ANES. COMPLICATIONS Flashcards
WHAT ARE THE 5 SYMPTOMS OF MALIGNANT HYPERTHERMIA THAT CLASSIFY IT AS A SYNDROME?
FEVER, TACHYCARDIA, HYPERCARBIA, RIGIDITY, AND TACHYPNEA.
WHEN DO MOST ANESTHETIC MISHAPS OCCUR?
MAINTENANCE
WHAT IS THE PATHOPHYSIOLOGY OF MALIGNANT HYPERTHERMIA?
A SARCOLEMMA PERMEABILITY DEFECT AND FAILURE OF REUPTAKE OF CALCIUM BY SARCOPLASMIC RETICULUM. THIS RESULTS IN TOO MUCH CALCIUM CAUSING ENHANCED GLYCOLYSIS, UNCOUPLING OF OXIDATIVE PHOSPHORYLATION, AND SUSTAINED ACTIVATION OF ACTIN MYOSIN FILAMENTS. THE BODY IS IN A HYPERMETABOLIC STATE.
WHAT TYPES OF PTS ARE MORE LIKELY TO HAVE MH?
MUSCULOSKELETAL DISORDERS? HIGH RISK OPERATION….ORTHOPEDICS, OPTHALAMIC, HEAD AND NECK.
WHAT IS THE EARLIEST AND MOST CONSISTENT CLINICAL SIGN OF MH
TACHYCARDIA
THE MOST SENSITIVE SIGN OF MH?
ET CO2 USUALLY > 55
WHAT ARE THE LATE SIGNS OF MH?
DIC, PULMONARY EDEMA, ARF, CNS SIGNS ARE BLINDNESS, SEIZURES, COMA, OR PARALYSIS.
WHAT ARE THE LAB FINDINGS OF MH?
ACIDOSIS, HYPOXIA, HYPERKALEMIA, HYPERCALCEMIA, HIGH MAGNESIUM, LOW SODIUM, INCREASED LACTATE, PYRUVATE, CREATINE PHOSPHOKINASE, LACTATE DEHYDROGENASE, ALDOLASE AND INCREASED MYOGLOBIN.
COULD YOU HAVE HAD A PRIOR SUCCESSFUL ANESTHETIC AND STILL HAVE MH?
YES
HOW TO TREAT MH?
STOP INHALED AGENTS, ABORT SURGERY, 100% O2, START ACTIVE COOLING, SODIUM BICARB, HYDRATION, AND DANTROLENE 2.5MG/KG IV REPEAT Q5-10MIN. MAX 10MG/KG.
WHAT ARE THE SYMPTOMS OF LARGE DOSES OF DANTROLENE?
WEAKNESS, NAUSEA, BLURRED VISION.
WHAT DO YOU DO IF DANTROLENE RECRUDENSCENCE OCCURS? (AS IT DOES IN 25% OF PTS)
CONTINUE DATROLENE AT 1-2MG/KG Q6 HRS FOR 24 HRS.
WHAT IS THE DEFINATIVE DIAGNOSIS OF MH?
HALOTHANE CONTRACTURE TEST.
WHAT ARE MH TRIGGERS?
VA AND SUX
IF YOU HAVE A PT WITH HX OF MH HOW DO YOU PROCEED?
DONT USE VA OR SUX. NOT NECESSARY TO USE DANTROLENE PROPHYLAXIS. NEW TUBING, CO2 ABSORBER ON MACHINE AND FLUSH FOR 10-60 MIN PRIOR TO USE. NO VAPORIZERS…OR TAPE SHUT.
WHAT IS THE MOST COMMON PERMANENT AIRWAY INJURY?
DENTAL TRAUMA
TMJ INJURY IS MOST COMMON IN WHAT DEMOGRAPHIC?
FEMALES
WHAT IS THE MOST HIGHLY COMPENSATED, LIFE THREATENING INJURY IN ANESTHESIA?
PHARYNGOESOPHAGEAL
COMMON SIGNS OF NEGATIVE PRESSURE PULMONARY EDEMA?
TACHYPNEA COUGH AND FAILURE TO MAINTAIN OXYGENATION IN A YOUNG HEALTHY MALE POST EXTUBATION. (ESP IF THEYVE HAD LARYGNOSPASM)
3 THINGS CAUSE ACUTE PULMONARY EDEMA BY INCREASING TRANSCAPILLARY PRESSURE GRADIENT…WHAT ARE THEY?
DECREASED INTERSTITIAL HYDROSTATIC PRESSURE, INCREASED VENOUS RETURN, INCREASED LEFT VENTRICULAR AFTERLOAD.
WHAT IS THE TREATMENT OF NEG PRESSURE PULM EDEMA?
USUALLY HAVE TO REINTUBATE. RESOLVES WITHIN 12-24 HOURS. SELF LIMITING.
WHAT DEMOGRAPHIC HAS A LOT OF POST EXTUBATION STRIDOR?
PEDIATRIC.
HOW DO YOU TREAT POST EXTUBATION STRIDOR?
DECADRON .25/.5 MG/KG MAY PREVENT.
TO TREAT IT….INHALED RACEMIC EPINEPHRINE .25-.5ML OF 2.25% SOLUTION IN 2.5ML OF SALINE
