Anesthesia Physiology Review Questions
Chapter One Introduction
1. Fill in the blanks
1. Physiology of anesthesia is the application of research physiology in clinical first aid , emergency resuscitation , intensive care monitoring and pain treatment .
2. The homeostasis of human body functions depends on neural regulation, humoral regulation and self-regulation.
3. The effects of anesthesia such as the stabilization of consciousness , the disappearance or reduction of pain , and muscle relaxation are mainly achieved by affecting the biological functions of the nervous system.
4. According to the formation process and different conditions, reflection can be divided into two forms: conditioned reflex and unconditioned reflex.
5. Various anesthesia methods affect human body functions mainly by affecting the activities of the nervous system and endocrine glands.
2. Multiple Choice Questions
1. The internal environment of the body refers to B
A body fluid; B extracellular fluid; C blood; D fluid in the small intestine; E intracellular fluid
2. An important regulatory process to maintain body homeostasis is A
A neural regulation; B humoral regulation; C self-regulation; D positive feedback regulation; E negative feedback regulation
3. Neuromodulation is characterized by A
A fast, short and precise; B long-lasting; C slow and diffuse; D broad and efficient; E limited
4. The dominant regulatory system in the body is D
A endocrine system; B immune system; C blood circulation system; D nervous system; E genitourinary system
5. The basic way of neuromodulation is A
A reflex; B reaction; C adaptation; D positive feedback; E negative feedback
6. The role of positive feedback regulation is D
A to maintain a stable internal environment; B to maintain a stable blood pressure; C to maintain a relatively stable body temperature;
D accelerates the completion of a certain physiological process; E keeps blood sugar concentration relatively constant
7. The following statement about reflection, the incorrect one is C
A reflex is the basic way of neuromodulation; the necessary structural basis of B reflex is the reflex arc;
C The reflex effect caused by the same stimulus should be exactly the same; D Reflex may be involved in humoral factors;
E reflexes are divided into conditioned reflexes and unconditioned reflexes
8. The correct statement about homeostasis includes A
A The absolute stability of the physicochemical properties of intracellular fluid; B It is the result of the regulation of nerves and body fluids;
C Negative feedback is an important way to maintain homeostasis; D Loss of homeostasis, life is threatened;
The Relative Stability of Physicochemical Properties of E Extracellular Fluid
9. The following are conditioned reflexes are B, C
A flexor reflex; B secretion of saliva caused by seeing fruit; C secretion of gastric juice caused by the smell of food;
D voiding reflex; E bowel phase of gastric juice secretion
10. The main impact of surgery on human physiological functions is manifested in ABCDE
A produces a stress response; B causes bleeding, pain and emotional tension; C initiates a physiological hemostatic response;
D Local inflammatory cell accumulation; E Increased reflex skeletal muscle contraction
3. Explanation of terms:
Internal environment: Refers to the extracellular fluid surrounding individual cells in the body
Steady state: various physical and chemical aspects of the internal environment remain relatively constant
Biological rhythm: Refers to the consistent and regular change pattern of body activities expressed in units of 24 hours.
4. Answer the following questions
1. Give an example and briefly describe the adverse reactions of anesthetic drugs.
Answer: If thiophenal sodium is used for rapid induction, it can inhibit respiratory consciousness, stop breathing, inhibit heart activity, and induce laryngospasm. Enflurane can inhibit breathing, dilate blood vessels, reduce peripheral resistance, produce hypotension, and even cause malignant hyperthermia; the stability of the nervous system and analgesic drug fentanyl can also inhibit breathing, resulting in bradycardia and bronchoconstriction. Vomiting and muscle stiffness; depolarizing muscle relaxant succinylcholine can cause hyperkalemia, increased intraocular pressure, arrhythmia, bradycardia and salivation, muscle aches and so on.
2. In connection with the contents of the following chapters, explain how the period of anesthesia (such as rough tracheal intubation, surgical trauma, excessive intraoperative bleeding, ambient temperature, body position, etc.) affects the homeostasis of the human body? What measures should be taken?
Chapter 2 Anesthesia and Nervous System
1. Fill in the blanks
1. Consciousness includes conscious content and waking state .
2. General anesthetics eliminate consciousness , sensation and voluntary movement by inhibiting the function of the cerebral cortex .
3. Local excitation is characterized by graded potentials , electrotonicity spread , and can be summed .
4. The memory process includes sensory memory , first-level memory , second-level memory , and third-level memory .
5. The core of consciousness content is thinking and language .
6. Awakening state includes conscious awakening and unconscious awakening .
7. Disturbance of consciousness dominated by wakefulness is divided into drowsiness , lethargy , and coma .
8. Muscle relaxants can be divided into competitive block muscle relaxants and non-competitive block muscle relaxants .
9. Disorders of consciousness dominated by content of consciousness include confusion and delirium .
10. The reflex centers in the brainstem include cardiovascular motor centers , respiratory centers , swallowing centers , and balance and other reflex centers.
