d. Drugs which are alpha-receptor antagonists cause the smallest changes in renal hemodynamics and function
18. a – General anesthesia temporarily depresses renal finction as measured by urinary output, GFR, RBF, and electrolyte excretion. Rebnal impairmaent is usually short- lived and completely reversible. Maintainance of systemic blood pressure and especially preopeartive hyfration lessen the effect on renal function.. Spinal and epidural anestheisia, but not to the same extent as general anesthesia. In this setting, decrements in renal function parallell the magnitude of symaptheitc blockade. Agents that produce myocardial depression (such as volatile anesthesic on renal autoregulation are conflicting, but their indirect effects on renal hemodybnamics are probably of greater significance (Duke and Rosenberg, 1996) ed, as evinced by decreases in GFR, RBF and increased renal vascular resistance. D is also a correct response.
19. How should a patient with suspected coronary artery disease be monitored via ECG intraoperatively?
a. Leads I and II
b. Lead II
c. ECG Leads I, II, and III
d. 12 lead ECG
e. Leads II and V5
19. e – The most important modality for monitoring this patient intraoperatively is a multiple lead ECG system. Up to 89% of ECG changes that are due to myocardial ischemia that are present on 12-lead ECG will be detected by a V5 precordial lead alone. Limb lead II and precordial lead V have been recommended for simultaneous monitoring to detace intraoperative myocardial ischemia. This combination should detect more than 98% of ischemic episodes. In addition, leads II (inferior) and V5
( apical, anterolateral) monitor the distribution of the RCA and LCA.
20. All of the following are considered essentials of preoperative cardiac evaluation EXCEPT:
a. History ( CAD, Ventricular function, arrhythmias, valvular disease)
b. Physical Exam (VS, Heart sounds)
c. Laboratry Eval (CXR, ECG, others as indicated)
d. Considering the surgeon?s history and physical as a complete risk assessment, after carefully noting his documentation.
20. d – While History, physical examination and laboratory studies are a firm foundation on which to build an anesthesic plan of care, deferrential trusting in a colleague?s assessment while valuable, but should never be considered complete. Disciplines outside anesthesia may share the mutual goal of an optimal patient outcome, but the focal areas of concern for respective disciplines are by neceiisty different. Entrusted with the care of patients demands precsion, diligence, and attention to detail. This begins with the preoperative cardiac evaluation. Preoperative cardaic assessment includes a history, physical examination and labortayru resulkts, as well as historical information should asses the presence, severity and reversibility of corinary aretert disease risk factors for coronary artery disease, anginal patterns, and history of myocardial infarction: The left and right ventricular function (exercise caacity, pulmonary edema, plumonary hypertension; and the prescene of sympromatic dysrhythmsias (palpitations, syncopal or presyncopal episodes. Patients with valvular heart disease may be symptomatic for emobolic events. On physical examination, particular attention should be paid to VS, HR, BP, and PP (determinants of myocardial O2 consumption and delivery) , JVD, peripheral edema, pulmonary edema, or an S3 gallup and the presence of murmurs. Baseline labs include CXR, and ECG. Further evaluation may be determined based on results (Reich and Jaffee)