Hepatic, Renal and Endocrine Anesthesia Flashcards

Which neuromuscular blocking agent is preferred in a patient with end-stage renal disease to avoid accumulation of active metabolites?

Answer: Atracurium

Atracurium undergoes Hofmann elimination and ester hydrolysis independent of organ function, making it the preferred NMBA in renal failure to avoid accumulation.

In a patient with chronic kidney disease (CKD stage 5), which opioid is safest to use due to lack of active renally-cleared metabolites?

Answer: Fentanyl

Fentanyl is metabolized to inactive norfentanyl and is not significantly renally excreted, making it preferred over morphine (active M6G accumulates) in renal failure.

Hyperkalemia in a renal failure patient undergoing anesthesia is a contraindication to which drug?

Answer: Succinylcholine

Succinylcholine causes a transient rise in serum potassium of ~0.5 mEq/L, which can precipitate life-threatening cardiac arrhythmias in already hyperkalemic renal failure patients.

Which regional anesthesia consideration is most important when planning a brachial plexus block for AV fistula creation in a CKD patient?

Answer: Limit local anesthetic dose because of altered protein binding increasing free drug

Hypoalbuminemia in CKD increases the free fraction of amide local anesthetics, raising the risk of systemic toxicity at standard doses.

Anemia in chronic renal failure is primarily caused by:

Answer: Decreased erythropoietin production by damaged kidneys

The kidneys produce erythropoietin in response to hypoxia; in CKD, reduced erythropoietin synthesis leads to normochromic normocytic anemia.

What is the primary concern when administering NSAIDs for postoperative analgesia in patients with pre-existing renal insufficiency?

Answer: Inhibition of prostaglandin-mediated afferent arteriolar dilation causing acute kidney injury

In renal insufficiency, the kidney relies on prostaglandins to maintain afferent arteriolar tone; NSAIDs block this compensatory mechanism and can precipitate acute kidney injury.