12. Chronic pain (pathological pain) can manifest as a state of inhibition , depression , and apathy .
13. Peripheral inflammatory transmitters are recognized among the transmitters that transmit pain information in the dorsal horn of the spinal cord .
14. The inhibition of nociceptive transmission by afferent fibers to the dorsal horn of the spinal cord mainly occurs in the glial region (SG) of the dorsal horn of the spinal cord .
15. The site of action of muscle relaxants is the N2 receptor on the posterior membrane of the nerve-muscle junction .
16. The main analgesic substances involved in the descending modulation system of the high central nervous system are opioid peptides, 5-HT, and norepinephrine .
17. American curare can compete with acetylcholine to bind to the _N2Ach receptor on the endplate membrane , and thus can _block the excitatory transmission at the excitatory_nerve-muscle junction.
18. Consciousness, sensation and most reflexes are gradually lost under anesthesia, but this loss is temporary and reversible. 19. In the central nervous system under anesthesia, the cerebral cortex is inhibited first , and the medulla is the latest to be inhibited.
20. The main target area of action of general anesthetics is the ascending reticular activating system (ARAS) .
2. Multiple Choice Questions
1. The wrong description of the changes in consciousness under anesthesia is E
A Temporary; B Reversible; C Cerebral cortex is inhibited first;
D Inhibition of the ascending reticular activating system (ARAS) leads to loss of consciousness; E "Intraoperative awareness" is completely dependent on the depth of anesthesia
2. The afferent fibers of polymodal nociceptors belong to D
A Aβ class; BAδ class; CAα; DC class; EAγ
3. The neurotransmitter belonging to the arousal suppression system is B
A Glu; B5-HT; CAsp; DACh; ENE
4. The mechanism by which local anesthetics affect the bioelectrical activity of the nervous system is D
A "scintillation-like blocking effect"; B blocking K+ channels; C blocking Ca2+ channels; D blocking Na+ channels;
E indirectly affects receptors for certain transmitters
5. The core of human consciousness content activities is A
ALanguage and thinking; BLearning; CMemory; DOrientation and emotion; EThinking and learning
6. The most serious grade of disturbance of consciousness is D
A lethargy; B lethargy; C confusion; D coma; E delirium
7. Through which receptors do non-depolarizing muscle relaxants act? B
A N1; B N2; C M1; D M2; E α
8. The main feature that distinguishes humans from animals is E
A has a strong ability to adapt to the environment; B has unconditioned reflex and conditioned reflex; C has the second signal system; D has the first signal system; E has the ability of learning and memory
9. The wrong statement about partial excitement is A
A has an "all or nothing" feature; B can perform temporal summation; C can perform spatial summation;
D exhibits electrotonic spread; E amplitude varies with subthreshold stimulus intensity
10. The following organs are dually innervated by sympathetic and parasympathetic nerves is D
ASkin and muscle blood vessels; BMany sweat glands; CArrector pili muscle; DCiliary muscle; EAdrenal medulla
3. Explanation of terms:
Pain: It is a subjective sensory and emotional experience related to tissue damage or potential damage. It is a common symptom of most diseases and an unpleasant feeling that is common to human beings and varies widely.
Muscle tension: refers to the continuous contraction of muscles caused by the continuous pulling of skeletal muscles by gravity in the natural environment.
Consciousness: The body's awareness or experience of objective things such as the external world and its own psychological and physiological activities.
Subcortical arousal: Refers to cycles of wakefulness, sleep, and instinctive behaviors such as emotion, autonomic function, and endocrine function.
Gate control theory: segmental neural network is composed of primary afferent group fibers (A) thin fibers (C) dorsal horn projection neurons (T cells) and glial area inhibitory interneurons (SG cells), among which SG plays a key role Gate action.
Impairment of Consciousness: Refers to varying degrees of changes in consciousness caused by changes in the activity of brain functional areas.
4. Answer the following questions
1. What are the characteristics of consciousness?
Answer: 1. Consciousness is the functional activity of the nervous system 2. Consciousness has subjective initiative 3. Consciousness has variability 4. Consciousness presupposes sensation 5. Consciousness presupposes memory
2. Give an example to briefly describe the effect of anesthesia on the bioelectrical activity of the nervous system.
Answer: Anesthetics can affect the bioelectrical activity of the nervous system by blocking the activity of various ion channels at the surgical site. For example, local anesthetics block voltage-gated Na+ channels in nerve cells at the surgical site. The general anesthetic ketamine can produce a scintillation-like blocking effect, so that nerve cells in the peripheral or central nervous system cannot generate action potentials. Enflurane inhibits Ca2+-dependent K+ channels. Halothane and isoflurane can inhibit the L-type voltage-dependent Ca2+ channel, reduce the concentration of Ca2+ in the cell, thereby reducing the release of energy from the transmitter of the chemical synaptic hull, and reducing the post-synaptic potential, etc.
