chapter 10. quiz 2 Sleep and Anesthesia Comparison

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What differentiates sleep from anesthesia in terms of reversibility?

Anesthesia is spontaneously generated and terminated.

Anesthesia lacks EEG patterns.

Sleep shows ready reversibility by noxious stimuli. (correct)

Sleep lacks modulation of brainstem autonomic function.

How do the EEG patterns differ between sleep and anesthesia?

They exhibit sharp α–θ EEG transitions.

They have different frequencies and types of activation. (correct)

They both show a uniform EEG picture.

They have the same EEG patterns.

What is unique about the transitions in consciousness between wakefulness and sleep compared to anesthesia?

Sleep has no transient stages during transitions. (correct)

Anesthesia requires drug elimination to transition.

Anesthesia has sharp α–θ EEG transitions.

Sleep involves continuous decrease in consciousness.

How does arousal differ between physiologic sleep and drug-induced unconsciousness?

Physiologic sleep individuals can be aroused with sufficient stimulation. (C) Signup and view all the answers

What is one key similarity between the neurons active during sleep in the VLPO and the neurons activated by certain anesthetics?

Both types of neurons are inhibited by the VLPO. (C) Signup and view all the answers

Why is the direct inhibition of the TMN insufficient to produce unconsciousness during anesthesia?

Because interaction with sleep-promoting nuclei alone does not lead to unconsciousness. (B) Signup and view all the answers

How does activation of the VLPO contribute to anesthesia according to the text?

By inhibiting the arousal nuclei and affecting transitions between wakefulness and sleep. (A) Signup and view all the answers

How do most anesthetics affect sleep architecture during the early postoperative period?

Decrease REM sleep duration (A) Signup and view all the answers

What is the impact of low dose propofol on REM sleep according to the text?

Facilitates REM sleep (C) Signup and view all the answers

How does anesthesia potentially interfere with circadian rhythms?

By influencing GABA and NMDA receptors (D) Signup and view all the answers

What effect does long-term ventilation have on REM sleep according to the text?

Diminishes REM sleep (B) Signup and view all the answers

1st postoperative night characterised by?

decrease in REM sleep. (A) Signup and view all the answers

anesthesia and painful surgical procedures affect sleep and circadian rhythms for as long as

6 month (C) Signup and view all the answers

What is a common perioperative complication associated with patients with OSA?

Newly detected Postoperative atrial fibrillation (B) Signup and view all the answers

Which factor is NOT associated with the increased risk of perioperative complications in patients with OSA?

Low blood pressure (B) Signup and view all the answers

What is a common outcome observed in patients with sleep-disordered breathing (SDB) after surgery?

Higher rates of severe perioperative complications (B) Signup and view all the answers

Which postoperative night are patients with OSA most vulnerable to hypoxia according to the text?

Night 2 or 3 (B) Signup and view all the answers

What is a distinctive feature of patients with obesity hypoventilation syndrome (OHS) compared to obese patients?

Higher mechanical ventilation rates (D) Signup and view all the answers

Why is it challenging to determine the specific effect of OSA on perioperative complications?

OSA comorbidities have similar effects on outcomes (A) Signup and view all the answers

OSA is associated with higher rate for

is not associated with difficult tracheal intubation or mask ventilation. (D) Signup and view all the answers

What drives the perioperative algorithm for patients with sleep-disordered breathing?

CPAP use preoperatively (C) Signup and view all the answers

For obese patients at risk for sleep apnea scheduled for surgery, when is a sleep study considered necessary based on the text?

Only for high-risk patients (B) Signup and view all the answers

In the perioperative period, which group of patients may require a preoperative sleep medicine consultation and/or CPAP prescription according to the text?

Patients with procedural and comorbidity-based risk factors (A) Signup and view all the answers

What is the primary consideration for the standard of care in perioperative management of patients with sleep-disordered breathing?

Severity of the disease (C) Signup and view all the answers

What drives the perioperative management algorithm for patients with sleep-disordered breathing?

A combination of disease severity, comorbidities, and procedural threat (C) Signup and view all the answers

In perioperative management, what is recommended for patients who have been prescribed CPAP preoperatively?

Continue using CPAP perioperatively (C) Signup and view all the answers

What is the suggested approach for high-risk patients with several risk factors in the perioperative period according to the text?

Having a sleep medicine consultation and possibly a CPAP prescription (C) Signup and view all the answers

What determines whether a preoperative sleep medicine consultation and/or a CPAP prescription may be needed for certain patients?

Risk factors related to the surgery and comorbidities (D) Signup and view all the answers

What is the main purpose of the STOP-Bang questionnaire in preoperative screening for obstructive sleep apnea?

Identify comorbidities of OSA that increase perioperative complications (C) Signup and view all the answers

What is the role of a clinical examination in preoperative screening for obstructive sleep apnea?

Provide a cost-effective initial assessment (C) Signup and view all the answers

Why is polysomnography (PSG) not recommended for preoperative screening despite its ability to identify sleep-disordered breathing?

