Anesthetis And Diseases

Question 1

How do you classify cardiac disease?

Answer 1

I: non-clinical with pre-existing condition, minimal anesthetic concerns

II: mild to moderate clinical signs with pre-existing condition. Need to stabilize before anesthetia

III: on-going fulminant heart failure. Anesthesia contra-indicated.

Question 2

What are some anesthetic-induced cardiac changes?

Answer 2

Decreased contractility
Decreased cardiac output
Hypotension

Question 3

What is a good pre-med plan for a patient with HCM?

Answer 3

Opioids, benzos, alfaxalone, dex, preoxygenate

Question 4

What are some main goals of anesthesia in patients with HCM?

Answer 4

Decrease stress
Increase diastolic function
Bradycardia is good

Question 5

What drugs would you use intra-op for a patient with HCM?

Answer 5

Etomidate

Question 6

What are some goals of anesthesia in a patient with DVD?

Answer 6

Promote forward blood flow

Minimize regurgitation into atrium

Question 7

What drugs would you use to pre-med a patient with DVD?

Answer 7

Opioids, benzos, anticholinergics, Ace

NO Dex!!

Question 8

What drugs would you use intra-op in a patient with DVD?

Answer 8

Etomidate or propofol + midazolam
Dobutamine

NO phenylephrine!

Question 9

What are the pharmacokinetic effects of chronic renal insufficiency?

Answer 9

Hypoprotinemia - increases available drugs in body

Decreased renal elimination

Azotemia alters BBB permeability

Drugs will have more profound effects!

Question 10

What are some goals of anesthesia on a patient with chronic renal insufficiency?

Answer 10

Increase renal blood flow
Give ionotrope
Aggressive fluid therapy
Decrease use of inhalants

Question 11

What are some goals of anesthesia on patient with liver disease?

Answer 11

Avoid excess drug doses
Favor reversible drugs
Increase liver blood flow
Compensate for low albumin and glucose

Question 12

What drugs are favored for anesthesia in a patient with liver disease?

Answer 12

Opioids, remifentanil, propofol, iso

Question 13

What is a good protocol for a patient with diabetes mellitus before having surgery?

Answer 13

1. Do through PE (including BP), CBC/chem, urinalysis
2. Feed normal meal + normal insulin dose the night before
3. Fast in the morning and give 1/2 dose of insulin, check BG before surgery

Question 14

What drugs are favored in patients with elevated intracranial pressure? What drugs should you avoid?

Answer 14

Favored: propofol, mannitol

Avoid: iso, morphine

Question 15

What effects does pregnancy have on anesthesia?

Answer 15

Increases oxygen demand
Higher risk of hypoxemia, hypoventilation (uterus pushes on diaphragm)
Increased risk of regurgitation and aspiration pneumonia

Question 16

What are some goals of anesthesia in a pregnant patient?

Answer 16

Maintain CV stability
Ensure appropriate oxygenation
Choose drugs that minimize fetal risk

Question 17

What drugs are favored in pregnant patients?

Answer 17

Opioids, benzos, propofol, alfaxalone

Question 18

What effect does pregnancy have on MAC?

Answer 18

Decreases MAC

Question 19

Geriatric patients undergoing anesthesia are prone to what?

Answer 19

Hypoxemia

Need supplemental oxygen

Question 20

Why do geriatric patients experience prolonged drug effects?

Answer 20

Decreased capacity of the liver to metabolize drugs

Decreased hepatic and renal perfusion