FINAL 2 Flashcards
Lateral and rotational deformity of the thoracolumbar spine
Scoliosis
Scoliosis: Spinous processes rotate toward the _____ side of the curve
Concave
Scoliosis: Ribs on convex side push ______ (gibbous deformity) while ribs on the concave side push _____
posteriorly
anteriorly
Scoliosis may have _____ (humpback) and _____(bent backwards).
Kyphosis
Lordosis
Scoliosis is measured by the ____ angle, where angle of the curve (____ surface of the top vertebra to ____surface of the bottom vertebra is measured using perpendicular lines from _____points to _____of the curve
Cobb Upper Lower end center
The angle is formed by the _______
intersection
Angle of the Curve and significance <10 >25 >40 >65 >100 >120
<10=Normal
>25= Echo shows evidence of increased PAP
>40=Need for Surgical Intervention
>65=Restrictive Lung Disease
>100=Symptomatic Lung Disease, Dyspnea on Exertion
>120=Alveolar Hypoventilation
Which orthopedic surgical corrections have a high anesthetic risk for respiratory complications and vent support, with high expected blood loss? According to that dumbass chart on slide 5-6
Cerebral Palsy
DMD
Spinal muscular atrophy
and infantile < 3 years
What preoperative test should be performed prior to Scoliosis Surgery?
Chest Xray ECG Echo PFTs Coags
Scoliosis is listed among the highest risk for pediatric surgeries. This is due to
Hypotension and CV collapse d/t high blood loss
Other risk factors associated with Scoliosis surgery
Anaphylaxis Anesthetic overdose Pneumothorax Hemothorax Impaired venous return from prone positioning Surgical manipulation VAE
She says know these vertebral arteries From top to bottom on the slide... = = =------A =------B = = =------C = =\_\_\_D = = =
Vertebral Artery
Cervical Radicular Artery
Thoracic Radicular Artery (T7)
Radicularis Magna (Artery of Adamkiwicz) (L1)
What monitors cortical and subcortical responses to peripheral nerve stimulation and compares it to a baseline value?
SSEPs
SSEPs monitor the ____ columns of the spinal cord
Dorsal (monitors sensory, not motor)
Things that effect SSEPs (3)
Anesthesia
BP
Temp
Inhalational agents effect motor evoked potentials _____ SSEPs.
greater than
Doses < _____MAC for Sevo and Des have minimal effect on SSEPs
<1.5 Mac
N2O potentiates volitiles and ___ amplitude of SSEPs by itself
decreases
IV agents have _______ effect on SSEPS
little
Maintain ETCO2 ______, Map _____ and _____thermia during SSEPS
All normal
ETCO2 35-45mmHg
MAP > 60mmHg
Normothermia
With motor evoked potentials keep MAP ___
> 65 mmHg
During Motor Evoked Potentials, use _____ for maintenance anestheisa
Propofol and Remi Gtts (TIVA)
Hypotension during Scoliosis surgery…assume it is due to
Blood loss…until proven otherwise
Some potential intraop complications during scoliosis surgery
ETT malposition- d/t prone positioning
Altered pulm compliance- d/t prone positioning
Bleeding
Excessive Heat loss
Neurologic injuries- d/t positioning and surgery
electrolyte abnormalities
Static Encephalopathy defined as a nonprogressive posture and movement disorder with poor muscle control, weakness, and increased muscle tone.
Cerebral Palsy
Cerebral Palsy is due to
Injury or abnormal development of immature brain
Cerebral Palsy is a defined as a posture and movement disorder with (3 characteristics)
poor muscle control
weakness
Increased muscle tone
Cerebral Palsy paresis types Single limb= Both limbs on same side= Both lower limbs= 3 limbs= All 4 limbs=
Single limb=monoparesis Both limbs on same side=hemiparesis Both lower limbs=diparesis 3 limbs=triparesis All 4 limbs=tetraparesis, or quadraparesis
Motor deficits of cerebral palsy may manifest as (3 things)
Hypotonia
Spasticity
Extrapyramidal features like choreoathetoid/dystonic movements or ataxia.
