Exam 1 Nagelhout Exam |231
Questions & Answers
decrease blood pressure
decrease renal blood flow
decrease GFR
decrease UO - -What are the renal effects of all anesthetics except nitrous
oxide?
- Halothane - -What anesthetic is associated with hepatotoxicity in adults
but not children?
- All except nitrous oxide - -What inhalation anesthetics trigger malignant
hyperthermia and are contraindicated?
- Nitrous Oxide - -This inhalation anesthetic blocks DNA and RNA synthesis.
- oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase - -How does Nitrous Oxide block DNA & RNA
production?
- (1) Nutritional disorders - elderly, vegans, and alcoholics
(2) Malabsorption disorders - prolonged use of proton pump inhibitors (H2
antagonists), pernicious anemia, atrophic gastritis, postgastrectomy, Crohn's
disease
(3) Infection - bacterial overgrowth, tapeworm - -What patients are at risk
with Nitrous oxide due to possible prior Cobalamin Deficiency?
- (1) Known deficiency of enzyme or substrate in methionine synthase
pathway
(2) Potential toxicity from expansion of gas filled space - emphysema,
pneumothorax, middle ear, surgery, pneumocephalus, air embolus
(3) Raised intracranial pressure - -What are the absolute contraindications to
Nitrous Oxide?
- (1) Pulmonary HTN
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV - -What are the relative contraindications to Nitrous
Oxide?
- Risk of myocardial ischemia - -What is a putative relative contraindication
to Nitrous Oxide?
,- after puberty - -When does the risk of halothane hepatotoxity increase?
- (1) Local anesthetics (reduced cancer recurrence and metastasis r/t anti-
inflammatory and direct effects)
(2) Neuraxial anesthesia (immunosuppressive - reduced recurrence &
metastasis)
(3) NSAIDS (COX-2 and prostaglandin inhibition in cancer cells; prevents
angiogenesis) - -Is there a better anesthetic technique to use when
performing surgery in cancer patients?
- (1) Opioids (angiogenesis; decreased long-term survival; inhibit natural
killer cells)
(2) Volatile anesthetics (activates insulin-like growth factors) - -Is there any
anesthetic technique you should avoid using when performing surgery in
cancer patients?
- Nitrous oxide (teratogenic in animals) - -What anesthetic is
contraindicated in pregnancy?
- first trimester - -When is nitrous oxide most likely to cause teratogenic
effects?
- relax the uterus (increase risk of postoperative miscarriage) - -What is the
effect of all anesthetics in pregnant women?
- spinal (less bleeding - inhalation = uterine relaxation and more bleeding) -
-Would it be better to use an inhalation anesthetic or spinal for a uterine
surgery? Why?
- (1) masks
(2) high-pressure fittings
(3) exhalation valves - -What are the three principle sources of waste
anesthetic gasses?
- <25 ppm - -Regulations in the USA require nitrous oxide levels to be
_________________.
- <2 ppm - -Regulations in the USA require halogenated gas levels to be
_____________.
- False (exception dexmedetomidine) - -T/F: All intravenous anesthetics
consistently produce adverse neurodevelopmental consequences.
- Nitrous oxide (50% NO = 15 mg IV morphine) - -Which of the inhalation
anesthetics has analgesic effects?
, - (1) Analgesia
(2) Rapid uptake and elimination
(3) Little cardiac or respiratory depression
(4) Nonpungent
(5) Reduces MAC of the more potent agents
(6) Minimal biotransformation - -What are the advantages of Nitrous Oxide?
- (1) Expansion of closed air spaces
(2) Requires high concentrations
(3) Amount of oxygen delivered is reduced
(4) Diffusion hypoxia, teratogenic increases
(5) PONV
(6) Supports combustion
(7) Immune suppression - -What are the disadvantages of Nitrous Oxide?
- (1) Moderate muscle relaxation
(2) Decreases cerebral metabolic rate
(3) Minimal biotransformation
(4) No significant systemic toxicity
(5) Inexpensive
(6) Possible neuro- and cardiac protection - -What are the advantages of
Isoflurane?
- (1) Pungent odor
(2) Airway irritant
(3) Trigger for malignant hyperthermia
(4) Slower induction and emergence - -What are the disadvantages of
Isoflurane?
- (1) Rapid uptake and elimination
(2) Stable molecules
(3) Minimal biotransformation
(4) No significant systemic toxicity
(5) Possible neuro- and cardiac protection - -What are the advantages of
Desflurane?
- (1) Airway irritant
(2) Expensive
(3) Heated vaporizer
(4) Rapid increase - reflex tachycardia & HTN
(5) Trigger for malignant hyperthermia - -What are the disadvantages of
Desflurane?
