Tag: Flourinated Anesthetics – Compilation

Flourinated Anesthetics – Compilation

FLOURINATED ANESTHETICS – COMPILATION

Q. 1

MAC of desflurane is –

 A

1.15

 B

2

 C

4

 D

6

Q. 1

MAC of desflurane is –

 A

1.15

 B

2

 C

4

 D

6

Ans. D

Explanation:

Ans. is ‘d’ i.e., 6

Methoxyflurane (MAC = 0.16 %)> Trilene (MAC = 0.2%)> Halothane (MAC = 0.74%)> Chloroform (MAC = 0.8 %) > Isoflurane (MAC = 1.15 %) > Enflurane (MAC= 1.68%) > Ether (MAC = 1.92 %) > Sevoflurane (MAC = 2.0 %) > Desflurane (MAC = 6.0%)> Cyclopropane (MAC = 9.2%) > N20 (MAC 104%).


Q. 2

Which of the following should be considered as the cause of generalized convulsions 20 minutes postoperatively ?

 A

Halothane

 B

Enflurane

 C

Isoflurane

 D

Sevoflurane

Q. 2

Which of the following should be considered as the cause of generalized convulsions 20 minutes postoperatively ?

 A

Halothane

 B

Enflurane

 C

Isoflurane

 D

Sevoflurane

Ans. B

Explanation:

Ans. is ‘b’ i.e., Enflurane

Enflurane is known to produce seizures.


Q. 3

Inhalation agent incompatable with sodaline

 A

Isoflurane

 B

Trichloro Ethylene

 C

Methoxy flurane

 D

Enflurane

Q. 3

Inhalation agent incompatable with sodaline

 A

Isoflurane

 B

Trichloro Ethylene

 C

Methoxy flurane

 D

Enflurane

Ans. B

Explanation:

B i.e. Trichloro ethylene

Sodalime with trilene forms phosgene (neurotoxic) gas.Q So this combination is contraindicated.

Sodalime is a mixture of 94% (Ca(OH)2 + 5% NaOH as catalyst + 1% KOHQ; with granule size of 4-8 meshQ. It should not be used with :

The drier the sodalime, the more likely it will degrade & absorb volatile anesthetics. It produces compound A with sevofluraneQ (clinically significant) and carbon monoxide with desflurane, isoflurane & enflurane (clinically insignificant). However, desflurarte can be broken down to CO by dry barium hydroxide lime to such an extent that it is capable of causing clinically significant CO poisoning.

Quiz In Between


Q. 4

Which of the following inhalational agent is contraindicated in a patient with history of epilepsy;

 A

lsoflurance

 B

Enflurane

 C

Halothane

 D

Sevoflurane

Q. 4

Which of the following inhalational agent is contraindicated in a patient with history of epilepsy;

 A

lsoflurance

 B

Enflurane

 C

Halothane

 D

Sevoflurane

Ans. B

Explanation:

B i.e. Enflurane 


Q. 5

Which of the following statements regard-ing desflurane is correct?

 A

It causes severe myocardial depression

 B

It is a structural analogue of isoflurane

 C

It has vary high blood and tissue gas partition coefficients

 D

It is metabolically unstable

Q. 5

Which of the following statements regard-ing desflurane is correct?

 A

It causes severe myocardial depression

 B

It is a structural analogue of isoflurane

 C

It has vary high blood and tissue gas partition coefficients

 D

It is metabolically unstable

Ans. B

Explanation:

B i.e. It is a structural analogue of isoflurane 

Desflurane’s structure is very similar to that of isoflurane. The only difference is substitution of a fluride atom for isofluranes chlorine atom. Q


Q. 6

Which of following is/are false:

 A

Enflurane interacts with sodalime

 B

Sevoflurane causes seizures

 C

Rapid recovery from propofol

 D

All

Q. 6

Which of following is/are false:

 A

Enflurane interacts with sodalime

 B

Sevoflurane causes seizures

 C

Rapid recovery from propofol

 D

All

Ans. D

Explanation:

B i.e. Sevoflurane causes seizures, C i.e. Rapid recovery from propofol >> A i.e. Enflurane interacts with sodalime

MAC (minimal alveolar concentration) is the best measure of anesthetic potencyQ.

Sevoflurane has anticonvulsant propertiesQ with no excitatory phenomenon, no increase in CBF or intracranial pressure. Muscle tone is reduced, potentiating nondepolarizing muscle relaxants. Cerebral 02 demand is decreased.

Sevoflurane, isoflurane & desflurane have anticonvulsant propertiesQ. Whereas, the main disadvantage of enflurane is that it often causes epileptiform EEG changesQ (more commonly during hypocapnia) that may persist for several weeks. Cerebral blood flow is doubled at MAC 1 and convulsionsQ occur at MAC2, so it should be used with extreme caution (or avoided) in patients with h/o epilepsy. Muscle relaxation is greater with enflurane than with halothane or isoflurane, enhancing the action of nondepolarizing relaxants.

