Anesthesia and Respiratory Depression
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Questions and Answers

What is a probable consequence of hypoventilation caused by opioids?

  • Hypercapnia and decreased CBF
  • Hypercapnia and increased CBF (correct)
  • Hypocapnia and increased CBF
  • Hypocapnia and decreased CBF

    • What is the mechanism by which opioids cause miosis?

  • Inhibition of the Edinger-Westphal nucleus in the oculomotor nerve
  • Blockade of the pupil constrictor muscle
  • Release of histamine in the anterior chamber
  • Stimulation of the Edinger-Westphal nucleus in the oculomotor nerve (correct)

    • Which of the following opioids is contraindicated in patients with impaired renal function?

  • Fentanyl
  • Morphine
  • Sufentanil (correct)
  • Alfentanil

    • What is the primary mechanism by which opioids cause nausea and vomiting?

    <p>Direct stimulation of the CTZ by acting as a partial agonist at the dopamine (D2) receptor</p> Signup and view all the answers

    Which of the following opioids is associated with a higher risk of biliary smooth muscle spasm?

    <p>Fentanyl</p> Signup and view all the answers

    What is the treatment for opioid overdose?

    <p>Airway management and ventilatory support followed by opioid antagonist</p> Signup and view all the answers

    What is the effect of increasing concentration of volatile anesthetics on spontaneously breathing patients' respirations?

    <p>Decreased alveolar ventilation</p> Signup and view all the answers

    What is the effect of cardiovascular depression on the rate of rise of FA/FI?

    <p>Increased rate of rise</p> Signup and view all the answers

    What is the effect of right-to-left shunt on the induction of anesthesia?

    <p>Delayed induction</p> Signup and view all the answers

    What is the primary mechanism of biotransformation of inhalation anesthetics?

    <p>Minimal metabolism</p> Signup and view all the answers

    What is the primary mechanism of opioid-induced ventilatory depression?

    <p>Mu receptor activation</p> Signup and view all the answers

    What is the effect of opioid-induced histamine release on cardiovascular function?

    <p>Decreased venous tone</p> Signup and view all the answers

    What is the effect of opioid-induced cough suppression on medullary cough centers?

    <p>Depression</p> Signup and view all the answers

    What is the primary mechanism of opioid-induced CNS effects?

    <p>Increased vagal tone</p> Signup and view all the answers

    What is the effect of woodene chest syndrome on laryngeal musculature?

    <p>Contraction</p> Signup and view all the answers

    What is the effect of nitrous oxide washout on alveolar partial pressures of oxygen?

    <p>Decreased oxygen</p> Signup and view all the answers

    What is the primary reason for the rapid decrease in plasma concentration of morphine?

    <p>Rapid conjugation with glucuronic acid</p> Signup and view all the answers

    Which opioid is associated with an increased risk of acute dystonia in untreated Parkinson's disease?

    <p>Alfentanil</p> Signup and view all the answers

    What is the mechanism of pain modulation by nerve stimulators?

    <p>Gate theory</p> Signup and view all the answers

    What is the primary mechanism of opioid tolerance?

    <p>No increase in the metabolism of opioids</p> Signup and view all the answers

    Which opioid has the highest elimination half-time?

    <p>Fentanyl</p> Signup and view all the answers

    What is the effect of benzos and fentanyl on GA?

    <p>Marked synergism in hypnotic and ventilatory depression effects</p> Signup and view all the answers

    What is the primary conjugation reaction of morphine in the liver?

    <p>Glucuronidation</p> Signup and view all the answers

    What is the primary site of pain perception?

    <p>Thalamus</p> Signup and view all the answers

    What is the primary benefit of regional anesthesia?

    <p>Improved analgesia in high-risk patients</p> Signup and view all the answers

    What is the decrease in MAC per decade from 1 year of age onward?

    <p>6%</p> Signup and view all the answers

    What is the primary factor affecting the onset, duration, and potency of local anesthetics?