2. What is consciousness? Which two components are included?
Answer: Consciousness is the organism's perception of itself and its environment. Human consciousness includes two components: conscious content and awakening state. 3. Briefly describe how the awakened state is maintained.
Answer: The maintenance of the cortical arousal state is related to the specific ascending projection system and the non-specific ascending projection system; the maintenance of the subcortical arousal state includes the biological clock of the hypothalamus. Brainstem reticular ascending projection system and behavioral arousal of the hypothalamus.
4. What are the indications for assessing state of consciousness?
5. What is a delirium state? What is coma?
A: Delirium is an acute high-level brain dysfunction. The patient's awareness and response to the objective environment have decreased, manifested as impaired cognition, attention, orientation and memory, slow thinking and reasoning, language dysfunction, illusions, hallucinations, sleep-wake cycle disorders, often accompanied by Nervous fear and excitement, may appear impulsive and aggressive behavior.
Coma is the most serious disturbance of consciousness. The patient loses consciousness completely. Various strong stimuli cannot make him wake up. According to the degree of severity, it can be divided into: shallow coma, moderate coma, and deep coma.
6. Under anesthesia, what is the performance of consciousness and feeling?
Answer: Consciousness, sensation, and most reflexes are gradually reduced, but this loss is temporary and reversible. As the patient gradually wakes up, consciousness gradually recovers.
7. What are the reflexes related to the depth of anesthesia? Where are the locations?
8. Taking succinylcholine as an example, briefly describe the mechanism of action of depolarizing muscle relaxants.
Answer: After the drug binds to AChR, it produces a similar depolarization effect after Ach binds to AChR, causing Na+ influx, depolarizing the endplate membrane, and generating endplate potential. However, this type of drug cannot be hydrolyzed by cholinesterase, and it needs to diffuse into the plasma for hydrolysis or excretion to reduce the concentration of the muscle relaxant. Since the muscle relaxant molecule released from the Ach receptor can recombine with AChR, the endplate membrane continues to depolarize, so that the endplate membrane potential receptor no longer responds to the Ach released from the motor nerve terminal, blocking the nerve- Transmission of excitation to muscle joints, resulting in reduced or absent muscle tone.
9. Taking tube curare as an example, briefly describe the mechanism of action of non-depolarizing muscle relaxants.
Answer: After binding to the receptor, the ion channels of the endplate membrane cannot be opened, and the endplate potential cannot be entangled. However, a large number of N2AChRs are occupied by muscle relaxants, resulting in the reduction of AChR on the endplate membrane that can bind to Ach, and the endplate potential caused by Ach After the summation, the threshold potential of the surrounding sarcolemma cannot be reached, and the muscle cells cannot generate action potentials, thereby preventing the conduction of excitation and causing muscle relaxation.
10. What are the characteristics of brain evoked potentials?
Answer: 1. There are clear internal and external stimuli; 2. There is a relatively constant latency; 3. The evoked potentials caused by various stimuli have a certain spatial distribution in the brain; 4. The evoked potentials caused by a certain stimulus have a certain form, different Sensory systems and responses vary.
11. Describe the analgesic mechanism of local anesthetics.
Answer: Local anesthetics are a class of drugs that can block the occurrence and conduction of nerve impulses. They have a blocking effect on any nerve, whether it is peripheral or central, afferent or efferent, axon or cell body, terminal or synapse. . The possible mechanisms by which local anesthetics cause Na+ channel inactivation and block Na+ influx include: reducing the ratio of activated channels, that is, increasing the ratio of inactivated channels; partially or completely inhibiting the process of Na+ channel configuration changes, directly interfering with Na+ channel activation, Thereby inhibiting the transition of channels from resting (standby) to open (activated); reducing ion flux through each open channel. After the inactivation of Na+ channels and the blockage of Na+ influx, the action potential cannot be generated or the depolarization rate and amplitude of the membrane are limited. Slow, prolonged refractory period, thereby affecting the occurrence and conduction of nerve impulses.
12. Describe the analgesic mechanism of general anesthetics.
Answer: It may mainly affect the function of the pain modulation system in the central nervous system
General anesthetics can promote the release of central nervous system inhibitory transmitters, reduce the sensitivity to NS excitatory transmitters, and affect the function of pain modulation in the central NS.
The analgesic mechanism of general anesthesia is to promote the release of central nervous system inhibitory transmitters such as GABA and weaken the sensitivity of excitatory transmitters such as glutamate.
13. Why do muscle tremors occur under the action of general anesthetics? What method is used to relax the muscles?
Chapter 3 Anesthesia and Respiration
1. Fill in the blanks
1. In the chemical regulation of pulmonary ventilation, the increase of PCO2 mainly causes the increase of . Hypoxic stimulation acts through peripheral chemoreceptors to enhance lung ventilation.
2. Factors affecting lung ventilation during anesthesia include _body position_ , airway obstruction , anesthesia method and anesthesia device_ , hypotension .