Enflurane interacts with sodalime but produce clinically insignificant amount of carbonmonooxide. Propofol has smooth & rapid induction and rapid recoveryQ.

Ketamine is a noncompetitive NMDA (glutamate) receptor antagonistQ and does not act on GABA-A receptor.

Quiz In Between


Q. 7

Following will be the choice of anaesthesia in an infected tooth posted for extraction:

 A

Local block with lignocaine

 B

Local block with lignocaine and adrenaline

 C

Isoflurane

 D

Enflurane

Q. 7

Following will be the choice of anaesthesia in an infected tooth posted for extraction:

 A

Local block with lignocaine

 B

Local block with lignocaine and adrenaline

 C

Isoflurane

 D

Enflurane

Ans. D

Explanation:

D i.e. Enflurane

“General anaesthesia is indicated in case of acute infection when LA may not be effective because of the local change in pH and there is a risk of spreading infecton”.Q

Anaesthesia in Dental Extraction

Local anesthesia would be adequate except in few situations as –

–  inability to tolerate dental treatment using LA (especially children).

– failure of previous attempt to treat under LA.

–   patients with special needs or disability which make it impossible to sit still (e.g. uncontrolled movements).

– allergy to LA

acute infection when local anesthesia may not be affective because of the local change in pHQ and there is risk of spreading infection.

Enflurane is most suitable inhalational agent for dental anesthesia with fewer irritant propertiesQ than isoflurane and a short recovery time. Isoflurane is widely used in contemporary practice, but is not recommended for dental surgery in spontaneously breathing patients as it is irritant and is associated with coughing, salivation, and desaturation.


Q. 8

Which one of the following is not a greenhouse gas?

 A

Carbon monoxide 

 B

Methane

 C

Nitrous oxide

 D

Water vapour

Q. 8

Which one of the following is not a greenhouse gas?

 A

Carbon monoxide 

 B

Methane

 C

Nitrous oxide

 D

Water vapour

Ans. A

Explanation:

Ans. is ‘a’ i.e., Carbon monoxide 


Q. 9

Inhalational agent of choice for neurosurgery ‑

 A

Halothane

 B

Enflurane

 C

Isoflurane

 D

N20

Q. 9

Inhalational agent of choice for neurosurgery ‑

 A

Halothane

 B

Enflurane

 C

Isoflurane

 D

N20

Ans. C

Explanation:

Ans. is ‘c’ i.e., Isoflurane

Anaesthetic agents of choice for vaous conditions Day care :

Ischemic heart disease :

Congenital heart disease

Left to right shunt :

Right to left shunt :

CHF :

Shock

To produce delibrate hypotenion

Epilepsy :

For electroconvulsive therapy :

Thyrotoxicosis :

Cardiac surgery :

Neurosurgery :

 

Propofol

Etomidate

Isoflurane

Ketamine

Ketamine

Ketamine

Isoflurane

Thiopentone

Methohexitone

Thiopentone

Isoflurane

Isoflurane

 

Quiz In Between


Q. 10

Which one of the following inhalational anesthetics is most likely to cause fluoride ion nephrotoxicity ? 

 A

 Methooxyflurane 

 B

Enflurane

 C

 Halothane

 D

 Isoflurane

Q. 10

Which one of the following inhalational anesthetics is most likely to cause fluoride ion nephrotoxicity ? 

 A

 Methooxyflurane 

 B

Enflurane

 C

 Halothane

 D

 Isoflurane

Ans. A

Explanation:

Ans. is ‘a’ i.e., Methooxyflurane 

o All inhalational agents depress renal function by decreasing the renal blood flow. Direct toxicity is caused by fluorinated compounds due to production of Inorganic fluoride (F-).

Agent 

Fluoride level produced

 Methoxyflurane o Sevoflurane

Enflurane

Isoflurane

Halothane

Desflurane

 50-80 mm (maximum)

30 – 50 mm

20 – 25 mm

4 – 8 mm

Produces only in anaerobic conditions Nil (minimal)

  • nal threshold beyond which fluoride levels are toxic is 50 mm. Methoxyflurane is most nephrotoxic —> Causes high output (Polyuric) renal failure. Desflurane has no nephrotoxicity.
  • evoflurane & enflurane does not cause renal toxicity in normal person, but should be avoided in renal diseases.

