Exam 1 Nagelhout
decrease blood pressure
decrease renal blood flow
decrease GFR
decrease UO - Answer-What are the renal effects of all anesthetics except nitrous oxide?
Halothane - Answer-What anesthetic is associated with hepatotoxicity in adults but not children?
All except nitrous oxide - Answer-What inhalation anesthetics trigger malignant hyperthermia and are
contraindicated?
Nitrous Oxide - Answer-This inhalation anesthetic blocks DNA and RNA synthesis.
oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase - Answer-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 - Answer-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 - Answer-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 - Answer-What are the relative contraindications to Nitrous Oxide?
Risk of myocardial ischemia - Answer-What is a putative relative contraindication to Nitrous Oxide?
after puberty - Answer-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) - Answer-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) - Answer-Is there any anesthetic technique
you should avoid using when performing surgery in cancer patients?
Nitrous oxide (teratogenic in animals) - Answer-What anesthetic is contraindicated in pregnancy?
first trimester - Answer-When is nitrous oxide most likely to cause teratogenic effects?
relax the uterus (increase risk of postoperative miscarriage) - Answer-What is the effect of all
anesthetics in pregnant women?
, spinal (less bleeding - inhalation = uterine relaxation and more bleeding) - Answer-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 - Answer-What are the three principle sources of waste anesthetic gasses?
<25 ppm - Answer-Regulations in the USA require nitrous oxide levels to be _________________.
<2 ppm - Answer-Regulations in the USA require halogenated gas levels to be _____________.
False (exception dexmedetomidine) - Answer-T/F: All intravenous anesthetics consistently produce
adverse neurodevelopmental consequences.
Nitrous oxide (50% NO = 15 mg IV morphine) - Answer-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 - Answer-What are the advantages of Nitrous Oxide?
(1) Expansion of closed air spaces
(2) Requires high concentrations
(3) Amount of oxygen delivered is reduced
decrease blood pressure
decrease renal blood flow
decrease GFR
decrease UO - Answer-What are the renal effects of all anesthetics except nitrous oxide?
Halothane - Answer-What anesthetic is associated with hepatotoxicity in adults but not children?
All except nitrous oxide - Answer-What inhalation anesthetics trigger malignant hyperthermia and are
contraindicated?
Nitrous Oxide - Answer-This inhalation anesthetic blocks DNA and RNA synthesis.
oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase - Answer-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 - Answer-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 - Answer-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 - Answer-What are the relative contraindications to Nitrous Oxide?
Risk of myocardial ischemia - Answer-What is a putative relative contraindication to Nitrous Oxide?
after puberty - Answer-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) - Answer-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) - Answer-Is there any anesthetic technique
you should avoid using when performing surgery in cancer patients?
Nitrous oxide (teratogenic in animals) - Answer-What anesthetic is contraindicated in pregnancy?
first trimester - Answer-When is nitrous oxide most likely to cause teratogenic effects?
relax the uterus (increase risk of postoperative miscarriage) - Answer-What is the effect of all
anesthetics in pregnant women?
, spinal (less bleeding - inhalation = uterine relaxation and more bleeding) - Answer-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 - Answer-What are the three principle sources of waste anesthetic gasses?
<25 ppm - Answer-Regulations in the USA require nitrous oxide levels to be _________________.
<2 ppm - Answer-Regulations in the USA require halogenated gas levels to be _____________.
False (exception dexmedetomidine) - Answer-T/F: All intravenous anesthetics consistently produce
adverse neurodevelopmental consequences.
Nitrous oxide (50% NO = 15 mg IV morphine) - Answer-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 - Answer-What are the advantages of Nitrous Oxide?
(1) Expansion of closed air spaces
(2) Requires high concentrations
(3) Amount of oxygen delivered is reduced
