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Chapter 46: Anesthesia for the Surgical Patient

Malignant hyperthermia (MH) can develop after receiving general anesthesia. Triggering agents include, but are NOT limited to

A. Halothane, isoflurane

B. Desflurane

C. Electroflurane

D. Hypoflurane, osteoflurane

Answer: A

Malignant hyperthermia (MH) is a hereditary, life-threatening, hypermetabolic acute disorder, developing during or after receiving general anesthesia. The clinical incidence of MH is about 1:12,000 in children and 1:40,000 in adults. A genetic predisposition and one or more triggering agents are necessary to evoke MH. Triggering agents include all volatile anesthetics (eg, halothane, enflurane, isoflurane, sevoflurane, and desflurane) and the depolarizing muscle relaxant succinylcholine. Volatile anesthetics and/or succinylcholine cause a rise in the myoplasmic calcium concentration in susceptible patients, resulting in persistent muscle contraction. (See Schwartz 10th ed., p. 1918.)

Postoperative nausea and vomiting (PONV) typically occurs in what percentage of surgical cases?

A. 10–15%

B. 90%

C. 20–30%

D. None

Answer: C

Postoperative nausea and vomiting (PONV) typically occurs in 20 to 30% of surgical cases, with considerable variation in frequency reported between studies (range, 8–92%). PONV is generally considered a transient, unpleasant event carrying little long-term morbidity; however, aspiration of emesis, gastric bleeding, and wound hematomas may occur with protracted or vigorous retching or vomiting. Troublesome PONV can prolong recovery room stay and hospitalization and is one of the most common causes of hospital admission following ambulatory surgery. (See Schwartz 10th ed., p. 1915.)

The intentional dilution of blood volume often is referred to as

A. Acute normovolemic hemodilution (ANH) anemia

B. Acute hypovolemic normodilution (AHN) anemia

C. Hypercoagulable hemodilution (HH) anemia

D. None of the above

Answer: A

The intentional dilution of blood volume often is referred to as acute normovolemic hemodilution (ANH) anemia. ANH is a technique in which whole blood is removed from a patient, while the circulating blood volume is maintained with acellular fluid. Blood is collected via central lines with simultaneous infusion of crystalloid or colloid solutions. Collected blood is reinfused after major blood loss has ceased, or sooner, if indicated. Blood units are reinfused in the reverse order of collection. Under conditions of ANH, the increased plasma compartment becomes an important source of O2, which is delivered to ...

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