Anesthesiology 5
A 22-year-old anesthesia patient with normal hepatic and renal function was given a bolus intravenous dose of a neuromuscular blocker that should have lasted only 5-10 min. Instead, the patient required mechanical ventilation for over 8 h.
Questions and tasks:
1. Which statement about the above mentioned problem is accurate? Explain each option briefly.
a) atracurium was the neuromuscular blocking drug administered
b) neostigmine should be administered to establish the nature of problem
c) the agent used was tubocurarine
d) the problem experienced by this patient is due to inadequate activity of acetylcholinesterase
e) this case is a good example of genetic variation in drug metabolism
2. The clinical use of succinylcholine, especially in patients with diabetes, is associated with (choose the most correct answer and explain your decision):
a) antagonism of pyridostigmine during the early phase of blockade
b) block of autonomic ganglia
c) elevated intragastric pressure
d) histamine release in genetically determined population
e) metabolism at the neuromuscular junction by acetylcholinesterase
3. Myalgias are common postoperative complaint of patients who receive large doses of succinylcholine, possibly the result of muscle fasciculatons caused by depolarization. Which drug administered in the operating room is used to prevent postoperative pain casued by succinylcholine? (choose the most correct answer and explain your decision)
a) baclofen
b) cisatracurium
c) dantrolen
d) diazepam
e) lidocaine
4. In anesthesia protocols that include succinylcholine, which of the following is a premonitory sign of malignant hyperthermia? (choose the most correct answer and explain your decision)
a) acidosis
b) bradycardia
c) hypotension
d) transient hypothermia
e) trismus