It is cost-prohibitive and inconvenient (A) Signup and view all the answers

In patients undergoing high-risk surgical procedures, what additional screening method is recommended alongside clinical examination?

standardized and validated questionnaires (e.g., Berlin). (B) Signup and view all the answers

What symptom of obesity hypoventilation syndrome (OHS) can be detected through a blood gas analysis?

Daytime hypercapnia (D) Signup and view all the answers

What should be included in the preoperative assessment of patients scheduled for low-risk procedures and have no previously diagnosed sleep-disordered breathing?

Standard perioperative monitoring (D) Signup and view all the answers

What method is recommended to detect hypercapnia as a major symptom of obesity hypoventilation syndrome (OHS)?

Blood gas analysis (B) Signup and view all the answers

Which clinical condition must be excluded to diagnose obesity hypoventilation syndrome (OHS) according to the text?

Kyphoscoliosis (C) Signup and view all the answers

What combination of factors indicates a high risk of obesity hypoventilation syndrome (OHS) in patients?

High carbon dioxide levels and low oxygen levels (C) Signup and view all the answers

What is the criterion for awake daytime hypercapnia that suggests a potential diagnosis of obesity hypoventilation syndrome (OHS)?

$PaCO_2 > 45$ mm Hg (C) Signup and view all the answers

What is the highly sensitive method for diagnosing obesity hypoventilation syndrome (OHS) according to the text?

Venous bicarbonate concentration test (B) Signup and view all the answers

What is a recommended strategy during the preanesthesia period to minimize the chance of postoperative sedation?

Consider regional anesthetic techniques (B) Signup and view all the answers

In the induction strategy for anesthesia, what should be utilized immediately after intubation to maintain lung volume during surgery?

Lung recruitment maneuvers with PEEP (C) Signup and view all the answers

What should be reduced whenever possible during intraoperative management ?

Use of sedatives and narcotics (D) Signup and view all the answers

What position is preferred for patients in the PACU bed to minimize gravitational effects on the upper airway?

45-degree elevated upper body (B) Signup and view all the answers

Which of the following is a recommended consideration for post-extubation care in the PACU?

Upper body elevation by 45 degrees (B) Signup and view all the answers

What should be documented for monitoring and treatment in case of impaired respiratory function in the PACU?

A defined plan including noninvasive ventilation (A) Signup and view all the answers

What should be avoided when extubating patients to reduce the risk of postoperative airway collapse?

Extubating patients during hypocarbia (C) Signup and view all the answers

To prevent residual neuromuscular blockade and reduce the risk of postoperative respiratory complications, what method should be used when administering nondepolarizing neuromuscular blocking drugs?

Titrate optimally by monitoring neuromuscular transmission (A) Signup and view all the answers

Which drug can help maintain upper airway patency during loss of consciousness and sleep, making it a potential option for postoperative pain therapy in high-risk patients?

Ketamine (C) Signup and view all the answers

When should the effects of neuromuscular blockade be reversed to avoid impairing upper airway function?

Only when present (C) Signup and view all the answers

What can help in achieving postoperative pain therapy for patients at high risk of airway collapse?

Ketamine (B) Signup and view all the answers

What is the preferred positioning before intubation to improve maintenance of the passive pharyngeal airway in patients with obstructive sleep apnea (OSA)?

Reverse Trendelenburg position (A) Signup and view all the answers

Which drug type should be used with caution to reduce the duration of paralysis during intubation in patients with OSA?

Nondepolarizing neuromuscular blocking drugs (C) Signup and view all the answers

What immediate action should be considered after successful intubation to maintain lung volume during surgery for patients with OSA?

Performing a lung recruitment maneuver (B) Signup and view all the answers

Which compound types impair upper airway patency when administered during sedation for procedures like endoscopy?

Opioids and GABAergic sedatives/hypnotics (A) Signup and view all the answers

What is a major concern for patients who are vulnerable to respiratory complications during sedation without a device bypassing the collapsible upper airway?

Sequelae of increased upper airway collapsibility (C) Signup and view all the answers

What is a key consideration for postoperative care to prevent the development of postoperative negative pressure pulmonary edema?

NIV (D) Signup and view all the answers

What is a viable treatment option for postoperative respiratory failure that also helps in preventing deoxygenation?

Non-invasive ventilation (NIV) (C) Signup and view all the answers

In postoperative care, what should be conducted before discharging a patient from the post anesthesia care unit (PACU)?

Performing a room air-challenge test (D) Signup and view all the answers

What alternative positioning method is recommended for patients who do not tolerate an elevated upper body position in postoperative care?

Positioning on the side (B) Signup and view all the answers

What is a key precaution to take when opioids are combined with sedatives or hypnotics?

Consider reducing opioid use if feasible (D) Signup and view all the answers

For patients at high risk of obstructive sleep apnea (OSA), what is a beneficial approach in the early postoperative period?

