YSK 3 Flashcards
1
Q
What percentage of the elderly population will require surgery prior to death?
A
Fifty percent will require surgery
2
Q
Preoperative death increases to threefold risk for the elderly population if they have what kind of concomitant disease?
A
Metabolic, cardiovascular, or respiratory
3
Q
What plays a more important role than relative age itself, in increasing the risk of the elderly patients?
A
Age related disease plays a more important role than relative age itself, in increasing the risk of patients
4
Q
What are the two types of depression in the elderly population?
A
Long term and endogenous or short term and reactive
5
Q
The two types of depression can be related to what type of symptoms in the elderly?
A
Either one can be related to poor appetite, weight loss, agitation, lack of energy, recurrent thoughts of suicide
6
Q
Elderly patients are prone to delirium, you have to distinguish this from what other illness?
A
have to distinguish from delirium from dementia, dementia is chronic and progressive
7
Q
What happens to the elderly’s arterial compliance?
A
Reduced arterial compliance increase afterload
8
Q
What happens to the elderly’s
DBP?
A
Diastolic blood pressure remains unchanged or decreases in absence of coexist disease
9
Q
What happens to the elderly’s
CO?
A
Cardiac output typically declines with age
10
Q
What happens to the elderly’s
HR?
A
Decreases in heart rate*** due to increase vagal tone, decrease sensitivity in adrenergic receptors, maximal heart rate declines one beat per min per year of age after the age of 50
11
Q
What happens to the elderly’s
and incidence of dysrhythmias?
A
Increased incidence of dysrhythmias have fibrosis of the conduction system, loss of SA cells, decrease diminished cardiac reserve
12
Q
What happens to the elderly’s
cardiac reserve?
A
Diminished cardiac reserve will have an exaggerated decrease in BP on induction, if they are hypertension, you will vasodilate and have more of a drop in BP
13
Q
What happens to the elderly’s
circulation time?
A
Prolonged circulation time*** decrease the onset of IV drugs, this will cause a prolonged effect of drugs as well
14
Q
The elderly population will respond less to hypovolemia, hypotension, or hypoxia with an increase in what?
A
Responds less to hypovolemia, hypotension, or hypoxia with an increase in heart rate therefore will not be able to compensate as quickly as someone that is younger
15
Q
The pulmonary system and the elderly, how is the elasticity of the lungs?
A
Elasticity is decreased (which is part of the aging process) promote closure of small airways, and 2nd you will have over distention of alveoli
16
Q
What kind of impairment is more common in PACU with the elderly patients?
A
Ventilatory impairment in PACU is more common*** make sure they are well oxygenated when you bring them to PACU
17
Q
What happens to Renal blood flow and kidney mass in the elderly?
A
Renal blood flow and kidney mass is decreased*****
18
Q
What happens to esophageal and intestinal motility in the elderly?
A
Esophageal and intestinal motility decrease**
19
Q
What happens to gastroesophageal sphincter tone in the elderly?
A
Gastroesophageal sphincter tone decreasesas a result these patients can be at bigger risk for pulmonary aspiration
20
Q
What happens to cerebral blood flow and brain mass in the elderly?
A
Cerebral blood flow and brain mass decrease w/ age**
21
Q
What do you have to do with the dosage requirements of local and general anesthetic for the elderly?
A
Local and general anesthetic dosage requirements reduced***
22
Q
What is the expected duration of action from spinal anesthesia in the elderly population?
A
Longer duration of action expected from spinal anesthesia** rate of absorption will be decreased
23
Q
What happens to the MAC for inhalational agents when it comes to the elderly?
A
MAC for inhalational agents is reduced Approx. 4% of decade of life over 40 (repeats this)
MAC decreases with age***
24
Q
What happens to the elimination half-life and duration of action in the elderly population?
A
Elimination half-life and duration of action may be prolonged*****related to hepatic changes, loss of liver mass
25
What would be beneficial for the elderly patient in terms of the gastric pH and gastric volume?
Attempts to increase gastric pH and decrease gastric volume may be beneficial*** Reglan and Pepcid would be good, just be careful with Reglan after 80 you can see CSN effects
26
What is an acceptable alternative to general anesthesia for the elderly?
Regional anesthesia - alternative to general anesthesia providing you elderly patient will be cooperative and alert (he repeats this)
27
What type of anesthesia are the elderly more sensitive to? (hint: has prolonged duration of action and exaggerated decrease in bp)
More sensitive to spinal anesthesia*** prolonged duration of action, exaggerated decrease in bp, make sure they are volume loaded
28
How do endocrine glands secrete their hormones?