Functional Capacity Classification for Cerebral Palsy Class 1 Class 2 Class 3 Class 4
Class 1- No limitation of activity
Class 2- Slight to moderate limitation
Class 3- Moderate to great limitation
Class 4- No useful physical activity
4 Classification systems for Cerebral Palsy
Physiology (type of muscle tone)
Topography (Area affected, like mono or quadriplegia)
Etiology (like prenatal, perinatal or postnatal)
Functional Capacity (Type 1,2,3,4)
Comorbidities with CP and anesthetic concerns (3)
Pulmonary- frequent respiratory infections
GI- Gerd- prone to aspiration
Neurologic- SCZ disorders, so avoid etomidate, ketamine, methohexital, EMLA, normeperidine.
CP: These patients are often on baclofen or dantrolene for spasicity, should you discontinue it?
nope, may need a decreased dose of NMBAs
CP: Can you give these patients Succs?
Yup- b/c these muscles are not denervated
CP: Avoid _______ in presence of VP shunt
caudal/epidural
CP: can these patients communicate pain
may not
This is a dwarfing syndrome that manifests as bone fragility and risk for multiple fractures
Osteogenesis Imperfecta (Mr. Glass from “unbreakable”)
4 types of Osteogenesis Imperfecta
Type 1- mildest form
Type 2 - most severe form (lethal)
Type 3- Progressively deforming form
Type 4- mild to moderate bone fragility
Main anesthetic consideration with Osteogenesis Inperfecta
Handle Gently
What is the most common progressive muscular dystrophy?
DMD
DMD have a waddling gait and ______ _______ (location and type of spinal curvature).
Lumbar Lordosis
DMD Pts have difficulty climbing _____
stairs
Avoid ____ with DMD d/t risk of hyperkalemia
Sux
DMD have _____ and _____ compromise
respiratory and CV
DMD have ______ of the tongue, leading to difficult intubations
hypertrophy
DMD have ____ blood loss during surgery
greater
NMBAs have ____ onset and ____duration of action with DMD patients.
slow
prolonged
____ is contraindicated with DMD d/t hyperkalemia, muscle rigidity rhabdomyolysis, myoglobinuria, arrhythmias and cardiac arrest.
Succs
DMD, best to ____ inhalational agents, d/t association with ____
avoid
MH
Cystic Fibrosis is a autosomal _______ disorder
recessive
What is the most common life-limiting inherited disorder among Caucasians?
Cystic Fibrosis
Patho of Cystic Fibrosis
Disruption of electrolyte transport in epithelial cells of sweat glands, airways, pancreatic ducts, intestine, biliary tree and vas deferens.
Sx of Cystic Fibrosis
Increased sweat chloride concentraiton (>60mEq/L) viscous mucus production, lung disease, intestinal obstruction, pancreatic insufficiency, biliary cirrhosis, and congenital absence of vas deferens.
Normal sweat chloride levels =
Dx for Cystic Fibrosis =
Normal = 40mEq/L CF= > 60 mEq/L
What is the most common cause of death and morbidity for CF patients?
Pulmonary disease
CF: enhanced absorption of ____ in the airway epithelium and failure to secrete ____ and ____
Na+
Cl- and fluid
CF: ______ leads to thickening of mucus, inflammation and infection
dehydration
CF: early signs of pulmonary dysfunction
____ in max expiatory flow rates at low lung volumes
___ in ratio of RV to TLC
Decreased
Increased
CF: Neonatal surgical indications (Hint* all GI related)
Meconium ileus
Meconium peritonitis
Intestinal Atresia
CF: Children/Teenager surgical indications (hint ENT and IV)
Nasal polypectomy
IV access
ENT surgery
CF: Adult surgical indications
Esophageal Varices
Recurrent pneumothorax
Cholecystecomy
Liver or Lung transplant
CF anesthetic management. Schedule surgery _____
later in the day. allows pt to be up moving to loosen secretions
CF: avoid _____ventilation
hyper
Avoid this induction agent with CF
Ketamine- due to increased secretions
____ and ______ anesthetic gases with CF
heat and humidify
Disadvantage of LMA in CF
inability to suction secretions
risk of laryngospasm and aspiration