3. Hypoxia can be divided into hypoxic hypoxia , blood hypoxia , _circulatory hypoxia_ , and tissue toxic hypoxia .
4. Factors affecting airway resistance include airflow form, airflow linear velocity, and airway caliber.
5. The transportation forms of carbon dioxide include physical dissolution, bicarbonate form, and carbamic acid hemoglobin form.
6. Commonly used anesthetics all inhibit pulmonary ventilation, and the dose of the same drug increases, and the degree of inhibition deepens .
2. Multiple Choice Questions
1. Vital capacity is equal to C
A supplementary inspiratory volume + supplementary expiratory volume; B functional residual volume - residual volume; C total lung volume - residual volume;
D supplement inspiratory volume + tidal volume; E supplement expiratory volume + tidal volume
2. The principle of artificial respiration is man-made B
A pressure difference between intrapulmonary pressure and intrathoracic pressure; B pressure difference between intrapulmonary pressure and atmospheric pressure; C breathing exercise;
D The pressure difference between intrathoracic pressure and atmospheric pressure; E The pressure difference between intrapulmonary pressure and intraabdominal pressure
3. The most important factor affecting airway resistance is E
A airway length; B airflow velocity; C airflow form; D respiratory movement; E airway caliber
4. Anesthesia drugs that cannot be used for asthmatic patients are C
A halothane; B atropine; C morphine; D ketamine; E sevoflurane
5. It is used for asthmatic patients, but the anesthetics that should not be used for pulmonary A hypertensive patients are
A lidocaine; B ketamine; C thiopental; D morphine; E halothane
6. Among the inhalational anesthetics, D
A halothane; B desflurane; C sevoflurane; D an(en)flurane; E isoflurane
7. The cause of the increase in alveolar-arterial oxygen partial pressure difference during anesthesia is correct E
ABronchiectasis; BIncreased cardiac output; CAortic regurgitation; DCongenital heart disease with left-to-right shunt; EPulmonary edema
8. An inhaled anesthetic that reduces tidal volume without increasing respiratory rate is D
A Enflurane; B Desflurane; C Sevoflurane; D Isoflurane; E Nitrous oxide
3. Explanation of terms:
Closing volume: The volume of gas in the lungs when the airway begins to close is called the closing volume
Closed volume: It is the lung volume above the residual volume when the airway at the bottom of the lung is closed, that is, the expiratory volume from the upper part of the lung.
Hypoxic pulmonary vasoconstriction (HPV):
Carbon dioxide excretion syndrome: It refers to symptoms such as blood pressure drop, slow heart rate, arrhythmia, and even cardiac arrest when the carbon dioxide in the blood is rapidly discharged under the condition of high and continuous partial pressure of carbon dioxide.
4. Answer the following questions
1. How does acute hypercapnia during anesthesia affect physiological function?
Answer: 1. Lower the PH value; 2. Excited breathing, which often cannot be displayed during anesthesia; 3. Dilate cerebral blood vessels, increase blood flow, and increase intracranial pressure; 4. Increase epinephrine and norepinephrine, ACTH, prolong and strengthen Parasympathetic response; 5. Increased cardiac output, dilated blood vessels, and arrhythmia during general anesthesia.
2. How does hypocapnia during anesthesia affect physiological function?
Answer: Respiratory alkalosis 1. Cerebral vasoconstriction; 2. Left shift of oxygen dissociation curve; 3. Inhibition of respiration; 4. Hypokalemia
3. Briefly describe the factors that affect lung ventilation during anesthesia?
Answer: 1. The influence of anesthetics on pulmonary ventilation: commonly used inhalational anesthetics and intravenous anesthetics inhibit pulmonary ventilation, and the degree of inhibition varies with the type of drug and the dose, and the degree of inhibition increases with the increase of the dose; 2. Other factors : a. Body position: reduce functional residual volume; b. Airway obstruction: decrease in intrapulmonary pressure, resulting in increased closed volume and hypoventilation; c. Anesthesia method and device: high epidural tissue level can reduce vital capacity, general anesthesia Decreased tidal volume increases mechanical dead space. Inhalation anesthesia device failure, increased airway resistance; d. Hypotensive alveolar dead space increased.
4. What are the characteristics of pulmonary circulation?
Answer: 1. The tube wall is thin and expandable; 2. The path is short and the resistance is small; 3. The blood pressure is low; 4. The pulmonary blood volume changes periodically; 5. The blood flow in the lung is unevenly distributed due to the influence of gravity.
5. How do PCO2, PO2, and H+ affect lung ventilation?
Answer: When PaCo2 is increased, the respiration is strengthened and the ventilation volume is increased; when it is decreased, the respiratory movement is weakened or suspended.
A decrease in PaO2 can stimulate breathing and increase lung ventilation. Deep and large breathing in patients with metabolic acidosis is the result of elevated H+.
