Endocrine, Metabolic, Electrolyte Response- Exam 1 Flashcards
How do deeper levels of anesthesia affect endocrine responses? Mortality?
Appear to reduce or eliminate endocrine responses; also reduce mortality
The pituitary is responsible for which functions?
Neural and endocrine
What part of the pituitary is the “neurosecretory” portion?
Posterior pituitary; it’s essentially modified nervous tissue
What does the pituitary SECRETE? (not produce)
ADH ( vasopressin)
Oxytocin
What is oxytocin responsible for?
Positive feedback loop during labor
Milk letdown during lactation
The “cuddle” hormone
Vasopressin (ADH)
Regulates renal water excretion (potent)
What do high concentrations of vasopressin result in?
Increased PVR Decreased cardiac contractility Decreased coronary BF Increased renal vascular resistance Reduces renal blood flow Stimulates release of vWF (improve hemostasis)
What stimulates vasopressin release?
Increase plasma osmolarity decreased blood volume or decreased blood pressure or perceived decreased blood pressure hypoglycemia angiotensin II stress pain
What does the anterior portion of the pituitary secrete?
Trophic hormones that regulate: Adrenal cortex (ACTH) Thyroid (TSH) ovaries/testes Growth (HGH)
What is the most damaging complication to pituitary?
Pituitary Apoplexy
How common is pituitary apoplexy?
Rare, more common in patients with pituitary adenomas usually diagnosed with post hoc
What are the symptoms of pituitary apoplexy?
Ptosis (droopy eyelids) Opthalmoplegia (paralysis of muscles controlling eye) Nonreactive and dilated pupils Decreased visual acuity Hormonal defects
Damage to pituitary usually blamed on what?
Ischemia, hemorrhage, edema of gland
Pituitary Apoplexy Tx
Hormonal replacement (HGH) Hypophysectomy
What are some catecholamines?
Epinephrine
Norepinhephrine
What does the adrenal medulla produce?
Epinephrine and norepinhephrine
Peripheral sympathethic and central nerve terminal produce what?
Norepinephrine
Over increase of _________ during CPB.
Catecholamines
Epinephrine concentrations increases _____fold on CPB over preop levels.
10
Norepinephrine concentration increases _______ fold on CPB over preop levels.
4
When is the biggest increase of catecholamines?
Initial cooling
When is the first “big” increase of catecholamines on bypass?
Initiation of bypass
What affect does continued cooling have on catecholamine production?
Appears to decrease the effect
When is the epinephrine peak?
When target temperature is reached