Endocrine glands secrete their hormone products directly into surrounding extracellular fluid ******distinguish them from exocrine glands such as salivary glands, sweat glands, and glands in the gi tract, they have ducts or hallow lumens to secrete
29
What are the important endocrine glands?
```
Pituitary gland
Thyroid gland
Parathyroid glands
Adrenal glands
Pancreas
Ovaries and testes
Placenta
```
30
Endocrine function is mediated by what??
Endocrine function is mediated by hormones***transport information from one cell (endocrine) to another set of cells (target cells)
31
Paracrine function, how does the hormone signal acting work?
Paracrine function; hormone signal acting on a neighboring cell of a different type******* such as in the pancreas (alpha and beta) they travel very short distance (differences?) and alter the behavior of cells
32
Hormones are classified into three major categories, what are they?
- Peptide or protein hormones (most hormones in the body have peptide or protein structures)
- Steroid hormones
- Amines or amino-acid derivatives
33
What are the peptide or protein hormones??
Includes insulin, growth hormone, vasopressin, angiotensin, prolactin, erythropoietin, calcitonin, somatostatin, ACTH, oxytocin, glucagon, and parathyroid hormone*****
34
Where are the peptide or protein hormones synthesized???
Synthesized in endocrine cells, processed by the cell and stored in secretory granules within the endocrine gland****
35
What are steroid hormones derived from?
Derived from cholesterol or have a chemical structure similar to that of cholesterol***
36
What are some common steroid hormones? (the ones in the adrenal cortex and reproductive hormones)
Common steroid hormones include hormones of the adrenal cortex (cortisol and aldosterone) and reproductive hormones** (estrogen, progesterone, testosterone, are the reproductive hormones) (active metabolites such as vitamin D, which is also a steroid hormone?)
37
What are the major sites of hormone degradation and elimination?
the liver and kidneys, also small amount occurs at the target cells itself
38
Where are hormone receptors located?
Hormone receptors located either on surface of cells or inside cells***
39
Every Hormone has a specific onset and duration of action, How long are the hormonal effects generated?
- Hormonal effects may be generated in seconds to minutes or several hours to days****
- typically those receptors outside the cells it will happen in seconds to minutes, if they have to go inside the several hours to days for the effects
40
What is the relationship between the number of hormone receptors to the concentration of circulating hormones?
Hormone receptor number is usually inversely related to the concentration of the circulating hormone******If you have hormone A around, you will have less of the receptors’ so you wont have an exaggerated effect, the opposite is also true. If you have small amounts of Hormone B, your body will maybe produce more receptors.
41
What is the negative feedback?
Negative feedback****Negative acts to limits or terminate the production and secretion of a certain hormone once an appropriate response occurs (limit excess)*************
42
What is know as the "master Gland"?
The pituitary gland (hypophysis) known as the “master gland”***
43
The pituitary gland secretes hormones that have far reaching effects on various (blank)
Secretes hormones that have far reaching effects on various homeostatic, developmental, metabolic, and reproductive functions of the body****
44
Where is the pituitary gland located and how much does it weigh?
- Small endocrine gland located at the base of the brain****
| - Only weighs 500mg and size of a pee, close to hypothalamus
45
What is the pituitary gland enclosed in?
Enclosed within the sella turcica***
46
What is the pituitary gland connected to?
- Connected to the overlying hypothalamus by the hypophyseal stalk ***
- Hypothalamus located below the thalamus, behind the optic chiasm, and between the optic tracts***
- The brain via the hypothalamus is an important regulator of pituitary gland secretion ***
47
What supplies the anterior lobe of the pituitary?
- Anterior lobe; superior hypophyseal artery
| - Hypophyseal is a branch of ceratoid artery
48
What supplies the posterior lobe of the pituitary?
- Posterior lobe; inferior hypophyseal artery
| - Hypophyseal is a branch of ceratoid artery
49
What are the six primary hormones of the anterior pituitary lobe?
```
Growth hormone
Adrenocorticotriophic hormone (ACTH
Thyroid stimulating hormone (TSH)
Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
Prolactin
```
50
What is Growth Hormone?
Growth hormone promote skeletal development and body growth (he repeats) regulate protein and carbohydrate metabolism
51
What is Adrenocorticotrophic hormone (ACTH)?