1. PCO2: Maintaining a certain concentration of CO2 in an arterial hematoma is a physiological and chemical factor necessary to maintain the excitability of the respiratory center. When the concentration of CO2 in the inhaled air increases appropriately (within the range of 1-7%), the breathing movement can be deepened and accelerated, but More than a little limit will have inhibitory and narcotic effects. 2. PO2: When the partial pressure of oxygen decreases, it can stimulate breathing and increase pulmonary ventilation. Hypoxia mainly works through peripheral chemoreceptors, and hypoxia inhibits the respiratory center; 3. H+: It can enhance breathing and is the function of peripheral chemoreceptors. effective stimulant.
6. Briefly describe the causes of hypoxia during anesthesia.
Answer: 1. Alveolar oxygen partial pressure decreases; 2. Alveolar-arterial oxygen partial pressure difference increases; 3. The function of blood carrying oxygen decreases, and the amount of flowing oxygen decreases. It is most common in anesthesia caused by severe anemia and acidosis Decreased blood oxygen saturation; 4. Oxygen release disorder in tissue cells
7. Why can't hypercapnic patients suddenly hyperventilate? Otherwise, what symptoms will appear?
Answer: high carbon dioxide can not be hyperventilated suddenly, otherwise it will appear: due to the accumulation of carbon dioxide and high partial pressure of carbon dioxide for a period of time, the excitation threshold of the respiratory or circulatory center to CO2 has gradually increased. Once it is quickly discharged, the respiratory and circulatory centers will lose The stimulation of CO2 partial pressure can show CO2 syndrome, manifested as a sudden drop in blood pressure, weakened pulse, respiratory depression or delayed respiratory recovery, and disturbance of consciousness.
Chapter 4 Anesthesia and Circulation
1. Fill in the blanks
1. Vasodilators can be used in patients with cardiac dysfunction, because the increase in afterload further reduces cardiac output .
2. The mechanism of increased heart rate and increased myocardial contractility during exercise is mainly due to the excitation of the cardiac sympathetic center and the inhibition of the cardiac vagal center .
3. The basic way to protect ischemic myocardium is to increase energy supply and reduce myocardial energy consumption.
4. Patients with intracranial hypertension are often characterized by elevated arterial blood pressure and decreased heart rate.
5. When electric shock cardioversion is used to treat arrhythmia, the stimulation should not fall into the "vulnerable period" of the ventricle, so as not to cause ventricular fibrillation.
6. Catecholamines can induce early afterdepolarization and delayed afterdepolarization to cause spontaneous arrhythmias.
7. Circulatory failure includes: heart failure and peripheral circulatory failure .
8. Decreased cardiac output during neuraxial anesthesia .
2. Multiple Choice Questions
1. The Starling mechanism means that the stroke volume of the heart depends on D
A mean arterial pressure; B heart rate reserve; C cardiac reserve; D ventricular end-diastolic volume;
EVendricle end-systolic volume
2. The physiological significance of atrioventricular delay is D
A prevents the ventricular muscle from fully tetanic contraction; B increases the contractility of the ventricular muscle; C prolongs the effective refractory period of the ventricular muscle;
D makes the atrium and ventricle not contract at the same time; E makes the amplitude of myocardial action potential increase
3. The degree of inhibition of anesthesia on cardiac output is A from mild to severe
A nitrous oxide > ether > isoflurane > halothane; B ether > nitrous oxide > isoflurane > halothane;
C isoflurane> halothane> nitrous oxide> ether; D nitrous oxide> ether> halothane> isoflurane;
E ether > isoflurane > halothane > nitrous oxide
4. Which of the following channels can be inhibited by quinidine to reduce myocardial excitability E
A Ca2+; B K+; C Cl-; D Mg2 + ; ENa+
5. The statement about the anatomical and physiological characteristics of the coronary circulation is wrong: D
A There are abundant capillaries, the ratio of which to the number of myocardial fibers is 1:1; B There are anastomotic branches between coronary vessels;
C blood flow is rich, 60～80ML/(100g min) D; myocardial blood flow is evenly distributed; E there are cavities in the ventricular cavity
6. Which of the following is not a cause of cardiac arrhythmia during anesthesia? E.
A Autonomic nerve imbalance; B Electrolyte disorder; C Anesthesia medication; D Surgical stimulation of the heart; E Blood transfusion
7. The reflex that can cause bradycardia or even arrest during eye surgery is B
A blink reflex; B eye heart reflex; C eyelid reflex; D pupil light reflex;
E Baroreceptor reflexes of the aortic arch and carotid sinus
8. The effective refractory period of ventricular myocardium depends on D
A the depolarization speed of the 0th phase of the action potential; B the level of the threshold potential level; C the length of the 2nd phase of the action potential;
D The length of the terminal repolarization phase of the action potential; E The function of the sodium-potassium pump
9. What happens to the circulatory system when the body position changes from supine to upright after anesthesia? E.
A blood pressure decreased; B blood pressure increased; C blood pressure remained unchanged; D heart rate slowed down; E none of the above is correct
10. The adjustment method to keep the cerebral blood flow relatively constant is C
A neural regulation; B humoral regulation; C self-regulation; D feed-forward regulation; E nerve-humoral regulation
3. Explanation of terms:
Vulnerable period: At the beginning of the relative refractory period, there is a short period during which strong stimulation can cause myocardial fibrillation. This period is called the vulnerable period.
