EDAIC Hepatic, Renal and Endocrine Anesthesia 2

Question 1

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

Accepted Answer

Atracurium

Answer

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

Question 2

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

Accepted Answer

Fentanyl

Answer

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

Question 3

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

Accepted Answer

Succinylcholine

Answer

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.

Question 4

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

Accepted Answer

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

Answer

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

Question 5

Anemia in chronic renal failure is primarily caused by:

Accepted Answer

Decreased erythropoietin production by damaged kidneys

Answer

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

EDAIC - European Diploma in Anesthesiology and Intensive Care Practice Test

EDAIC - European Diploma in Anesthesiology and Intensive Care Practice Test

EDAIC Hepatic, Renal and Endocrine Anesthesia 2