    <p>pKa</p> Signup and view all the answers

    Which evoked potential is the most sensitive?

    <p>Motor</p> Signup and view all the answers

    What is the NIOSH-set exposure limit for volatile anesthetics?

    <p>2 ppm nitrous oxide</p> Signup and view all the answers

    What is the effect of nitrous oxide on methionine synthetase?

    <p>Decreases the activity</p> Signup and view all the answers

    What is the most likely place to have a leak in an anesthesia machine?

    <p>Between flow meters to common gas outlet check valve</p> Signup and view all the answers

    What is the effect of morphine on vagal nuclei in medulla?

    <p>Stimulation</p> Signup and view all the answers

    What is the primary mechanism by which malignant hyperthermia affects muscle function?

    <p>Excessive Ca++ release</p> Signup and view all the answers

    What is the recommended observation period for a patient with masseter spasm following succinylcholine administration?

    <p>At least 12 hours</p> Signup and view all the answers

    What is the primary reason for the increased incidence of malignant hyperthermia when succinylcholine is used with volatile anesthetics?

    <p>Volatile anesthetics potentiate the effect of succinylcholine</p> Signup and view all the answers

    What is the primary mechanism of metabolism for atracurium?

    <p>Hoffman elimination and ester hydrolysis</p> Signup and view all the answers

    What is the primary cause of cardiac side effects seen with high doses of atracurium?

    <p>Histamine release</p> Signup and view all the answers

    What is the effect of administering anticholinesterase drugs, such as neostigmine, prior to succinylcholine?

    <p>It increases the duration of succinylcholine's neuromuscular blockade</p> Signup and view all the answers

    What is the primary reason for the additive, not independent or synergistic nature of local anesthetics' toxicities?

    <p>Similar mechanisms of action</p> Signup and view all the answers

    What is the effect of PH adjustment on the onset of local anesthetic block?

    <p>Speeds up the onset</p> Signup and view all the answers

    Why are spinal nerves and nerve roots more susceptible to local anesthetic-induced toxicity?

    <p>They have a slower sodium channel inactivation</p> Signup and view all the answers

    What is the primary mechanism of methemoglobinemia induced by topical administration of local anesthetics?

    <p>Oxidation of hemoglobin to methemoglobin</p> Signup and view all the answers

    What is the primary reason for the increased cardiovascular toxicity of bupivacaine?

    <p>Higher affinity for resting and inactive cardiac sodium channels</p> Signup and view all the answers

    What is the primary treatment for local anesthetic systemic toxicity (LAST)?

    <p>Airway management and seizure suppression</p> Signup and view all the answers

    What is the primary mechanism by which non-depolarizing NMBs exert their effect?

    <p>Competitive antagonism of Ach binding to the NAChR</p> Signup and view all the answers

    What is the primary reason for the contraindication of succinylcholine in otherwise healthy children?

    <p>Risk of malignant hyperthermia</p> Signup and view all the answers

    What is the purpose of pairing an anticholinesterase with an antimuscarinic for reversal of neuromuscular blockade?

    <p>To prevent the unwanted muscarinic effects of increased acetylcholine</p> Signup and view all the answers

    What is the effect of volatile anesthetics on non-depolarizing NMBs?

    <p>Dose-dependent potentiation</p> Signup and view all the answers

    What is the significance of fade on TOF monitoring in non-depolarizing NMBs?

    <p>Indicates the degree of fade during repetitive stimulation</p> Signup and view all the answers

    What is the significance of clinical assessment of recovery from NM blockade?

    <p>It is an unreliable method of assessing recovery</p> Signup and view all the answers

    What is the primary determinant of the rate of rise of FA/FI?

    <p>Solubility of the anesthetic in blood</p> Signup and view all the answers

    What is the effect of increasing cardiac output on the rate of rise of FA/FI?

    <p>It decreases the rate of rise of FA/FI</p> Signup and view all the answers

    What is the primary mechanism by which the second gas effect accelerates the rate of rise of FA/FI?

