Exam 1 Nagelhout Questions and
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When is nitrous oxide most likely to cause teratogenic effects? - ANSWER-first trimester
What is the effect of all anesthetics in pregnant women? - ANSWER-relax the uterus
(increase risk of postoperative miscarriage)
Would it be better to use an inhalation anesthetic or spinal for a uterine surgery? Why? -
ANSWER-spinal (less bleeding - inhalation = uterine relaxation and more bleeding)
What are the three principle sources of waste anesthetic gasses? - ANSWER-(1) masks
(2) high-pressure fittings
(3) exhalation valves
Regulations in the USA require nitrous oxide levels to be _________________. -
ANSWER-<25 ppm
This inhalation anesthetic blocks DNA and RNA synthesis. - ANSWER-Nitrous Oxide
How does Nitrous Oxide block DNA & RNA production? - ANSWER-oxidies the Cobalt
atom on Vitamin B12
inhibits methionine synthetase
What patients are at risk with Nitrous oxide due to possible prior Cobalamin Deficiency?
- ANSWER-(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 are the renal effects of all anesthetics except nitrous oxide? - ANSWER-decrease
blood pressure
decrease renal blood flow
decrease GFR
decrease UO
,What anesthetic is associated with hepatotoxicity in adults but not children? - ANSWER-
Halothane
What inhalation anesthetics trigger malignant hyperthermia and are contraindicated? -
ANSWER-All except nitrous oxide
What are the absolute contraindications to Nitrous Oxide? - ANSWER-(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 relative contraindications to Nitrous Oxide? - ANSWER-(1) Pulmonary
HTN
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV
What is a putative relative contraindication to Nitrous Oxide? - ANSWER-Risk of
myocardial ischemia
When does the risk of halothane hepatotoxity increase? - ANSWER-after puberty
Is there a better anesthetic technique to use when performing surgery in cancer
patients? - ANSWER-(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 any anesthetic technique you should avoid using when performing surgery in
cancer patients? - ANSWER-(1) Opioids (angiogenesis; decreased long-term survival;
inhibit natural killer cells)
(2) Volatile anesthetics (activates insulin-like growth factors)
What anesthetic is contraindicated in pregnancy? - ANSWER-Nitrous oxide (teratogenic
in animals)
Regulations in the USA require halogenated gas levels to be _____________. -
ANSWER-<2 ppm
T/F: All intravenous anesthetics consistently produce adverse neurodevelopmental
consequences. - ANSWER-False (exception dexmedetomidine)
Which of the inhalation anesthetics has analgesic effects? - ANSWER-Nitrous oxide
(50% NO = 15 mg IV morphine)
, What are the advantages of Nitrous Oxide? - ANSWER-(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 disadvantages of Nitrous Oxide? - ANSWER-(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 advantages of Isoflurane? - ANSWER-(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 disadvantages of Isoflurane? - ANSWER-(1) Pungent odor
(2) Airway irritant
(3) Trigger for malignant hyperthermia
(4) Slower induction and emergence
What are the advantages of Desflurane? - ANSWER-(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 disadvantages of Desflurane? - ANSWER-(1) Airway irritant
(2) Expensive
(3) Heated vaporizer
(4) Rapid increase - reflex tachycardia & HTN
(5) Trigger for malignant hyperthermia
What are the advantages of Sevoflurane? - ANSWER-(1) Rapid uptake and elimination
(2) Nonpungent
(3) Excellent for inhalation induction
(4) Possible neuro- and cardiac protection
What are the disadvantages of Sevoflurane? - ANSWER-(1) Reacts with soda lime
Answers Best rated A+ Guaranteed
Success Latest Update
When is nitrous oxide most likely to cause teratogenic effects? - ANSWER-first trimester
What is the effect of all anesthetics in pregnant women? - ANSWER-relax the uterus
(increase risk of postoperative miscarriage)
Would it be better to use an inhalation anesthetic or spinal for a uterine surgery? Why? -
ANSWER-spinal (less bleeding - inhalation = uterine relaxation and more bleeding)
What are the three principle sources of waste anesthetic gasses? - ANSWER-(1) masks
(2) high-pressure fittings
(3) exhalation valves
Regulations in the USA require nitrous oxide levels to be _________________. -
ANSWER-<25 ppm
This inhalation anesthetic blocks DNA and RNA synthesis. - ANSWER-Nitrous Oxide
How does Nitrous Oxide block DNA & RNA production? - ANSWER-oxidies the Cobalt
atom on Vitamin B12
inhibits methionine synthetase
What patients are at risk with Nitrous oxide due to possible prior Cobalamin Deficiency?
- ANSWER-(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 are the renal effects of all anesthetics except nitrous oxide? - ANSWER-decrease
blood pressure
decrease renal blood flow
decrease GFR
decrease UO
,What anesthetic is associated with hepatotoxicity in adults but not children? - ANSWER-
Halothane
What inhalation anesthetics trigger malignant hyperthermia and are contraindicated? -
ANSWER-All except nitrous oxide
What are the absolute contraindications to Nitrous Oxide? - ANSWER-(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 relative contraindications to Nitrous Oxide? - ANSWER-(1) Pulmonary
HTN
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV
What is a putative relative contraindication to Nitrous Oxide? - ANSWER-Risk of
myocardial ischemia
When does the risk of halothane hepatotoxity increase? - ANSWER-after puberty
Is there a better anesthetic technique to use when performing surgery in cancer
patients? - ANSWER-(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 any anesthetic technique you should avoid using when performing surgery in
cancer patients? - ANSWER-(1) Opioids (angiogenesis; decreased long-term survival;
inhibit natural killer cells)
(2) Volatile anesthetics (activates insulin-like growth factors)
What anesthetic is contraindicated in pregnancy? - ANSWER-Nitrous oxide (teratogenic
in animals)
Regulations in the USA require halogenated gas levels to be _____________. -
ANSWER-<2 ppm
T/F: All intravenous anesthetics consistently produce adverse neurodevelopmental
consequences. - ANSWER-False (exception dexmedetomidine)
Which of the inhalation anesthetics has analgesic effects? - ANSWER-Nitrous oxide
(50% NO = 15 mg IV morphine)
, What are the advantages of Nitrous Oxide? - ANSWER-(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 disadvantages of Nitrous Oxide? - ANSWER-(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 advantages of Isoflurane? - ANSWER-(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 disadvantages of Isoflurane? - ANSWER-(1) Pungent odor
(2) Airway irritant
(3) Trigger for malignant hyperthermia
(4) Slower induction and emergence
What are the advantages of Desflurane? - ANSWER-(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 disadvantages of Desflurane? - ANSWER-(1) Airway irritant
(2) Expensive
(3) Heated vaporizer
(4) Rapid increase - reflex tachycardia & HTN
(5) Trigger for malignant hyperthermia
What are the advantages of Sevoflurane? - ANSWER-(1) Rapid uptake and elimination
(2) Nonpungent
(3) Excellent for inhalation induction
(4) Possible neuro- and cardiac protection
What are the disadvantages of Sevoflurane? - ANSWER-(1) Reacts with soda lime
