Liver - Co-existing

Question 1

Cholecystectomy: Anesthetic Management
Maintenance:
1. judicious use of ? (will cause ?)       
2. pneumoperitoneum => ??
3. ventilation impaired by?
4. drugs to antagonize SOO spasm?

Answer 1

1. opioids - SOO spasm
2. decreased VR and CO
3. increased intra-abd pressure
4. NTG, glucagon IV naloxone

Question 2

Hepatitis Anesthetic Considerations

• NPO status
• hypovolemic
  1. physiologic abnormalities?

Answer 2

1. coag issues, encephalopathy

Question 3

Cirrohosis: Preop/Induction

• volume status *need infusion of plts or vit K
  1. intubation? *admin glucose solution
  2. cardiomyopathy =? 3. PB?
• ETOH onboard

Answer 3

1. RSI (bleeding = full stomach)
2. sensitive to myocardial depressant drugs
3. decrease albumin levels

Question 4

Cirrohosis: Maintenance

1. VAs to use? *MRs (clearance/Vd/pancuronium)
   * maintain portal vein BF 4. Increased ?
2. Balanced technique? 5. Best MRs?
3. Plasma cholinesterase activity?

Answer 4

1. sevo/iso/des
2. IAs/N2O + opioids
3. succs and mivacurium ok
4. Vd
5. mivacurium/cisat/atracurium

Question 5

Porphyria: Anesthetic Management

• avoid triggers *assess CNS and skeletal fxn
  1. Cardiac- meds/HTN? 4. Cimetidine?
  2. Preop meds? * F/E manag
  3. minimize stress preop by? * may need postop vent

Answer 5

1. BB (for HTN and tachycardia)
2. aspiration prophylaxis and anxyioltyics
3. admin NS/glucose infusion
4. decreases heme consumption and inhibits ALA synthetase

Question 6

Porphyria: Regional?

1. Contraindicated?
2. pre-anesthetic?
3. exacerbation?
4. CV instability d/t?

Answer 6

1. No
2. Neuro eval
3. Avoid RA
4. ANS neuropathy, hypovolemia, sympathectomy

Question 7

Porphyria: General Anesthesia

1. Ideal meds (in general)?
2. Good Induction meds?
3. Maintenance meds?

Answer 7

1. short acting agents
2. propofol or ketamine (avoid in history if CV instability)
3. N2O, IAs, opioids, NDMR

Question 8

Cholecystectomy: Anesthetic Management
Induction/PreInduction
* consider volume replacement, F/E
1. intubation?

Answer 8

1. RSI w/ cuffed ett