Adrenocorticotrophic hormone (ACTH) regulate growth of adrenal cortex, regulate release cortisol and androgenic hormones from adrenal glands, also results in a little of skin pigmentation
52
What is Thyroid stimulating hormone (TSH)?
Thyroid stimulating hormone (TSH) controls growth and metabolism of thyroid gland
53
What is Follicle stimulating hormone (FSH)?
Follicle stimulating hormone (FSH) stimulate ovarian follicle development in females and spermatogenesis in males
54
What are Luteinizing hormone (LH)?
Luteinizing hormone (LH) induce ovulation and corpus luteum development in females, stimulate the testis to produce testosterone in males*** (extra YSK)
55
What is Prolactin?
Prolactin produce mammary gland development and milk production
56
Hyposecretion of the anterior pituitary disorders are related to what?
- Related to large pituitary tumors, postpartum shock (Sheehan’s syndrome), irradiation, trauma, and hypophysectomy
- Generalized panhypopituitarism is more common
57
Patients with anterior pituitary disorders, what maybe required perioperatively when it comes to thyroid and corticosteroid?
Patients may require thyroid hormone replacement and corticosteroid coverage in the perioperative period*** due to the possibility DI after removal of the tumor, make sure you have vasopressin available
58
Growth Hormone is under dual control of what?
Under dual control of the hypothalamus (he repeats this) two hormones, stimulated by growth hormone and inhibited by somatostatin hormone
-Normal growth hormone in adults is 1-5mg/mL
59
Growth Hormone is stimulated by what?
- Stimulated by stress, hypoglycemia, exercise, and deep sleep******
- Normal growth hormone in adults is 1-5mg/mL
60
What does Growth Hormone due to Blood glucose levels?
Increases blood glucose levels…! (he repeats this) Because it decreases sensitivity of the cells to insulin, so they will have higher glucose levels
61
What happens to the internal organs and lung volumes with someone that has a hypersecretion of growth hormone?
- Overgrowth of internal organs liver heart spleen kidney
| - Lung volumes increase lead to v/q mismatch
62
What happens to the exercise tolerance with someone that has hypersecretion of growth hormone?
Limited exercise tolerance muscle weakness and decrease body mass and skeletal frame (YSK KNOW AGAIN)
63
What are issues can lead to symptomatic cardiac disease? with someone that has hypersecretion of growth hormone?
Cardiomyopathy, hypertension, and accelerated atherosclerosis can lead to symptomatic cardiac disease pt presents with Chf dysrhythmias and aortic aneurysm
64
What are the ECG results with someone that has a hypersecretion of growth hormone?
ECG results…!******YSK again (Often show Lventric hypertrophy, conduction defects, st segment and t waves depression)
65
What is the treatment for acromegaly?
Treatment for acromegaly aimed at restoring normal growth hormone levels or micro dissection of the tumor
66
What is the preanesthetic cardiac evaluation for someone that has hypersecretion of growth hormone?
Preanesthetic cardiac evaluation…! Present with chf dysrhythmias and aortic aneurysm (he repeats this )
67
Posterior pituitary lobe, where is ADH synthesized?
ADH largely synthesized in the supraoptic nucleus****
68
Posterior pituitary lobe, where is oxytocin synthesized?
Oxytocin largely synthesized in the paraventricular nucleus****
69
Posterior pituitary lobe, What does ADH primarily do?
Antidiuretic hormone acts primarily to increase urine osmolarity****, decrease serum osmolarity, and increase blood volume
70
ADH is secreted in response to what?
ADH is secreted in response to an increase in plasma osmolarity or plasma sodium ion concentration, a decrease in blood volume, or a decrease in blood pressure******
71
What inhibits the action of ADH?
Ethanol, phenytoin, chlorpromazine, and lithium all inhibit the action of ADH or its release*******
72
Kidneys continue to reabsorb water despite the presences of what two things??? (hypersecretion of ADH)
Kidneys continue to reabsorb water despite the presence of hyponatremia (<130 mEq/L) and plasma hypotonicity (<270 mOsm/L)********
73
Where is the most calcium stored?
99% ca exist in the boney skeleton 1% is the in extra cellular space of tissues
74
What percentage of calcium is ionized?
- Of the calcium in the blood 40% is bond to protein and 60% is ionized******
- Ionized exerts its effect***
75
What are the three principal hormones that operate to regulate the plasma concentration of calcium?
