Morgan and Mikhail's Clinical
Anesthesiology Questions with Complete
Verified Solutions latest update 2025
Neuromuscular effects of isoflurane? --- correct answer ---Relaxes
skeletal muscle
Toxicity associated with isoflurane? --- correct answer ---Minimal
risk to kidneys or liver given its limited oxidative metabolism.
Contraindications to isoflurane? --- correct answer ---None
***Pts with severe hypovolemia may not tolerate its vasodilating
effects.
Drug interactions with isoflurane? --- correct answer ---
Nondepolarizing neuromuscluar blocking agents are potentiated by
isoflurane
***Epinephrine can be safely administered in doses up to 4.5 mcg/kg.
,this anesthetic boils at room temperature? --- correct answer ---
Desflurane
***This problem necessitated the develompent of a special vaporizer
for desflurane.
***The very low solubility of desflurane causes rapid induction and
emergence from anesthesia. Wake-up times are approxmiately 50%
less than those observed following isoflurane.
Cardiovascular effects of desflurane? --- correct answer ---Rapid
increases in desflurane concentration leads to a transient but
sometimes worrisome elevation in heart rate, BP, and catecholamine
levels that are more pronounced than those that occur with isoflurane.
***Particularly in pts with cardiac disease.
***These cardiac responses can be attenuated by fentanyl, esmolol, or
clonidine.
,Respiratory effects of desflurane? --- correct answer ---Decreased
tidal volume and increased respiratory rate which causes an overall
decrease in ventilation and rise in resting PaCO2
***Like other modern volatile anesthetics, desflurane depresses the
ventilatory response to rising PaCO2 levels.
Why is Desflurane a poor choice for inhalation induction? --- correct
answer ---Pungency and airway irritation during desflurane induction
can cause *salivation, breath holding, coughing, and laryngospasm.*
Airway resistance may increase in children with reactive airway
susceptibility.
cerebral effects of desfluane? --- correct answer ---Direct vasodilation
of cerebral blood vessels causing increased cerebral blood flow and
elevated intracranial pressure.
This increase in intracranial pressure is countered by decline in
cerebral metabolic rate of O2 consumption which tends to cause
cerebral vasoconstriction
, With cerebral O2 consumption decreased during desflurane
anesthesia, periods of desflurane hypotension (MAP ~ 60) is adequate
enough to maintain aerobic metabolism despite the low cerebral
perfusion pressure.
Neuromuscular effects of desflurane? --- correct answer ---Desflurane
is associated with dose-dependent decrease in the response to train-
of-four and tetanic peripheral nerve stimulation.
Desflurane is degraded by desiccated CO2 absorbent into potentially
clinically significant levels of what dangerous gas? --- correct answer
---Carbon monoxide
***Carbon monoxide poisoning is difficult to diagnose under general
anesthesia, but carboxyhemoglobin may be detectable by arterial
blood gas analysis or lower than expected pulse-ox readings
***Disposing of dried out absorbent or use of calcium hydroxide can
minimize risk of carbon monoxide poisoning.
Contrainidcations to desflurane? --- correct answer ---Desflurane
shares many of the contraindications of other modern volatile
anesthetics:
Anesthesiology Questions with Complete
Verified Solutions latest update 2025
Neuromuscular effects of isoflurane? --- correct answer ---Relaxes
skeletal muscle
Toxicity associated with isoflurane? --- correct answer ---Minimal
risk to kidneys or liver given its limited oxidative metabolism.
Contraindications to isoflurane? --- correct answer ---None
***Pts with severe hypovolemia may not tolerate its vasodilating
effects.
Drug interactions with isoflurane? --- correct answer ---
Nondepolarizing neuromuscluar blocking agents are potentiated by
isoflurane
***Epinephrine can be safely administered in doses up to 4.5 mcg/kg.
,this anesthetic boils at room temperature? --- correct answer ---
Desflurane
***This problem necessitated the develompent of a special vaporizer
for desflurane.
***The very low solubility of desflurane causes rapid induction and
emergence from anesthesia. Wake-up times are approxmiately 50%
less than those observed following isoflurane.
Cardiovascular effects of desflurane? --- correct answer ---Rapid
increases in desflurane concentration leads to a transient but
sometimes worrisome elevation in heart rate, BP, and catecholamine
levels that are more pronounced than those that occur with isoflurane.
***Particularly in pts with cardiac disease.
***These cardiac responses can be attenuated by fentanyl, esmolol, or
clonidine.
,Respiratory effects of desflurane? --- correct answer ---Decreased
tidal volume and increased respiratory rate which causes an overall
decrease in ventilation and rise in resting PaCO2
***Like other modern volatile anesthetics, desflurane depresses the
ventilatory response to rising PaCO2 levels.
Why is Desflurane a poor choice for inhalation induction? --- correct
answer ---Pungency and airway irritation during desflurane induction
can cause *salivation, breath holding, coughing, and laryngospasm.*
Airway resistance may increase in children with reactive airway
susceptibility.
cerebral effects of desfluane? --- correct answer ---Direct vasodilation
of cerebral blood vessels causing increased cerebral blood flow and
elevated intracranial pressure.
This increase in intracranial pressure is countered by decline in
cerebral metabolic rate of O2 consumption which tends to cause
cerebral vasoconstriction
, With cerebral O2 consumption decreased during desflurane
anesthesia, periods of desflurane hypotension (MAP ~ 60) is adequate
enough to maintain aerobic metabolism despite the low cerebral
perfusion pressure.
Neuromuscular effects of desflurane? --- correct answer ---Desflurane
is associated with dose-dependent decrease in the response to train-
of-four and tetanic peripheral nerve stimulation.
Desflurane is degraded by desiccated CO2 absorbent into potentially
clinically significant levels of what dangerous gas? --- correct answer
---Carbon monoxide
***Carbon monoxide poisoning is difficult to diagnose under general
anesthesia, but carboxyhemoglobin may be detectable by arterial
blood gas analysis or lower than expected pulse-ox readings
***Disposing of dried out absorbent or use of calcium hydroxide can
minimize risk of carbon monoxide poisoning.
Contrainidcations to desflurane? --- correct answer ---Desflurane
shares many of the contraindications of other modern volatile
anesthetics:
