Diseases with Anesthesia Issues

Question 1

Ankylosing Spondylitis

Answer 1

Keywords: sacroiliitis (early manifestation), bamboo spine, associated with HLA-B27, seronegative, RF negative

Ventilation Issues: difficult mask ventilation secondary to decreased movement of TMJ resulting in ill-fitting mask. Restrictive lung disease from pulmonary fibrosis.

Intubation: Limited mobility of cervical spine resulting in difficult intubation. Associated with atlantoaxial instability.

Epidural: Increased risk of epidural hematoma due to multiple epidural attempts. Increased platelet dysfunction due to NSAID therapy. No risk of peripheral neuropathy.

Question 2

Sickle Cell Disease

Answer 2

Avoid hypothermia, hypoxia, acidosis, hyperthermia, hypotension to prevent sickling. IV fluids for dehydration with NPO status. Want adequate Hgb/Hct. Want Hct at least 35-40%.

Question 3

Malignant Hyperthermia

Answer 3

Autosomal dominant defect in ryanodine receptors resulting in increased release of Ca2+ from sacroplasmic reticulum. Results in muscle rigidity, increased oxygen consumption, hypercarbia, lactic acidosis, elevated CK, hyperkalemia, elevated CK and rhabdomyolysis. Treatment with Dantrolene. Monitor for coagulopathy.

Question 4

Adult Polycystic Kidney Disease

Answer 4

Autosomal dominant disease. Contraindication for robotic prostatectomy given steep Tberg positioning and increased intracranial pressure (sacular aneursyms). Also contraindicated for Ehler Danlos and Marfan Syndrome.

Question 5

Intubation and Type I DM

Answer 5

Hyperglycemia can cause glycosylation and stiff neck resulting in limited neck extension.

Question 6

Duchenne’s Muscular Dystrophy

Answer 6

X-linked recessive causing issue in dystrophin causing respiratory and gastric hypomotility. Can cause hyperkalemia 2/2 rhabdomyolysis. Phenytoin used to treat myotonic crises. Neostigmine can precipitate crisis and NMB do not improve symptoms)

Question 7

Diabetic Neuropathy

Answer 7

HR 80-90 and orthostatic hypotension. Increased number of esophageal relaxations

Question 8

Pregnancy and Anesthesia

Answer 8

Decreased serum Albumin levels 2/2 increased plasma volume (causing dilution)

Question 9

Acute Intermittent Porphryia

Answer 9

Worse with inducer of cytochrome p450 (barbiturates and ETOH)

Question 10

Hypokalemic Periodic Paralysis

Answer 10

Calcium channels. Associated with metabolic alkalosis, hypothermia, glucose load, stress, exercise, steroids.