- (1) Rapid uptake and elimination
(2) Nonpungent
Questions & Answers
decrease blood pressure
decrease renal blood flow
decrease GFR
decrease UO - -What are the renal effects of all anesthetics except nitrous
oxide?
- Halothane - -What anesthetic is associated with hepatotoxicity in adults
but not children?
- All except nitrous oxide - -What inhalation anesthetics trigger malignant
hyperthermia and are contraindicated?
- Nitrous Oxide - -This inhalation anesthetic blocks DNA and RNA synthesis.
- oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase - -How does Nitrous Oxide block DNA & RNA
production?
- (1) Nutritional disorders - elderly, vegans, and alcoholics
(2) Malabsorption disorders - prolonged use of proton pump inhibitors (H2
antagonists), pernicious anemia, atrophic gastritis, postgastrectomy, Crohn's
disease
(3) Infection - bacterial overgrowth, tapeworm - -What patients are at risk
with Nitrous oxide due to possible prior Cobalamin Deficiency?
- (1) Known deficiency of enzyme or substrate in methionine synthase
pathway
(2) Potential toxicity from expansion of gas filled space - emphysema,
pneumothorax, middle ear, surgery, pneumocephalus, air embolus
(3) Raised intracranial pressure - -What are the absolute contraindications to
Nitrous Oxide?
- (1) Pulmonary HTN
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV - -What are the relative contraindications to Nitrous
Oxide?
- Risk of myocardial ischemia - -What is a putative relative contraindication
to Nitrous Oxide?
,- after puberty - -When does the risk of halothane hepatotoxity increase?
- (1) Local anesthetics (reduced cancer recurrence and metastasis r/t anti-
inflammatory and direct effects)
(2) Neuraxial anesthesia (immunosuppressive - reduced recurrence &
metastasis)
(3) NSAIDS (COX-2 and prostaglandin inhibition in cancer cells; prevents
angiogenesis) - -Is there a better anesthetic technique to use when
performing surgery in cancer patients?
- (1) Opioids (angiogenesis; decreased long-term survival; inhibit natural
killer cells)
(2) Volatile anesthetics (activates insulin-like growth factors) - -Is there any
anesthetic technique you should avoid using when performing surgery in
cancer patients?
- Nitrous oxide (teratogenic in animals) - -What anesthetic is
contraindicated in pregnancy?
- first trimester - -When is nitrous oxide most likely to cause teratogenic
effects?
- relax the uterus (increase risk of postoperative miscarriage) - -What is the
effect of all anesthetics in pregnant women?
- spinal (less bleeding - inhalation = uterine relaxation and more bleeding) -
-Would it be better to use an inhalation anesthetic or spinal for a uterine
surgery? Why?
- (1) masks
(2) high-pressure fittings
(3) exhalation valves - -What are the three principle sources of waste
anesthetic gasses?
- <25 ppm - -Regulations in the USA require nitrous oxide levels to be
_________________.
- <2 ppm - -Regulations in the USA require halogenated gas levels to be
_____________.
- False (exception dexmedetomidine) - -T/F: All intravenous anesthetics
consistently produce adverse neurodevelopmental consequences.
- Nitrous oxide (50% NO = 15 mg IV morphine) - -Which of the inhalation
anesthetics has analgesic effects?
, - (1) Analgesia
(2) Rapid uptake and elimination
(3) Little cardiac or respiratory depression
(4) Nonpungent
(5) Reduces MAC of the more potent agents
(6) Minimal biotransformation - -What are the advantages of Nitrous Oxide?
- (1) Expansion of closed air spaces
(2) Requires high concentrations
(3) Amount of oxygen delivered is reduced
(4) Diffusion hypoxia, teratogenic increases
(5) PONV
(6) Supports combustion
(7) Immune suppression - -What are the disadvantages of Nitrous Oxide?
- (1) Moderate muscle relaxation
(2) Decreases cerebral metabolic rate
(3) Minimal biotransformation
(4) No significant systemic toxicity
(5) Inexpensive
(6) Possible neuro- and cardiac protection - -What are the advantages of
Isoflurane?
- (1) Pungent odor
(2) Airway irritant
(3) Trigger for malignant hyperthermia
(4) Slower induction and emergence - -What are the disadvantages of
Isoflurane?
- (1) Rapid uptake and elimination
(2) Stable molecules
(3) Minimal biotransformation
(4) No significant systemic toxicity
(5) Possible neuro- and cardiac protection - -What are the advantages of
Desflurane?
- (1) Airway irritant
(2) Expensive
(3) Heated vaporizer
(4) Rapid increase - reflex tachycardia & HTN
(5) Trigger for malignant hyperthermia - -What are the disadvantages of
Desflurane?
- (1) Rapid uptake and elimination
(2) Nonpungent
