A decrease in cholinesterase activity has been associated with:

a. obesity

b. thyrotoxicosis

c. alcoholism

d. burns

D. Burns- Burns, liver disease, 3rd trimester of pregnancy, carcinoma, renal failure and collagen diseases as well as certain drug therapy have been associated with a decrease in cholinesterase activity. Increased cholinesterase activity has been associated with obesity, alcoholism, thyrotoxicosis, nephrosis, psoriasis and electro-convulsive therapy.

1. Therapeutic hypothermia has been studied in two patient populations: 1) patients who have return of spontaneous circulation (ROSC) after cardiac arrest, and 2) patients undergoing aneurysm clipping. The outcomes of these large trials suggest that:

a. Both patient populations benefit from hypothermia

b. Neither patient population benefitted from hypothermia

c. Only the aneurysm study showed a benefit from hypothermia

d. Only the ROSC studies showed a benefit from hypothermia

D.

A 44-year-old man presents to the emergency room with a table saw injury to the left hand. The surgeon plans to explore the wound and possibly repair tendon and vascular injuries. The estimated operative duration is between 1-5 hours and an axilla block with bupivacaine is planned as the primary anesthetic technique. The patient has a seizure with the inejction of bupivacaine. Which of the following should be your FIRST therapeutic action?

- Administer a short-acting muscle relaxant to stop muscle contractions

-Administer intra-lipid

-Administer lidocaine to prevent cardiac arrhythmias

-Administer oxygen and ensure a patent airway

 D. Administer oxygen. The treatment of local anesthetic toxicity is similar to the management of other medical emergencies and focuses on airway, breathing and circulation. Ensuring adequate oxygenation and ventilation is paramount to avoid progressive acidosis.

Pathophysiologic factors affecting the anesthetic management of patients with hypothyroidism include:

• hypernatremia

• hyperglycemia

• difficulty with intubation and airway management

• increased blood viscosity due to elevated hematocrit

difficulty with intubation and airway management.

Potential problems of hypothyroidism include hypoglycemia, anemia, hyponatremia and difficulty during intubation because of a large tongue or the presence of a goiter. Hypothermia secondary to a low metabolic rate is a common postoperative complication.

A 73-year-old man with prostate adenocarcinoma presents for robotic-assisted prostatectomy. His medical history is significant for poorly controlled, refractory hypertension, COPD, chronic kidney disease, and non-obstructive coronary artery disease. His home medications include aspirin, hydrochlorothiazide, lisinopril, and amlodipine. His blood pressure in the pre-op holding area is 177/98 mmHg. Anticipating likely intraoperative hypertension, you consider the vasodilatory agents in your armamentarium. Which of the following is MOST correct regarding these drugs?

a. The vasodilatory effects of nitroglycerin on the arterial and venous sides are similar

b. The pharmacologic half-life of hydralazine is prolonged in patients with chronic kidney disease

c. Nesiritide is less effective than nitroglycerin in reducing right atrial pressure

d. The most common acid-base disturbance seen with sodium nitroprusside overuse is metabolic acidosis

C. Nitroglycerin is a much more potent venodilator than arterial dilator. Hydralazine is metabolized by acetylation in the liver, so an increase in the half-life would not be expected in a patient with chronic kidney disease. According to Barash, nesiritide is even more effective than nitroglycerin in reducing right atrial pressure. Metabolic acidosis is part of the triad of cyanide toxicity (along with tachyphylaxis and elevated SvO2) that can be seen with sodium nitroprusside administration.