coexisting disease Flashcards
what are the s/s for thyroid storm?
high fever, tachycardia, agitation, severe dehydration
in a patient with hyperthyroidism, propranolol may exacerbate ___ following SAB
hypotension
patient with hyperthyroidism has an ____ response to prossors.
exaggerated
pheochromocytoma secretes excessive catecholamines including ____ and ____
norepinephrine and epi
pheochromocytoma: neuroendocrine tumor of the adrenal glands or ____ tissue that failed to involute
extra-adrenal chromaffin
a patient with a pheochromocytoma - anesthetic plan?
- elective C-section
- preop therapy with a-blockers followed by b-blockers
B-blockade without prior A-blockade results in
unopposed a-stimulation, severe HTN
T/F: Pregnancy has no consistent effect on the course of bronchial asthma
TRUE
T/F: Bronchial asthma may be exacerbated during pregnancy d/t bronchoconstriction
FALSE: Bronchial asthma may improve during pregnancy d/t bronchodilation
anesthetic plan for pt with bronchial asthma?
continuous labor epidural
Why is an epidural preferable to spinal in bronchial asthmatic patient?
gradual onset- tolerate intercostal muscle weakness. reports of bronchoconstriction following SAB
avoid H2 blockers (cimetidine, ranitidine) because it increases sensitivity to ___ that causes ____
histamine, spasm
avoid GETA in asthmatic pt because ETT can trigger ____
bronchospasm
which drug on induction will cause bronchial relaxation
ketamine
which IH should you avoid in asthmatic?
desflurane
T/F paraplegia causes an increased incidence of preterm labor
TRUE
Paraplegia - consider autonomic hyperreflexia if lesion is above what spinal level?
T7
Autonomic hyperreflexia - triggers
stimulation of skin, distention of hollow viscus (bladder, uterus)
Autonomic hyperreflexia s/s
pilomotor erection, sweating, flushing, headache, severe HTN, bradycardia
paraplegic patient - avoid ___ d/t risk of hyperkalemia
succinylcholine
anesthetic plan for paraplegia: early ____ to prevent ____
early epidural analgesia to prevent hyperreflexia
which pattern of MS is characterized by attacks that appear abruptly and resolve over several months?
exacerbating remitting
what are the 2 general patterns of MS
exacerbating remitting and chronic progressive
how does MS manifest?
neurological defects that present as pyramidal, cerebellar, or brainstem symptoms
T/F the etiology for MS is unclear
TRUE. but possible link to previous exposure to vial agent that may trigger autoimmune response. [loss of myelin in CNS]
motor weakness, impaired vision, ataxia, bladder/bowel dysfunction, and labile emotions are characteristic of what disease?
MS
How is MS treated?
symptomatically and by immunosuppression. often tx is marked by relapses and regression
T/F Pregnancy has no effect on progression Multiple Sclerosis
TRUE.
T/F Pregnancy decreases the risk of relapse of MS
FALSE - slight increase
T/F MS relapses are most often seen in the postpartum period
TRUE. approx 3x higher rate than non-pregnant
T/F Pregnancy does not have an overall negative effect on long-term outcome of MS
TRUE
MS - anesthetic plan should have a careful assessment of which two areas
neurological and respiratory
What is the concern with MS and neuraxial anesthesia?
- potential neurotoxic exposure of demyelinated spinal cord.
- concerns over relapse of symptoms
For an MS patient, do not exceed concentrations of >____% bupivacaine infusions.
0.25
T/F SAB is recommended over epidural for MS pt
FALSE - Epidural better tolerated than SAB for MS patient, however SAB has been successfully employed. CSE technique well tolerated with IT opioids
T/F GA Is contraindicated with MS
FALSE - but avoid succs with severe musculoskeletal involvement
What can happen with a dural puncture with a patient with a brain tumor?
brain herniation and death
Brain tumor patient: ____ blocks for first stage labor, ___ block for 2nd stage labor
b/l lumbar sympathetic blocks for first stage, pudendal block for second stage
Brain Tumor C section: GETA with generous narcs to blunt reflexes during laryngoscopy and avoid sudden inc in ___ and ____
BP and ICP
T/F Pseudotumor Cerebri - benign intracranial HTN is not mass related, and epidural or spinal block is okay
TRUE
T/F Epilepsy is shown to have an increased risk of convulsions with use of local anesthetics
FALSE. proceed as normal
Myasthenia Gravis is usually treated with anticholinergic agents such as ____ or ____
neostigmine or edrophonium
T/F women are 3 times more likely to develop MG than men
TRUE
Pregnancy can exacerbate MG symptoms, causing cholinergic crisis, which requires dose adjustment of ____
neostigmine
MG contraindicated drugs
-ABX: gentamycin, kanamycin, streptomycin, plymyxin, colistin, tetracycline, lincomyicn
Tocolytics: Mag sulf
Cardiac meds: quinidine, propranolol
Beta Adrenergics: Ritodrine, Terbutaline
Others: Quinine, Penicillamine, Lithium
IV dose of neostigmine is given in ratio of __:__ to oral dose
30:1. monitor fetal HR!