Q. 11

Which anaesthetic drug contributes to green house effect‑

 A

Enflurane

 B

Desflurane

 C

Sevoflurane

 D

Halothane

Q. 11

Which anaesthetic drug contributes to green house effect‑

 A

Enflurane

 B

Desflurane

 C

Sevoflurane

 D

Halothane

Ans. B

Explanation:

Ans. is ‘b’ i.e., Desflurane 


Q. 12

Fastest induction and recovery is seen with ‑

 A

Desflurane

 B

N,0

 C

Halothane

 D

Enflurane

Q. 12

Fastest induction and recovery is seen with ‑

 A

Desflurane

 B

N,0

 C

Halothane

 D

Enflurane

Ans. A

Explanation:

Ans. is ‘a’ i.e., Desflurane 

  • decreasing order (Increasing order of B : G partition coefficient and blood solubility) : –

Desflurane (0.42)Q > Cyclopropane (0.44) > N20 (0.47) > Sevoflurane (0.69)Q > Isoflurane (1.38) >

Enflurane (1.8) > Halothane (2.4) > Chloroform (8) > Trilene (9) > Ether (12) > Methoxyflurane (15)Q.

Quiz In Between


Q. 13

Smooth induction is seen by –

 A

Ether

 B

Halothane

 C

Isoflurane

 D

Enflurane

Q. 13

Smooth induction is seen by –

 A

Ether

 B

Halothane

 C

Isoflurane

 D

Enflurane

Ans. C

Explanation:

Ans. is ‘c’ i.e., Isoflurane

Induction by inhalation agents

 

Unpleasant    Intermediate                Smooth

 

 Ether Halothane Isoflurane

 

En flurane Desflurane  

Sevoflurane

Nitrous oxide


Q. 14

Which of the following fluorinated agent does not produce fluoride to produce toxicity ‑

 A

Sevoflurane

 B

Methoxyflurane

 C

Desflurane

 D

Enflurane

Q. 14

Which of the following fluorinated agent does not produce fluoride to produce toxicity ‑

 A

Sevoflurane

 B

Methoxyflurane

 C

Desflurane

 D

Enflurane

Ans. C

Explanation:

Ans. is ‘c’ i.e., Desflurane 

Quiz In Between



Flourinated Anesthetics – Compilation

FLOURINATED ANESTHETICS – COMPILATION


IMPORTANT POINTS ON FLUORINATED ANESTHETICS:

1. Desflurane:

  • Newer all fluorinated congener of isoflurane.
  • Greenhouse gas causing maximum global warming.
  • Mainly for outpatient surgery.
  • Fastest-acting inhalation anesthetic with minimum blood: gas partition coefficient (0.42).
  • Pungent odor.
  • Highly volatile.
    • Thermostatically heated special vaporizer used for delivering precise concentration of pure desflurane vapor in carrier gas (N2O + O2) mixture.
  • Metabolically stable, only 0.2% metabolized.

Actions & Uses:

  • Less potent than isoflurane.
  • Safe anesthetic for geriatric patients.
  • CVS effects similar to isoflurane without coronary steal.
    • Causes mild myocardial depression.
    • Lesser than enflurane/halothane.
  • Do not provoke seizures, arrhythmia, no liver & kidney toxicity.

Adverse effect:

  • Coughing & laryngospasm – Pungent odour – Unsuitable for induction.

2. Enflurane: 

  • Faster acting halothane substitute.
  • Halogenated ether.
  • Causes maximum respiratory depression.
  • Contraindicated in epilepsy – Maximum propensity provoking seizures.

3. Methoxyflurane:

  • Most potent inhalation agent (least MAC).
  • Not used now. (Halothane – Most potent).
  • Slowest onset & recovery.
  • Should not be used in closed circuit – Reacts with rubber tubing.
  • Boiling point more than water (104°C).

Metabolism:

  • Intrarenal metabolism → Fluoride ion production.
  • Causes renal toxicity (high output renal failure & hepatotoxicity). 

Exam Important

  • Desflurane is greenhouse gas causing maximum global warming.
  • Desflurane is mainly for outpatient surgery.
  • Desflurane is fastest-acting inhalation anesthetic with minimum blood: gas partition coefficient (0.42).
  • Desflurane is of pungent odor, highly volatile, metabolically stable, only 0.2% metabolized.
  • Safe anesthetic for geriatric patients is desflurane.
  • Desflurane has CVS effects similar to isoflurane without coronary steal.
  • Desflurane causes mild myocardial depression but l 
  • Enflurane contraindicated in epilepsy with maximum propensity provoking seizures.
  • Methoxyflurane is the most potent inhalation agent (least MAC).
  • Methoxyflurane should not be used in closed circuit reacts with rubber tubing.
  • Methoxyflurane boiling point more than water (104°C).
  • Intrarenal metabolism of methoxyflurane produces fluoride ions causing high output renal failure & hepatotoxicity. 
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