Basics Of Anesthesia Chapter 3 Autonomic Nervous System

Front 1

Anesthesiology has been described as the practice of ____ medicine.

Back 1

autonomic nervous system (ANS)

Front 2

Preoperatively, what is the most practical bedside test to evaluate the ANS function?

Back 2

recording SBP and HR response when patient changes from supine to upright posture.

Front 3

in regard to SBP & HR, ANS dysfunction is suspected when what 2 things occurs?

Back 3

1.orthostatic hypotension (SBP decrease more than 30mmHg)

2.absence of an increase in HR on assuming the upright posture.

Front 4

The central ANS includes?

Back 4

1.hypothalamus (stress responses, SBP control, temperature regulation)

2.medulla and pons (hemodynamic and ventilatory control)

Front 5

Preganglionic fibers of the SNS arise from ?

Back 5

thoracolumbar portions of the spinal cord

Front 6

Preganglionic fibers in the PNS arise from ?

Back 6

craniosacral portions of the spinal cord

Front 7

the small amount of norepinephrine that is not subjected to reuptake into the postganglionic nerve endings, is subjected to what?

Back 7

deamination in the cytoplasm by the enzyme monoamine oxidase

Front 8

are postganglionic fibers of SNS distributed all over body or limited at effector organs?

Back 8

distributed all over body

mass reflex

Front 9

are postganglionic fibers of PNS distributed all over body or limited at effector organs?

Back 9

limited at effector organs

Front 10

what are postganglionic fibers of PNS that release ACh called?

Back 10

cholinergic

Front 11

what are postsynaptic receptors that respond to ACh 2 classifications?

Back 11

nicotinic or muscarinc

Front 12

Action of acetylcholine at responsive receptors is terminated by ?

Back 12

hydrolysis of this neurotransmitter by the enzyme acetylchoninesterase (true cholinesterase)

Front 13

Beta 1 effector organs & responses (2)

Back 13

1.Heart
--increased HR, contractility, conduction velocity

2.Fat cells
--Lipolysis

Front 14

Beta 2 effector organs & responses (6)

Back 14

1.Blood vessels (especially skeletal and coronary arteries)- dilation
2.Bronchioles - dilation
3.Uterus - relaxation
4.Kidneys - renin secreation
5.Liver - Gluconeogenesis
6.Pancreas - insulin secretion

Front 15

Alpha 1 effector organs & responses (4)

Back 15

1.Blood vessels - constriction
2.Pancreas - inhibition of insulin secretion
3.Intestine - relaxation
4.bladder - consgtriction of spincter

Front 16

Alpha 2 effector organs & responses (3)

Back 16

1.Postganglionic (presynaptic sympathetic nerve endings) - inhibition of NE release

2.CNS (postsynaptic) - increased K+ conductance

3.Platelets - aggregation

Front 17

Dopamine 1 effector organ & response

Back 17

Blood vessels - dilation

Front 18

Dopamine 2 effector organ & response

Back 18

Postganglionic (presynaptic) sympathetic nerve endings - inhibition of NE release

Front 19

Muscarinic effector organs & responses (5)

Back 19

1.Heart - decreased HR, contractility, conduction velocity

2.Bronchioles - constriction
3.Salivary glands - stimulation of secretions
4.Intestines - constriction, relaxation of sphincters, stimulation of secretions
5.Bladder - contraction, relaxation of sphincter

Front 20

Nicotinic effector organs & responses (2)

Back 20

1.Neuromuscular Junction - skeletal muscle contraction

2.Autonomic Ganglia - SNS stimulation

Front 21

________ are compounds with hydroxyl groups on the 3 and 4 positions on the benzene ring of phenylethylamine.

Back 21

Catecholamines

Front 22

Endogenous catecholamines are ?

Back 22

dopamine, norepinephrine, and epinephrine

Front 23

Cathecholamines that do not occur endogenously are ?

Back 23

isoproternol and dobutamine.

Front 24

Catecholamines are predominantly effect which system?

Back 24

the CV system

Front 25

List from most to least the effect of dopamine on MAP, HR, CO, SVR, Renal blood flow, Cardiac dysrhythmias

Back 25

1.CO, renal blood flow
2.SVR, MAP, HR, cardiac dysrhythmias

Front 26

List from most to least the effect of NE on MAP, HR, CO, SVR, Renal blood flow, Cardiac dysrhythmias

Back 26

1. SVR, MAP
2.cardiac dys
3.decreased HR, CO, renal BF

Front 27

List from most to least the effect of epinephrine on MAP, HR, CO, SVR, Renal blood flow, Cardiac dysrhythmias

Back 27

1.cardiac dys
2.HR, CO, SVR
3.MAP
4.decreased renal BF

Front 28

List from most to least the effect of isoproternol on MAP, HR, CO, SVR, Renal blood flow, Cardiac dysrhythmias

Back 28

1,HR, CO, cardiac dys
2.decreased MAP, SVR, renal BF

Front 29

List from most to least the effect of dobutamine on MAP, HR, CO, SVR, Renal blood flow, Cardiac dysrhythmias

Back 29

1.CO
2.Renal BF
3.MAP, HR
4.decreased SVR, cardiac dys

Front 30

what does dopmaines effects depend on?