In an MG patient, ____ anesthesia is preferable to ____.
regional, general
MG patient is highly sensitive to which agents
depolarizing and NDNMB. intubation doses 1/2 to 1/3 normal
T/F MG patient is more resistant to effects of opioids and LA agents.
FALSE. more receptive to effects of opioids and LA.
Cholinergic crisis should be treated with which drug?
atropine - IV & IM
profound muscle weakness, resp failure, loss of bladder/bowel function, disorientation, diplopia are symptoms of?
Cholinergic Crisis (MG)
Normal Hgb= HgbA, Sickle Cell =
HgbS
Heteroxygous “sickle trait” =
HgbAS
Homozygous =
HgbSS
which Two forms of sickle cell dz have a higher incidence off preeclampsia?
HgbSS or HgbSC
6 things to avoid in sickle cell patient
hypoxia, HoTN, dehydration, hypothermia, acidosis, tourniquets
Sickle Cell: prefer epidural with adequate bolus with ___ prior to block
warmed IVF
Sickle Cell: spinal or epidural?
epidural. decreased risk of HoTN.
what is the most common hereditary coagulation abnormality
VonWillebrand Disease
VonWillebrand Disease: what is the most common type? how do you tx?
type 1, Rx with DDAVP 0.3mg/kg
Tachphylaxis can occur with DDAVP therapy at >___hr
48
T/F Neuraxial blockade is a relative contraindication to sickle cell, although can be considered if coagulation times are monitored and appropriately treated
TRUE
Factor V Leiden: variant of human coagulation factor __ that cannot be activated by ___ and therefore causes a ___coagulability disorder
V C hyper
Factor V Leiden: Patient on lovenox very early in pregnancy is converted to heparin at week __ to facilitate neuraxial blockade
38
Factor V Leiden: if prophylactic LMWH dose- hold >__hours before block
12
Factor V Leiden: if therapeutic LMWH dose- hold >__hours before block
24
Rheumatoid Arthritis - what are the resp concerns
restrictive lung dz, possible pleural effusions
RA - what is the preferred anesthetic
continuous labor epidural, but may fail d/t arthritis.
for c-section, can use epidural or spinal. avoid potential difficult airway, may need awake fiberoptic intubation
SLE: Early implementation of ___ anesthesia is recommended
regional
T/F Due to the incidence of valve disorders and vegetation on SLE patient, prophylactic antibiotics are always recommended.
FALSE. only required if pt is high risk for endocarditis. (previous IE, unprepared cyanotic heart disease, implanted prosthetic devices, cardiac transplantation with cardiac valvulopathy)
vocal cord palsy is seen with which disorder
SLE
Maternal Addiction to amphetamines has what effect on catecholamines?
depletion. limited response to indirectly acting sympathomimietics such as ephedrine.
Maternal Addiction to amphetamines increases or decreases MAC for GA? what is the consequence?
increases. increased IH = inc risk for uterine atony.
Maternal Addiction - which drug can decrease plasma cholinesterase?
cocaine - prolongs duration of 2-chloroprocaine and succinylcholine
the vasoconstrictive effects of cocaine have what effect on the fetus?
decreased uteroplacental blood flow
Chronic cocaine - preferred anesthetic for C section
neuraxial - less HoTN - exaggerated HTN, tachycardia with ETT, severe tachyarryhtmias with GA
T/F There is little evidence that HIV or antiretroviral drugs increase the incidence of pregnancy complications, or that pregnancy alters the course of infection
TRUE
Pharyngeal lymphatic hypertrophy can create a potentially difficult airway in the patient with ___
HIV
Hypotension d/t decreased afterload will reverse a ____ shunt, with resulting ___ shunting and cyanosis.
L–>R, R–>L
beware SAB!
cardiac output is highest in pregnancy when?
~80% above baseline immediately following delivery, this will be stressful for patient with cardiomyopathy
How does alcohol affect pregnancy/
increased risk of hemorrhage d/t esophageal varies, clotting abnormalities d/t hepatic dz, cardiomyopathy, neuropathy, increased gastric volume, acidity
Which drug causes an increased risk of PTL, abrupt placentae, congenital abnormalities, growth retardation, LBW?
cocaine
T/F Chronic cocaine use can cause increased clotting
FALSE - causes thrombocytopenia