Vitamin D
Parathryroid hormone (PTH)
Calcitonin
76
What is Vitamin D?
Vitamin D comes from compounds from foods, or from ultraviolet actions in the skin, inactive pro hormone
77
What is Parathyroid hormone (PTH)?
Parathyroid hormone (PTH) ***principle regulator of ca homeostasis, secreted by the parathyroid gland
78
What is Calcitonin?
Calcitonin Secreted from C cells in the thyroid gland in response to elevated serum ionized ca
79
What form of calcium exerts physiologic effects?
Only the free, ionized form of calcium exerts physiologic effects*****
80
What is the most important regulator of plasma calcium?
- PTH is the most important regulator of plasma calcium: (he repeats this)
- Decreases in plasma calcium stimulate PTH secretion and increases in plasma calcium inhibit PTH secretion*******
81
What augments intestinal absorption of calcium and facilitates actions of PTH?
- Vitamin D augments intestinal absorption of calcium, facilitates action of PTH on bone, and augments renal absorption of calcium in distal tubules*****
- Inadequate vitamin D intake or absorption of insufficient expose to sunlight of will lead to poor intestinal absorb of calcium (he repeats this)
82
What is secreted by the parafollicular cells in the thyroid glands?
- Calcitonin secreted by parafollicular cells (he repeats this) in the thyroid gland; secretion stimulated by hypercalcemia and inhibited by hypocalcemia
- Calcitonin Effect opposite of the pth and lowers ionized calcium levels
83
What is the Parathyroid gland's blood supply?
Blood supply: inferior thyroid arteries*****
84
PTH is sectered from what type of cells in the parathyroid gland?
Parathyroid hormone (PTH) is secreted from chief cells of the parathyroid gland in response to a low serum ionized calcium concentration (he repeats this)
85
What two electrolyte imbalance will stimulate PTH secretion?
****hyperphosphatemia and acute hypomagnesemia also stimulate PTH secretion
86
What will produce an abrupt decline in PTH synthesis and output?
Elevation in serum calcium ion concentration produces an abrupt decline in PTH synthesis and output (he repeats this) conditions associated with chronic serum elevated calcium levels: immobility, malignancy, and pagiots disease (something related to the bone)
87
Parathyroid gland function and PTH secretion are inhibited by what?
Parathyroid gland function and PTH secretion are inhibited by severe and chronic hypomagnesemia (he repeats this) different from the previous slide
88
What are the ECG signs of Hypercalcemia?
ECG signs patient will present with cardiac conduction disturbances, shortened QT intervals, prolong PR*****
89
What is the treatment for Hypercalcemia?
- Most effective initial treatment is rehydration followed by brisk diuresis (with isotonic saline solution) may receive Lasix 40-80 mg q2-4hrs, loop diuretic will promote calciuresis by decreasing tubal reabsorption and eventually to reduce calcium levels
- Additional therapy; administration of bisphosphonate or calcitonin
- Treat underlying cause
90
What is the anesthetic considerations for hypercalcemia?
- Monitor ionized calcium levels with serial measurements of K+ and Mg+. Avoid hypovolemia and acidosis. Invasive monitoring may be necessary. Responses to anesthetic agents are not predictable
- Acidosis increase ionized portion of ca, avoid hypoventilation (he repeats this)
91
What are the ECG findings for Hypocalcemia?
ECG findings…! May have prolonged QT intervals, related to delayed ventricular repolarizations, predisposed ventricular dysrhythmias******
92
What are the two signs for hypocalcemia?
- Chvosteks sign – contraction or twitching of ipsilateral of facial muscles, mandible of jaw
- Trousseaus sign – inflate bp cuff slightly about SBP for a few minutes, eventually will have flexion of the wrist and thumb, then have an extension of the fingers
93
Adults secrete about how much of insulin a day?
Adults normally secrete ~50 units of insulin each day from β-cells of the islets of Langerhans and α-cells secrete glucagon****
94
How is insulin stimulated?
- Beta cell stimulation insulin is going to be release via exocytosis from beta cells to the surround capillaries, the surround capillaries will pick up insulin and go into circulation, go through portal circulation, and have the first pass affect, the liver will get rid of about 50% of insulin (just know this, from what he says)
- Total daily insulin secretion is 60 units, but total peripheral is about 30 units***********
95
What causes an increase in rate of insulin secretion?
