Co-existing diseases Flashcards
Considerations with achondroplasia
atlantoaxial instability
Foramen magnum stenosis
OSA
inc lordosis/kyphoscoliosis - difficult neuraxial
Restrictive lung disease
Beckwith-Wiedemann Syndrome
Omphalocele organomegaly macrosomia large fontanelles macroglossia polycythemia hypoglycemia
Williams Syndrome
Elfin-like
Supravalvular aortic stenosis - if unknown can lead to death on induction of anesthesia
HyperCa
Hyperkalemic Periodic Paralysis Triggers
Acidosis Rest after exercise Stress Sux Temp extremes Hypoglycemia
Mutation in Na channel
How do they following change in elderly people:
- Beta receptor response
- Catecholamine levels and response
- Sensitivity to drugs
- Lung volumes
- Cardiac output
- Neuraxis
- Dec Beta receptor response –> less inc in chronotropy, ionotropy = less ability to inc CO
- Dec baroreceptor activity, dec ACH release with vagal stim + INC NE levels
- Dec lean mass + more fat (prolongs duration) + dec TBW (small Vd) = more sensitive. Dec clearance of remi.
- TLC same
- CC inc = small airway collapse
- CC inc faster than FRC = inc A-a
- VC dec
- RV dec
- Chest wall compliance dec
- Lung compliance inc - Fibrosis –> diastolic dysfunction, SA node dysfunction = MORE reliant on atrial kick
- Dura more permeable = more sensitive
- Dec myelinated fibers
- Smaller epidural space - age = #1 factor for local spread
Pre-op testing needed for myotonic dystrophy
EKG, ECHO
Cardiology consult with any conduction block - can progress rapidly and need transcutaneous pacing, not responsive to atropine
Avoid Sux, Neo, hypothermia…NMBDs not able to relive contracture
Tx = phenytoin or quinine
1 inherited bleeding disorder
vWD
Carrier for factor VIII
Tx = DDAVP, Factor VIII or vWF concentrate, Cryo
Causes of acquired vWD
Severe AS Non-pulsatile VAD ASD/VSD Hypothryoidism SLE Malignancies
Valproic acid
Cipro
Tetracyclines
Griseofulvin
Signs of Multiple Myeloma
Anemia HyperCa Bone Fractures Acute/chronic renal failure Frequent pneumonia, pyelonephritis Neuropathies
Pyloric stenosis labs and optimization
hypoK, hypoCl metabolic alkalosis
Inc serum bicarb
Elevated urine SG
Dec urine Cl
Tx = NaCl bolus and D5 1/2NS infusion to rususictate before surgery
Inc CSF pH = apnea risk
Abnormalities in DiGeorge Syndrome
CATCH-22 Cardiac (interrupted arch, truncus, TOF) Abnormal facies Thymic aplasia Cleft palate Hypocalcemia
Induction and management of TEF
Inhalation
Spontaneous ventilation, avoid PPV
ETT cuff deep, past fistula
Associations with Pierre-Robin
Stickler syndrome
Velocardiofacial
Treacher-Collins
Things associated with POCD
Age >60
Lower educational level
Previous TIA/CVA
POCD at time of dishcarge
Prolonged in hemophilia B
aPTT
Deficiency in hereditary angioedema
C1 esterase inhibitor deficiency
- will have low C4 levels
- accumulation of bradykinin
Spirometry with GBS
Restrictive pattern
-Dec TLC
Paramytonia congenita
ion channel disease
avoid hypo or hyperthermia
avoid SUX
avoid ND-NMBDs if possible but are safe to use
Hunter and Hurler syndromes
Accumulation of dermatans and glycoaminoglycans
- Large tongue, airway soft tissue = difficult airway
- obstructive lung disease
- valve abnormalities and diffuse coronary narrowing
Spirometry with ALS
Restrictive pattern
-Dec TLC
= SAME as GBS
Associations with choanal atresia
CHARGE
- Coloboma of the eye
- Heart defects
- Atresia of choana
- Retardation in growth or development
- GU abnormalities
- Ear abnormalities and deafness
Associations with ankylosing spondylitis
Difficult intubation A-A subluxation TMJ Inc risk epidural hematoma, difficult placement, narrower and potential excessive spread Aortic insufficiency
Test to diagnose acromegaly
IGF1
- remember inc lung volumes
Causes of sickling
Six H’s cause SICKling
- hypothermia
- hyperthermia
- hypotension
- hypoxemia
- hypovolemia
- H+ ions (acidosis)
Abnormalities with Goldenhar Syndrome
Craniofacial microsomia
Epibulbar dermoid
Rib or vertebral abnormalities
Facial asymmetry —> OSA, difficult mask, difficult intubation
Fanconi Syndrome
Proximal tubule defect in kidney
Growth restriction, rickets
Non-anion gap metabolic acidosis, polyuria, dehydration, hypoK
1 complication during anesthesia in Down syndrome
Bradycardia
Things to avoid in AIP
Benzos Barbiturates Nifedipine etOH Glucocorticoids Hypothermia
Precipitants of hemolysis in G6PD deficiency
Methylene blue Sulfa ASA Quinidine Fava Acidosis Nitrofurantoin Isoniazid
Signs and Symptoms with autonomic dysreflexia
Vasoconstriction BELOW lesion
Vasodilation above lesion, HA, ICH, Stroke, Seizures,
Tx = vasodilators
