Endocrine, Metabolic, Electrolyte Response- Exam 1

Question 1

How do deeper levels of anesthesia affect endocrine responses? Mortality?

Answer 1

Appear to reduce or eliminate endocrine responses; also reduce mortality

Question 2

The pituitary is responsible for which functions?

Answer 2

Neural and endocrine

Question 3

What part of the pituitary is the “neurosecretory” portion?

Answer 3

Posterior pituitary; it’s essentially modified nervous tissue

Question 4

What does the pituitary SECRETE? (not produce)

Answer 4

ADH ( vasopressin)

Oxytocin

Question 5

What is oxytocin responsible for?

Answer 5

Positive feedback loop during labor
Milk letdown during lactation
The “cuddle” hormone

Question 6

Vasopressin (ADH)

Answer 6

Regulates renal water excretion (potent)

Question 7

What do high concentrations of vasopressin result in?

Answer 7

Increased PVR
Decreased cardiac contractility
Decreased coronary BF
Increased renal vascular resistance
Reduces renal blood flow
Stimulates release of vWF (improve hemostasis)

Question 8

What stimulates vasopressin release?

Answer 8

Increase plasma osmolarity
decreased blood volume or decreased blood pressure or perceived decreased blood pressure
hypoglycemia
angiotensin II
stress
pain

Question 9

What does the anterior portion of the pituitary secrete?

Answer 9

Trophic hormones that regulate:
Adrenal cortex (ACTH)
Thyroid (TSH)
ovaries/testes
Growth (HGH)

Question 10

What is the most damaging complication to pituitary?

Answer 10

Pituitary Apoplexy

Question 11

How common is pituitary apoplexy?

Answer 11

Rare, more common in patients with pituitary adenomas usually diagnosed with post hoc

Question 12

What are the symptoms of pituitary apoplexy?

Answer 12

Ptosis (droopy eyelids)
Opthalmoplegia (paralysis of muscles controlling eye)
Nonreactive and dilated pupils
Decreased visual acuity
Hormonal defects

Question 13

Damage to pituitary usually blamed on what?

Answer 13

Ischemia, hemorrhage, edema of gland

Question 14

Pituitary Apoplexy Tx

Answer 14

Hormonal replacement (HGH)
Hypophysectomy

Question 15

What are some catecholamines?

Answer 15

Epinephrine

Norepinhephrine

Question 16

What does the adrenal medulla produce?

Answer 16

Epinephrine and norepinhephrine

Question 17

Peripheral sympathethic and central nerve terminal produce what?

Answer 17

Norepinephrine

Question 18

Over increase of _________ during CPB.

Answer 18

Catecholamines

Question 19

Epinephrine concentrations increases _____fold on CPB over preop levels.

Answer 19

10

Question 20

Norepinephrine concentration increases _______ fold on CPB over preop levels.

Answer 20

4

Question 21

When is the biggest increase of catecholamines?

Answer 21

Initial cooling

Question 22

When is the first “big” increase of catecholamines on bypass?

Answer 22

Initiation of bypass

Question 23

What affect does continued cooling have on catecholamine production?

Answer 23

Appears to decrease the effect

Question 24

When is the epinephrine peak?

Answer 24

When target temperature is reached

Question 25

When is the norepinephrine peak?

Answer 25

After release of cross-clamp and rewarming