Excitement reentry: The excitement from a certain place is transmitted along one path, and then returns to the original place through another path, so that the place is excited again, which is called reentry.
Carotid sinus syndrome: Under certain pathological conditions, such as hypersensitivity of baroreceptors, slight stimulation can reflexively cause arterial blood pressure to drop, heartbeat to slow down or even pause.
Bainbridge reflex: When anesthetized animals are rapidly infused with fluid or blood, the originally slow heart rate can be increased reflexively.
Oculocardiac reflex: Compression of the eye reflex causes slowing of the heart rate or even cardiac arrest.
4. Answer the following questions
1. Briefly describe the effect of myocardial automaticity change on arrhythmia.
Answer: The influence of changes in myocardial self-discipline on arrhythmia: 1. Changes in normal self-discipline: changes in sinus node self-discipline can cause sinus tachycardia/bradycardia and sinus arrhythmia; 2. Abnormal self-discipline: ectopic The self-discipline of the pacemaker is increased; 3. Triggered activity: caused by after depolarization, which refers to the membrane potential oscillation that occurs during the repolarization of the action potential or after the repolarization is completed, and is a subthreshold depolarization. If the depolarization reaches the threshold potential, a single or a series of action potentials can be generated. machine-triggered activity.
2. Where is the site of slow excitation conduction in cardiomyocytes? What are the advantages and disadvantages?
Answer: Located at the atrioventricular junction, benefit: the atrium excites and contracts before the ventricle, which is beneficial to the blood filling of the ventricle. Disadvantage: prone to conduction block.
3. What are the before and after loads of the myocardium?
Answer: Preload refers to the load carried by the myocardium during contraction, which determines the length of the myocardium before contraction.
Afterload refers to the load or resistance encountered by the heart muscle when it begins to contract. Afterload does not affect the initial length of the myocardium.
4. Why is controlled blood pressure lowered during anesthesia?
Answer: Why is controlled blood pressure reduction during anesthesia: 1. For operations on tissues and organs with rich blood supply, controlled blood pressure reduction can reduce the bleeding in the surgical field, make the surgical field clear, and facilitate surgical operations; 2. Vascular surgery, through Controlled blood pressure reduction, reducing vascular tension, and reducing vascular rupture caused by surgical operations;
5. When blood pressure drops, what neurohumoral regulation does the human body use to restore blood pressure to normal levels?
Answer: A. Nerve regulation: 1. Baroreceptor reflex: the drop in blood pressure causes the efferent impulse of the cardiac vagus nerve to decrease, the efferent impulse of the cardiac sympathetic nerve and sympathetic vasoconstrictor nerve to increase, the heart rate to increase, the myocardial contraction to increase, and the cardiac output to increase. Vasoconstriction, peripheral resistance increases, and arterial blood pressure rises; 2. Chemoreceptor reflex: it can only work when arterial blood pressure drops to 80mmHg. Blood pressure drops, stimulates the carotid body, chemoreceptors in the aorta body, and reflects to increase arterial blood pressure; 3. Cerebral ischemia response: it only works when arterial blood pressure is lower than 50mmHgsh, and excites the sympathetic vasoconstrictor center to increase blood pressure; B. Humor regulation : 1. Epinephrine and norepinephrine: excite the heart and constrict blood vessels; 2. Renin-angiotensin system: renin catalyzes the transformation of angiotensin into angI, which is further transformed into angII, angIII. angII has a strong vasoconstrictor effect, and can also stimulate the release and synthesis of antidiuretic hormone; angIII can stimulate the secretion of aldosterone; 3. Vasopressin: shrink small blood vessels; 4. Thyroid hormone: directly acts on the myocardium, which can increase the heart rate , increased myocardial contractility and increased cardiac output; 5. Vasoactive substances and vasoconstrictor substances generated by vascular endothelium: EDCF, ET
6. Is it dangerous to raise the patient's head or legs suddenly after deep anesthesia? Why?
Answer: It is dangerous: after deep anesthesia, the cardiovascular compensatory function is obviously inhibited, and the effect of gravity becomes the main factor to regulate the direction of blood flow. If the patient's head is raised suddenly, the venous return decreases, and severe hypotension occurs immediately; if the patient's legs are raised, the amount of blood returning to the heart increases significantly. For patients with low cardiopulmonary function, the heart load may be exceeded and acute pulmonary edema may be induced.
