Anaesthetic Implication of Concurrent Diseases MCQs

Thyroid storm can present during and post surgery with fever (>40°C), sweating, sinus tachycardia (>140bpm), coma, nausea, vomiting, diarrhea. Management involves rehydration with IV saline and glucose, administration of steroid, beta blockers, propylthiouracil and paracetamol. Reference : Oxford handbook of Anesthesia, edition 4, page no 577

Cholinergic crisis can be differentiated from myasthenic crisis by administering small IV doses of anticholinesterases. With a cholinergic crisis, there are significant muscarinic effects (e.g., salivation, bradycardia, miosis) and an accentuated muscle weakness. Because this patient's Vt decreased with the administration of edrophonium, the diagnosis of cholinergic crisis is made. Although atropine may be needed to treat the cholinergic symptoms, muscle weakness will be worse and these patients need to be intubated until the muscle strength returns. Reference: Hines: Stoelting's Anesthesia and Co-Existing Disease, ed 6, p 450

Succinylcholine, depolarizing muscle relaxant can cause an increase in the potassium concentration up to 0.5 mEq/L can be used to facilitate endotracheal intubation only in the absence of hyperkalemia. Meperidine (pethidine), opioid should be avoided because of accumulation of its metabolite normeperidine. Sevoflurane usage for long hours can cause accumulation of compound A, that has been found nephrotoxic. Reference : Morgan and Mikhail's clinical anesthesia, 6th edition, page no. 689

Succinylcholine, depolarizing muscle relaxant can cause an increase in the potassium concentration upto 0.5 mEq/L can be used to facilitate endotracheal intubation only in the absence of hyperkalemia. Meperidine(pethidine), opioid should be avoided because of accumulation of its metabolite normeperidine. Sevoflurane usage for long hours can cause accumulation of compound A, that has been found nephrotoxic in rats. Reference: Morgan and Mikhail’s clinical anaesthesia, 6th edition, page no . 689

Ketamine use may cause nystagmus and Blepharospasm. It is also known to increase intra-ocular pressure . Hence should be avoided in eye surgeries. Reference: Morgan and mikhail’s clinical anaesthesiology 6th edition pg 591.

Pheochromocytoma is an endocrine tumor (with release of catecholamines) in which 90% of patients are hypertensive, 90% of the tumors originate in one adrenal medulla, and 90% of all pheochromocytomas are benign. This disease is rare ( Reference: Barash: Clinical Anesthesia, ed 7, pp 1339-1340; Hines: Stoelting's Anesthesia and Co-Existing Disease, ed 6, pp 392-395.

Insulin metabolism involves both the liver and kidneys. Renal dysfunction, however, has a greater impact on insulin metabolism than does hepatic dysfunction. In fact, unexpected prolonged effects of insulin sometimes are seen in patients with renal disease. Reference: Stoelting: Pharmacology and Physiology in Anesthetic Practice, ed 4, p 478

Surges in BP can occur at induction, formation of the pneumoperitoneum, and with tumor handling. The fluctuations in BP tend to be transient, and medication needs to respond in a similar fashion. hypertension can be treated in a number of ways: intermittent 2g boluses of Magnesium, boluses of remifentanil, phentolamine, sodium nitroprusside, or labetalol (if associated with a tachycardia). Reference : Oxford handbook of Anesthesia, edition 4, page no 582