Back 30

dose

Front 31

which receptors does dopamine stimulate?

Back 31

Depending on dose, directly stimulates dopamine, beta, and alpha adrenergic receptors.

Front 32

what makes dopamine unique among this class of drugs?

Back 32

ability to stimulate dopamine receptors and redistribute blood flow to the kidneys

Front 33

Renal effects at what dose of dopamine? and what are the renal effects?

Back 33

< 3mcg/kg/min

aldosterone secretion & increased BF to kidneys resulting in increased UOP

Front 34

Beta adrenergic stimulation at what dose of dopamine? and what are the effects?

Back 34

(3-10 mcg/kg/min)

1.myocardial contractility w/o marked changes in HR and SBP
2.evoking the release of endogenous stores of norepinephrine, which predisposes to cardiac dysrhythmias.

Front 35

when is the secondary release of NE not effective with dopamine administration?

Back 35

when cardiac catecholamine stores are depleted, as with chronic CHF

Front 36

Beta and alpha adrenergic agonist effects at what dose of dopmaine?

Back 36

10-20 mcg/kg/min

Front 37

Predominate alpha adrenergic effects at what dose of dopamine?

Back 37

>20 mcg/kg/min

Front 38

IV infusion of dopamine interferes with what mechanism related to respiratory system? why?

Back 38

ventilatory response to hypoxemia

it's an inhibitory neurotransmitter at carotid bodies

Front 39

High dose dopamine can inhibit ?

Back 39

release of insulin, leading to hyperglycemia.

Front 40

Most often used in clinical situations characterized by?

Back 40

1.decreased CO
2.SBP
3.increased LVEDP
4.oliguria

Front 41

Extravazation of dopamine produces? and what's the tx?

Back 41

intense local vasoconstriction

treated with phentolamine

Front 42

Norepinephrine

Back 42

an endogenous neurotransmitter for alpha and beta adrenergic receptors

Front 43

clinial indications for NE?

Back 43

hypotension

Front 44

MOA of NE maintenance of BP?

Back 44

vasoconstriction, increased SVR

Front 45

which effects are greater with NE, beta 1 or alpha 1? and where?

Back 45

alpha 1 > beta 1

in the peripheral vasculature

Front 46

why might CO be decreased despite increased SBP when NE is administered?

Back 46

1.increased ventricular afterload

2.baroreceptor-mediated reflex bradycardia

Front 47

are the beta 2 effects of NE significant?

Back 47

no mininmal

Front 48

Used for treatment of refractory hypotension as may occur in early period following ligation of vascular supply to a phenochromocytoma.

Back 48

NE

Front 49

Epinephrine stimulates which receptors?

Back 49

alpha-1, beta-1, and beta-2 receptors

Front 50

where does vasoconstriction occur when epi stimulates alpha 1 receptors?

Back 50

skin, mucosa, hepatorenal vasculature

Front 51

where does vasodilation occur when epi stimulates beta 2 receptors? net effect?

Back 51

skeletal muscles

decreased SVR and a preferential distribution of CO to skeletal muscles

Front 52

Effect of epi on Beta-1 receptor?

Back 52

1.increase HR
2.increased contractility
3.increased CO
4.increased automaticity (manifest as cardiac irritability in form of PVC’s)

Front 53

what effect does epi have on renal blood flow?

Back 53

greatly decreased

Front 54

which catecholamine has the most significant effect on metabolism of all the catecholamines?

Back 54

epinephrine

Front 55

what in response to surgical stimulation is a likely explanation for the hyperglycemia that is often observed in perioperative period?

Back 55

Epinephrine release

Front 56

Subcutaneous epinephrine is also used in combination with local anesthetics. Why?

Back 56

to decrease systemic absorption and provide local hemostasis

Front 57

Along with oxygen, what is the most important pharmacologic treatment of cardiac arres?

Back 57

epinephrine

Front 58

Isoproterenol

Back 58

a synthetic catecholamine with potent stimulant effects on beta-1 and beta-2 receptors. No alpha-1.

Front 59

Effects of Isoproterenol

Back 59

1.Myocardial contractility
2.increased CO
3.increased HR
4.increased SBP
5.increased cardiac automaticity
6.decrased SVR
7.decreased diastolic BP

Front 60

regarding isoproterenol, Excessive tachycardia and simultaneous diastolic hypotension may ?

Back 60

decrease coronary blood flow at time myocardial oxygen requirements are increased by tachycardia.

Front 61

Clinical uses of Isoproterenol ?

Back 61

1.increase HR after heart transplant or complete heart block (chemical packmaker).

2.in patients with valvular heart disease to decrease PVR