    <p>It increases the uptake of the first gas, which accelerates the rate of rise of the second gas</p> Signup and view all the answers

    What is the effect of decreasing the FRC on the rate of rise of FA/FI?

    <p>It increases the rate of rise of FA/FI</p> Signup and view all the answers

    What is the primary reason why pediatric inhalation induction is faster than adults?

    <p>They have a smaller FRC relative to their minute ventilation</p> Signup and view all the answers

    What is the effect of increasing the inspired concentration of the anesthetic on the rate of rise of FA/FI?

    <p>It increases the rate of rise of FA/FI</p> Signup and view all the answers

    What is the primary mechanism by which the concentration effect accelerates the rate of rise of FA/FI?

    <p>It increases the uptake of the anesthetic into the blood, which produces a concentration effect</p> Signup and view all the answers

    What is the effect of a competitive antagonist on the potency and efficacy of an agonist?

    <p>Decreases potency, does not affect efficacy</p> Signup and view all the answers

    What is the effect of decreasing the solubility of the anesthetic in blood on the rate of rise of FA/FI?

    <p>It increases the rate of rise of FA/FI</p> Signup and view all the answers

    What is the primary mechanism of termination of action of a bolus dose of an induction agent?

    <p>Redistribution to other tissues</p> Signup and view all the answers

    What is the primary mechanism by which the alveolar to mixed venous partial pressure difference affects the rate of rise of FA/FI?

    <p>It increases the uptake of the anesthetic into the blood</p> Signup and view all the answers

    What is the meaning of pKa in the context of weak acids and bases?

    <p>The pH at which the weak acid is completely non-ionized</p> Signup and view all the answers

    What is the volume of distribution (Vd) of a drug?

    <p>The amount of drug administered divided by the initial plasma concentration</p> Signup and view all the answers

    What is the effect of increasing the fresh gas flow on the rate of rise of FA/FI?

    <p>It increases the rate of rise of FA/FI</p> Signup and view all the answers

    What is the meaning of the term 'high extraction ratio' (HER) in pharmacokinetics?

    <p>The fraction of the drug entering the liver which is removed</p> Signup and view all the answers

    What is the primary mechanism of action of propofol?

    <p>Increased affinity of the GABAa receptor for GABA</p> Signup and view all the answers

    What is the recommended observation period for a patient with masseter spasm following succinylcholine administration?

    <p>At least 12 hours</p> Signup and view all the answers

    What is the primary mechanism of hepatic clearance of a drug?

    <p>Rate of metabolism occurring in the liver is the difference between the concentration entering the liver and the concentration exiting the liver times the blood flow through the liver</p> Signup and view all the answers

    What is the primary mechanism of action of non-competitive antagonists?

    <p>Binds to an allosteric site, reducing efficacy of the agonist</p> Signup and view all the answers

    What is the primary factor affecting the onset, duration, and potency of local anesthetics?

    <p>Lipid solubility of the anesthetic</p> Signup and view all the answers

    What is the primary mechanism by which malignant hyperthermia affects muscle function?

    <p>Excessive Ca++ release</p> Signup and view all the answers

    What is the formula for creatinine clearance (ml/min)?

    <p>(140-age) X lean body mass (kg)/plasma creatinine concentrationX72</p> Signup and view all the answers

    What is the effect of adding succinylcholine to volatile anesthetics?

    <p>Markedly increased incidence of malignant hyperthermia</p> Signup and view all the answers

    What is the primary reason for the increased duration of succinylcholine-induced neuromuscular blockade after administering an anticholinesterase drug?

    <p>Inhibition of butyrylcholinesterase</p> Signup and view all the answers

    What is the primary mechanism of atracurium metabolism?

    <p>Ester hydrolysis and Hoffman elimination</p> Signup and view all the answers

    What is the cardiovascular side effect seen with high doses of atracurium?

    <p>Hypotension and tachycardia</p> Signup and view all the answers

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