7. What happens to blood pressure and heart rate when intracranial pressure rises? Why?
Answer: Blood pressure rises and heart rate slows down. Elevated intracranial pressure increases cerebral vascular pressure, especially intracranial venous pressure, which reduces the pressure difference between mean arterial pressure and calm arterial pressure, that is, reduces effective perfusion pressure, which will cause a decrease in cerebral blood flow , in order to maintain the required cerebral blood flow, the body, through the reflex action of the autonomic nervous system, constricts the blood vessels around the body, increases blood pressure, and increases cardiac output to increase cerebral perfusion pressure, accompanied by slowed breathing rhythm and increased breathing depth . Causes high arterial pressure, accompanied by slowed heart rate, increased cardiac output, and slowed respiratory rhythm.
8. What are the measures to protect the myocardium? Which of these items are the most important?
Answer: The basic way to protect the myocardium is to increase energy supply and reduce myocardial energy consumption, the latter being more important. 1. Increase energy supply: use glucose, insulin, and potassium chloride before operation to increase myocardial tolerance; add glucose to cardioplegia to increase anaerobic metabolism of ischemic myocardium; 2. Reduce myocardial consumption: hypothermia: prolong myocardial Tolerance time to ischemia; Cardiac arrest: Myocardial oxygen consumption can be significantly reduced at room temperature; Drugs: Add procaine and glucocorticoids to the cardioplegia to protect the structure of the myocardium; 3. Maintain the cardioplegia Appropriate pH, ion composition, ion concentration and osmotic pressure.
Chapter 5 Anesthesia and the Liver
1. Fill in the blanks
1. In patients with hepatic insufficiency, the function of synthetic protein is decreased , and the content of plasma protein has no significant change .
2. The sympathetic nerve is excited, the hepatic artery vasoconstricts , and the hepatic blood flow decreases temporarily , and returns to normal after a few minutes.
2. Multiple Choice Questions
1. The factor that can dilate the hepatic artery is E
A sympathetic nerve stimulation; B 5-hydroxytryptamine; C angiotensin; D norepinephrine; E prostaglandin
2. When the sympathetic nerve is excited, the regulation of hepatic blood flow is incorrect
A Temporary decrease in hepatic blood flow; B Increase in portal venous pressure; C Decreased blood flow in portal venous pressure; D Hepatic artery constriction;
E Portal pressure contraction
3. The specificity of evaluating liver function damage is high, and the most sensitive liver function test is C
A Determination of blood ammonia; BAST determination; CALT determination; D Cholinesterase determination; E Alkaline phosphatase determination
4. Oddi sphincter spasm and increased biliary pressure, opioid narcotic analgesics with the strongest effect is
A Morphine; B Fentanyl; C Pethidine; D Butorphanol; E Nalbuphine
3. Explanation of terms:
Enzyme inhibition (enzyme inhibition): Many substances or liver cell lesions themselves can inhibit the activity of drug-metabolizing enzymes, delay drug metabolism, prolong drug efficacy, easily cause drug accumulation in the body, and even cause relatively excessive poisoning.
4. Answer the following questions
1. What are the main physiological functions of the liver? Which of these functions are relevant to clinical anesthesia?
Answer: The main physiological functions are: 1. Blood storage and blood purification; 2. Secretion of bile to participate in digestion; 3. Metabolism of nutrients 4. Synthesis and endocrine of important proteins 5. Participation in coagulation and fibrinolysis 6. Host defense function 7. Biotransformation Function. 8 Bilirubin Metabolism
Related: bilirubin metabolism, protein metabolism, coagulation and fibrinolysis, biotransformation.
2. Why do patients with liver disease appear highly sensitive to drugs?
Answer: In patients with liver disease, the synthesis of protein decreases, the part of the drug that binds to albumin decreases, and the pharmacologically active part increases accordingly, so...
3. What changes in drug sensitivity occur in patients with hyperglobulinemia?
A: Reduced drug sensitivity
4. Why are patients with liver disease prone to bleeding during surgery?
Answer: Liver cell damage, coagulation factor, pt is significantly prolonged.
5. What are the important causes of postoperative liver failure?
Answer: infection
Chapter 6 Anesthesia and Kidneys
1. Fill in the blanks
1. Renal blood flow is characterized by rich blood flow, relatively less oxygen intake, and uneven distribution of blood flow . The perfusion pressure can be kept stable in the range of 80-180.
2. The phenol red excretion test can be used as an indicator to reflect the secretory function of the renal proximal tubule .
3. The common causes of perioperative oliguria are prerenal, renal and postrenal.
2. Multiple Choice Questions
1. The most commonly used clinical substance for measuring glomerular filtration rate is B
A iodine; B endogenous creatinine; C urea; D inulin; E glucose
2. The cause of postrenal oliguria in the perioperative period is D
A Anxiety; B Tension; C Blood loss; D Bilateral ureteral obstruction; E Electrolyte disturbance
3. The main difference between primary urine and plasma is C
A glucose concentration; BNaCl concentration; C protein content; D crystal osmotic pressure; EpH value
3. Explanation of terms:
Clearance rate: the quotient of the total amount of the substance excreted from urine per unit time (Ux×V, Ux is the concentration of x substance in urine, v is the volume of urine) and the concentration of the substance in plasma at that time (Px), Expressed in CL.