Ingestion of a meal increases rate of insulin secretion 5 to 10 fold*******
96
When does plasma insulin levels reach peak levels?
- Plasma insulin levels rise reaching peak levels 30 -60 minutes after eating is initiated******
- Between meals, insulin levels drift downward
97
Elevated plasma glucose levels directly activate what cells in the pancreas?
Elevated plasma glucose levels directly activate β-cells of the pancreas, stimulating insulin synthesis and secretion. Low plasma glucose concentrations inhibit this response
98
What is the most stimulator for insulin release?
Plasma glucose is by far the most stimulator for insulin release*
99
Maximal insulin response occurs at what levels?
Maximal insulin response…! Occurs at glucose levels of 400 - 600 but very little insulin will be release below 50******
100
What else is a potent stimulator of insulin release? besides glucose levels?
Amino acids also are potent stimulators of insulin release ***not as pronounced as glucose levels
101
What has the most important role to enhance hepatic glucose output?
Glucagon has the Most important role is to enhance hepatic glucose output and increase plasma glucose********
102
When is glucagon secreted?
Secreted in response to…! Hypo glycemia and other various stressors such as infection, toxemia, severe injury and surgery*****
103
What are the two causes of insulin deficiency?
Cause by a Relative or absolute insulin deficiency (repeats this)
104
What happens in an insulin deficiency patient?
Glucose is present in abundance but, due to lack of insulin, is unable to reach cells for energy provision Insulin, Direct nutrients on where to go and reduce plasma glucose levels (he repeats this)
105
What is considered an absolute deficiency of insulin?
- Insulin-dependent diabetes mellitus (IDDM):
- ~ 10% of diabetics have type 1 or IDDM
- These patients have an absolute deficiency of insulin********dependent entirely of exogenous forms of insulin
106
What is the recommended target blood glucose range for the anesthetic management of the diabetic patient?
Recommended target blood glucose range…!***120-140 In periop period
107
What is the difference between the oral hypoglycemic and insulin regimens?
oral hypoglycemics are going to increase insulin from the pancreas and improve tissue sensitivity, oral hypoglycemics are going to have a slower and lower rise in glucose levels, decrease hepatic glucose output increase peripheral insulin sensitive……. greatest risk is hypoglycemia (insulin regimens***)
108
What is the universal goal for the intraoperative management of a diabetic patient?
Universal goal…! 120-140 perioperative goal***
109
What may produce less deleterious changes in glucose homeostasis in a diabetic patient?
RA regional anesthesia may produce less deleterious changes in glucose homeostasis****
110
what is the acute treatment for the hypoglycemic surgical patient?
Acute treatment for the hypoglycemic surgical patient…IV administration of 25 mL of 50% glucose*****within 30min get an accu check
111
What are the two hormones in the thyroid?
- two hormones: (both bound to proteins and stored within the gland
- Triiodothyronine (T3) (this one is more potent and less protein bound)
- Thyroxine (T4)
112
Which hormone is released more from the thyroid?
Thyroid gland releases more T4 than T3**************
113
The increase in metabolic rate that is accompanied by the thyroid gland are what?
- Rise in oxygen consumption
- (increase) CO2 production
- Heart rate and contractility also increased***
- (indirectly you will have an increase in M/V ****due to blowing off the extra CO2 production
114
What are the clinical manifestations of excess thyroid hormone?
- Weight loss, heat intolerance, muscle weakness, diarrhea, hyperactive reflexes, and nervousness***
- Fine tremor, exophthalmos, or goiter may present***particular when causes are due to graves disease
115
What are the cardiac signs of hyperthyroidism?
Cardiac signs…! Range from ST to Afib and CHF, when you have new onset of afib, they work you up for thyroid disease
116
What is the induction agent of choice for hyperthyroidism?
Induction agent of choice…! Thiopental (anti thyroid activity associated with higher doses)
117
Which drugs should you avoid with a patient that has hyperthyroidism?
Drugs that stimulate the sympathetic nervous system are to be avoided*****ketamine, pancaronium (increase HR), indirect acting adrenergic agonist, should be avoided
118
A patient with hyperthyroidism, intraoperatively, what would their volume status be?
- Patients may be hypovolemic and vasodilated******intraoperatively
- Adequate anesthetic depth must be maintained (avoid tachycardia hypotension)
119
What should you be considered with a patient that has hyperthyroidism and NDMRS and MAC levels?
