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Questions and Answers
What is the gold standard for testing for malignant hyperthermia?
Which of the following is NOT a characteristic of the pathogenesis of malignant hyperthermia?
What is the primary underlying cause of the hypermetabolic state seen in malignant hyperthermia?
Which of the following is NOT a common clinical manifestation of malignant hyperthermia?
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Which of the following is a risk factor for postoperative nausea and vomiting (PONV)?
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What is the leading cause of delayed discharge from the post-anesthesia care unit (PACU)?
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Which of the following is NOT a cause of temporary pseudocholinesterase deficiency?
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What is the purpose of the dibucaine number test?
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Which of the following is NOT an example of a disease state that can cause pseudocholinesterase deficiency?
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What is the significance of pseudocholinesterase deficiency in relation to the use of succinylcholine?
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Which of the following is responsible for the metabolism of succinylcholine?
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Study Notes
Malignant Hyperthermia (MH)
- A hypermetabolic state characterized by tachycardia, hyperthermia, hypercarbia, hypoxemia, and acidosis (metabolic)
- Muscle rigidity and DIC are common complications
- Asymptomatic until triggered, typically by exposure to succinylcholine and volatile anesthetic agents
- 3 times greater incidence in children than adults
Genetic Testing for MH
- Gold standard for testing: Caffeine-halothane contracture test
- Genetic component of the ryanodine receptor (RYR1 gene) is associated with MH
Associated Conditions
- Strabismus
- Scoliosis
- Burkitt lymphoma
- Neuroleptic malignant syndrome
- Myelomeningocele
- Congenital hip dislocations
Post-Operative Nausea and Vomiting (PONV)
- Strong association with motion sickness
- Risk factors: female, young, laparoscopic, ear, breast, colon, or eye surgery, non-smoker, use of volatile agents, and use of nitrous oxide
- 30% of all patients undergoing general anesthesia (GA) experience PONV
- 70% of at-risk patients undergoing GA experience PONV
- Leading cause of delayed PACU discharge and 2nd leading cause of hospital re-admission within 24 hours
Pseudocholinesterase Deficiency
- Succinylcholine is the only depolarizing agent used, metabolized by plasma cholinesterase (pseudocholinesterase)
- Prolonged paralysis and apnea can occur due to deficiency
- Genetic component: three distinct allele phenotypes
- Disease states: hepatic failure, malnutrition, acute infection, carcinoma
- Drug therapy: neostigmine, oral contraceptives
- Alterations in enzyme activity: 3rd trimester of pregnancy, newborns, and infants
Dibucaine Number
- Dibucaine inhibits metabolism of a choline substrate by plasma cholinesterase
- Percentage of inhibition of plasma cholinesterase by dibucaine is the dibucaine number
- Dibucaine number can help diagnose pseudocholinesterase deficiency: normal is 80%, atypical is 20%
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Description
Test your knowledge on anesthesia-specific topics like Pseudocholinesterase deficiency, Malignant hyperthermia, Post-op nausea and vomiting, and Difficult airway. Learn about Succinylcholine metabolism, prolonged paralysis, and apnea.