Maintain CPAP treatment throughout the early postoperative period (B) Signup and view all the answers

In patients being treated with CPAP at home, what should be ensured during the perioperative period?

Check the functioning of the CPAP device preoperatively (C) Signup and view all the answers

What is a recommended strategy to prevent airway collapse and maintain respiratory function in high-risk patients?

Reduce opioid use whenever possible (B) Signup and view all the answers

What contributes to the disrupted sleep-wake pattern seen in many ICU patients?

Exposure to dim light during the day (A) Signup and view all the answers

What is a common source of noise in the ICU environment?

Medical and monitoring device alarms (D) Signup and view all the answers

Which factor influences melatonin rhythm in the ICU setting?

Increasing age (A) Signup and view all the answers

What is a common characteristic of the EEG activity in ICU patients receiving sedatives or mechanical ventilation?

Does not fit into standard criteria for sleep and wakefulness (D) Signup and view all the answers

How does exposure to dim light in the ICU affect internal circadian rhythms?

Disrupts alignment with external 24-hour rhythm (D) Signup and view all the answers

What percentage of sleep in the ICU occurs during the day?

~50% (C) Signup and view all the answers

What effect do β-blockers have on melatonin secretion?

Decrease melatonin secretion (D) Signup and view all the answers

How do opioids affect REM sleep according to the text?

Reduce REM-sleep duration (D) Signup and view all the answers

Which medication inconsistently affects melatonin ?

Benzodiazepines (B) Signup and view all the answers

What is the recommended approach to improving sleep quality for ICU patients based on the text?

Reduce light and noise exposure during the night (A) Signup and view all the answers

Which neurotransmitter system do medications used for treating insomnia in the ICU interact with?

GABA system (D) Signup and view all the answers

What physiological consequence of sleep disturbance in the ICU can lead to an increased risk of infections?

Increased low-grade inflammation (D) Signup and view all the answers

Which endocrinological effect is a result of sleep disturbance in the ICU?

impaired glucose tolerance (C) Signup and view all the answers

How does sleep disturbance in the ICU impact respiratory function?

Decreased ventilatory CO2 response (B) Signup and view all the answers

Which cognitive function is affected by sleep disturbance in the ICU?

increase delirium risk (B) Signup and view all the answers

What is a consequence of sleep disturbance in the ICU on metabolic function?

Increased catabolic states (B) Signup and view all the answers

What is the prevalence of narcolepsy?

0.05-0.08% (A) Signup and view all the answers

Which neurotransmitter system is primarily affected in narcolepsy?

orexin neurons pathways (D) Signup and view all the answers

What distinguishes narcolepsy with cataplexy from narcolepsy without cataplexy?

Experience of sudden loss of muscle tone (A) Signup and view all the answers

What is the suggested origin of narcolepsy according to the text?

Autoimmune response against orexin neurons (B) Signup and view all the answers

Which treatment is specifically effective for cataplexy in narcolepsy?

Tricyclic antidepressants (C) Signup and view all the answers

How should medical treatment for narcolepsy be supported according to the text?

With behavioral therapy (D) Signup and view all the answers

What is a recommended approach to anesthesia for patients with narcolepsy based on the text?

Consideration of regional anesthesia (D) Signup and view all the answers

Why is it important to maintain medical treatment for narcolepsy during the preoperative period?

To prevent postsurgical hypersomnia (D) Signup and view all the answers

What is a cardinal feature used to define restless legs syndrome?

Urge to move the limbs (D) Signup and view all the answers

What is a common condition that may cause isolated periodic limb movement during sleep?

Excessive caffeine consumption (C) Signup and view all the answers

What is the main consequence of frequent arousals due to limb movements during sleep in patients with periodic limb movement disorder?

Sleep disruption (B) Signup and view all the answers

Which medication type is mentioned as a potential cause of symptoms similar to restless legs syndrome?

Antidepressants (B) Signup and view all the answers

In which group of patients would a polysomnography (PSG) test be recommended according to the text?

Patients at risk of sleep-disordered breathing (A) Signup and view all the answers

What is the recommended 1st line treatment for restless legs syndrome according to the text?

dopamine agonists (B) Signup and view all the answers

Which medication should be avoided for patients with restless legs syndrome based on the text?

Neuroleptics (A) Signup and view all the answers

Why might ketamine be considered a superior anesthetic drug for patients with restless legs syndrome according to the text?

It enhances dopamine levels in the brain (B) Signup and view all the answers

What is the best approach to provide symptom relief in patients with restless legs syndrome after surgery according to the text?

Early mobilization (A) Signup and view all the answers

What should be monitored closely before, during, and after surgery to prevent symptomatic restless legs syndrome symptoms?

Iron and ferritin blood levels (B) Signup and view all the answers

Which drug administration during and after surgery might benefit patients with restless legs syndrome?

Benzodiazepines (C) Signup and view all the answers