rate and volume of lungs.
Alveolar gas concentration; dependent on uptake, ventilation, second gas effect, and concentration effect.
Arterial gas concentration; dependent on ventilation (perfusion mismatch?)
FA will eventually approach FI.
Because of uptake by the body.
To "wash out" the lungs of N2.
To prevent hypoxia.
Lungs "washed" with O2, major agent concentration increased, anesthesia circuit space decreased (huh?)
Increased CO => increased uptake by body => slower induction.
Higher alveolar blood flow increases uptake, decreasing alveolar concentration and slowing induction.
High FGF, low anesthetic circuit volume (lung volume), low circuit absorption, decreased solubility, and increased ventilation.
N2O moves 35x faster.
When there is air trapped in a confined space (e.g. obstructed bowel or tension pneumocephalus, air embolus, etc.).
Altered physiologic state characterized by reversible loss of consciousness, analgesia of the entire body, amnesia, and some degree of muscle relaxation.
Anesthetic potency of an inhalation agent correlates directly with its lipid solubility.
Molecules of the agent dissolving at specific hydrophobic sites.
N2O has no muscle relaxant activity.
N2O
Ketamine (IV) and N2O (inhaled).
Deoressed sympathetic activity.
You would not use it for heart patients, because it decreases BP and increases HR.
They maintain cardiac output better. The older ones tend to cause hypotension and tachycardia.
All inhaled anesthetics decrease renal blood flow, thereby decreaseing urine output.
Halothane hepatitis; likely a result of increase in fluoride ion concentration.
Pediatric patients.