EDAIC Hepatic, Renal and Endocrine Anesthesia 5

Question 1

A patient with Addison's disease presents for urgent bowel resection. They have not received their usual hydrocortisone today. What is the appropriate perioperative steroid management?

Accepted Answer

Hydrocortisone 100 mg IV at induction, then 50 mg every 8 hours for 24-48 hours

Answer

Major surgery in primary adrenal insufficiency requires stress-dose steroid coverage: hydrocortisone 100 mg IV at induction then 50 mg q8h for 24-48h, tapering to maintenance as the patient recovers.

Question 2

In a patient with end-stage renal disease on hemodialysis, which neuromuscular blocking agent is SAFEST regarding accumulation of active metabolites?

Accepted Answer

Cisatracurium

Answer

Cisatracurium undergoes organ-independent Hofmann elimination, producing laudanosine (minimally active) without relying on renal or hepatic clearance, making it the safest NMBA in renal failure.

Question 3

Which of the following best describes the 'sick euthyroid syndrome' encountered in critically ill ICU patients and its anesthetic implication?

Accepted Answer

Low T3 and T4 with normal or low TSH; routine replacement is not recommended

Answer

Sick euthyroid syndrome reflects reduced peripheral T4-to-T3 conversion in critical illness; TSH is normal or low, and thyroid replacement is generally not beneficial and may be harmful.

Question 4

During hepatic resection, the Pringle maneuver (portal triad occlusion) is applied for 45 minutes. What is the main anesthetic concern during reperfusion?

Accepted Answer

Hemodynamic instability from release of vasoactive mediators and metabolic acidosis

Answer

Reperfusion after prolonged Pringle maneuver releases accumulated lactic acid, potassium, and vasoactive mediators into the systemic circulation, causing hypotension, metabolic acidosis, and dysrhythmias.

Question 5

A 72-year-old with type 2 diabetes on metformin is scheduled for elective hip arthroplasty under spinal anesthesia. Metformin should be withheld preoperatively primarily to prevent:

Accepted Answer

Lactic acidosis if renal perfusion is compromised perioperatively

Answer

Metformin does not cause hypoglycemia but accumulates when renal perfusion is impaired (dehydration, contrast, hypotension), leading to lactic acidosis; it should be withheld 24-48h before procedures that risk renal compromise.

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 5