Osmotic diuresis: Osmotic diuresis refers to the diuresis that occurs due to the reduction of water reabsorption due to the increase of solute concentration in the tubule fluid in the renal tubules and collecting ducts.
4. Answer the following questions
1. Where can the block plane of spinal anesthesia reduce renal blood flow? T4
2. Briefly describe the relationship between renal ischemia time and changes in renal function.
Answer: Kidney ischemia time < 2h, functional change > 3h, organic change > 4h, often lead to acute renal failure, uremia
3. What conditions can affect kidney function during anesthesia and surgery?
Answer: The large operation area, long operation time, massive blood loss or fluid loss during the operation, and excessive stretching of internal organs can cause hypotension, etc., which can lead to a sharp decrease in blood flow. If it is not corrected in time, it will lead to renal tubular damage or even acute renal failure.
Chapter 7 Anesthesia and Endocrinology
1. Fill in the blanks
2. When the level of thyroid hormone increases significantly, the food intake and appetite decrease, the body's metabolic rate increases, and the body loses weight.
2. Multiple Choice Questions
1. The main factor affecting the secretion of calcitonin is B
A blood magnesium concentration; B blood calcium concentration; C blood phosphorus concentration; D blood sodium concentration; E blood potassium concentration
2. The anesthetic that increases cortisol concentration is D
A Morphine; B Barbiturates; C Fentanyl; D Ether; E Enflurane
3. The factor that reduces cortisol concentration is E
A Surgical trauma; B Hypotension; C Hypoxia during operation; D Carbon dioxide accumulation; E Hypothermia
3. Explanation of terms:
Stress response: When the body blocks harmful stimuli, such as trauma, blood loss, surgery, hunger, pain, hypoxia, cold, excessive mental stimulation, etc., the body will undergo a series of adaptive and tolerance reactions, called Stress or stress response.
4. Answer the following questions
1. Briefly describe the effects of anesthesia and surgery on endocrine function.
2. Describe the effects of anesthesia and surgery on thyroid function.
Answer: In the case of low temperature, the thyroid function is hyperactive at the beginning of cooling, but it is suppressed as the temperature drops. Neuraxial anesthesia has little effect on thyroid function,
Chapter 8 Anesthesia and body temperature
1. Fill in the blanks
1. Generally, the room temperature of the operating room is 22-25 ℃ , and the humidity is 50%-60% .
2. Hypothermia means that the core temperature of the human body is lower than 35 ℃.
2. Multiple Choice Questions
1. What does not belong to automatic thermoregulation is D
A increase or decrease of skin blood flow; B shivering; C sweating; D curling up in severe cold; E thyroid hormone secretion increased
2. When the body is at rest, the main organ producing heat is B
A kidney; B liver; C muscle; D brain; E stomach
3. The wrong statement about the impact of low temperature on the circulatory system is D
A conduction slows down; B coronary blood flow decreases C myocardial oxygen consumption decreases; DP-R interval shortens; EQRS wave group widens
4. The effect of low temperature on the respiratory system is wrong E
A. As the body temperature drops, the breathing gradually becomes deeper and slower; B. When the temperature is below 25°C, the breathing becomes weak or even stops;
C can increase the anatomical dead space; D can shift the oxygen dissociation curve to the left; E is beneficial to tissue oxygen supply
5. Which of the following operations can cause body temperature to rise is D
A large area of deep body exposure; B flushing with a large amount of low-temperature liquid; C local low-temperature protection measures;
D Use bone cement; E Disinfect with cold disinfectant such as ethanol
3. Explanation of terms:
Malignant hyperthermia: It is a hypermetabolic reaction of skeletal muscle related to drugs and genetics. Tonic contraction of the skeletal muscles of the whole body, accompanied by a sharp rise in body temperature and progressive circulatory failure, and other hypermetabolic crises
4. Answer the following questions
1. What are the factors affecting body temperature during the perioperative period?
Answer: (1) Effect of anesthesia drugs on body temperature, including anesthesia drugs and anesthesia method (2) Operating room temperature and relative humidity (3) Surgical operation (4) Other factors
3. Briefly describe the effects of high fever on the body.
Answer: It causes a series of metabolic disorders (1) Usually, for every 1°C increase in body temperature, the substance metabolism can increase by 13%. Due to the increase in oxygen consumption and insufficient oxygen supply, metabolic acidosis, hyperkalemia, etc. (2) Body temperature The heart rate increases by an average of 10 beats/min for every 1°C increase, and excessive sweating can lead to decreased blood volume and increased oxygen consumption, which will inevitably increase the burden on the heart and lungs, and is prone to arrhythmia and myocardial ischemia (3) If the patient has spontaneous breathing , Respiratory alkalosis may occur due to increased heat dissipation due to hyperventilation. (4) High fever is prone to irritability, and children are especially prone to convulsions.