NDMRs (start with a little) and MAC levels **********(MAC levels are not increase in a patient with hyperthyroidism, therefor no change in MAC)
120
Thyrotoxicosis can be associated with what two disease?
(he repeats this) Thyrotoxicosis can be associated with myopathies and myasthenia graves
121
What is the most serious threat in the postoperative period for a patient that has hyperthyroidism?
Most serious threat in the postoperative period is thyroid storm:********usually happens 6 to 24 hours following surgery but it can happen during as well
122
What are the symptoms of thyroid storm?
- Hyperpyrexia
- Tachycardia
- Altered consciousness if they are awake, can start off if agitation and progress to stupor and then advance to delirium coma
- Hypotension
- (He repeats this)(mimics MH, will not have No muscle rigidity, not going to have the marked lactic and resp acidosis, not have an increase in creatine kinase in the labs)
123
What are several potential surgical complications with a subtotal thyroidectomy?
- Recurrent laryngeal nerve palsy**** (coarseness – unilateral nerve palsy, stridor for bilateral nerve palsy)(you are going to DL to check the cords, they will be spontaneously breathing and watch the cords move)
- Hematoma formation***may cause airway compromise, immediate treatment would have to open the wound and get clot out if this happens
- Hypoparathyroidism****from unintentional removal of the parathyroid glands, cause low ca with in 24 hours to 72 hours
- Pneumothorax****related to neck exploration
124
What are some causes of hypothyroidism?
Causes include; autoimmune disease, thyroidectomy, radioactive iodine, antithyroid medications, iodine deficiency, or failure of the hypothalamic-pituitary axis (he said get familiar with the axis?) (this is known as 2nd hypothyroidism)
125
what are some clinical manifestation for hypothyroidism?
- Weight gain, cold intolerance, muscle fatigue, lethargy, constipation, hypoactive reflexes, dull facial expression, and depression** extremities will be cool and mottled due to peripheral vasoconstriction
- Cardiovascular manifestations**** SV and CO will be decrease
- Pleural, abdominal, and pericardial effusions may present
126
Myxedema coma results from extreme hypothyroidism and characterized by what?
Myxedema coma results from extreme hypothyroidism and characterized by; impaired mentation, hypoventilation, hypothermia, hyponatremia, and congestive heart failure*****more commonly in elderly patients, can be precipitated by surgery, trauma, or infections
127
What is the steroid replacement and possible ventilatory support for hypothyroidism?
Steroid replacement (he repeats this) hydrocortisone 100mg every 8 hrs, in case they have any coexisting adrenal gland suppression) and possible ventilatory support (if required, may be due to hypoventilation)
128
For hypothyroidism, those patients are more susceptible to the hypotensive effects of what agents?
Hypothyroid patients more susceptible to the hypotensive effect of anesthetic agents (will have diminished CO, blunted barro receptor reflex)
129
what is the recommended induction agent of choice for someone that has hypothyroidism?
Possible Ketamine
130
What are the potential complications for a patient with hypothyroid during the intraopertive period?
Potential complications; hypoglycemia, anemia, hyponatremia, difficulty during intubation, and hypothermia*****all of these are related to low metabolic rate postoperatively, can have large tongues
131
What should you be concerned about with patients with hypothyroidism in the postoperative period?
Possible delayed recovery from general anesthesia****they could hypothermic, have resp depression, slower drug biotransformation
132
What should you use for pain relief in the postoperative period for a patient with hypothyroidism?
Nonopioid for postoperative pain relief want to be concern with the vulnerable resp depression, use percedex Toradol or ofrimev
133
What does Aldosterone do?
Causes sodium to be reabsorbed **** where Na goes, water goes) in the distal renal tubule in exchange for potassium and hydrogen ions
134
80% of adrenal catecholamine secretion is in the form of what?
80% of adrenal catecholamine secretion is in the form of epinephrine*****except in pheochromocytoma (nori more)
135
what are the clinical manifestations of phyochromocytoma?
Headache, hypertension, sweating, and palpitations******
136
What are the anesthetic considerations for phyochomocytoma?
- Preoperative assessment should focus on the adequacy of adrenergic blockade and volume replacement***concern about HR changes, ventricular ectopy, check EKG
- Invasive monitoring (aline) and good intravenous access
- Intraoperative hypertension treated with…! Phentolamine is first choice, never treat with beta blocker**********
- Post-resection hypotension might need infusions of epi or nori) /postoperative hypertension (may be volume overloaded)
