Final_Skin & Musculoskeletal Dx Flashcards
MS - anesthetic management
- tight temperature control (normothermia)
- Avoid: spinal, Sux
EB - anesthetic management
- Avoid skin trauma/mucous membranes
- Corticosteroids if on long-term management
- Bullae formation from: Tape, BP cuff, Tourniquets, Adhesives, ECG leads, Scrubbing skin with alcohol
- Pad EVERYTHING
- Sheepskin pad
- Silicone gel pillow
- IV, A-line suturing
- Minimize airway instrumentation (Difficult intubation possible)
- Spinal/epidural OK
EB - ruptured bullae tx
epi-soaked gauze
CREST Syndrome - associated with?
Scleroderma
C:calcinosis in skin
R: raynauds
E: esophageal dysfxn
S: Sclerodactyly (thickening/tightening of skin on fingers/hands)
T: Telangiectasis (dilation of capillaries causing red marks on surface of skin)
Scleroderma - anesthetic implications
- Difficult airway?
- IV access may be difficult
- Cardiac evaluation
- Pulmonary evaluation
- Risk for aspiration
- Degree of renal dysfunction
- Minimize peripheral vasoconstriction
Muscular dystrophy
- Group of hereditary diseases
- Painless degeneration and atrophy of skeletal muscle fibers
- Progressive, symmetrical weakness and wasting
- No skeletal muscle denervation
- Sensation and reflexes are intact
DMD - anesthetic implications
Sux C/I
-have dantrolene available
Myotonic Dystrophy
aka Steinert Disease
-avoid Sux, etomidate
Mitochondrial dystrophies
avoid propofol based anesthetic techniques
Myasthenia Gravis
- Most common disease affecting neuromuscular junction
- chronic autoimmune disorder caused by decrease in functional acetylcholine receptors at neuromuscular jxn
Myasthenia Gravis: S/S
Hallmark: weakness + rapid exhaustion of voluntary muscle strength with repetitive use followed by partial recovery with rest
Most vulnerable muscles (myasthenia gravis)
skeletel muscles innervated by cranial nerves (ocular, pharyngeal, laryngeal)
-ptosis, diplopia, dysphagia
Anesthetic Management of MG
Regional/LA If GA: usually need GETA Pharyngeal/laryngeal muscle weakness *resistant to sux *sensitive to NDNMR
MG: majority of morbidity/mortality d/t
swallowing + respiratory muscle dysfunction
Most common joint disease in U.S.
osteoarthritis
Osteoarthritis
degenerative process that affects cartilage
-pathogenesis: r/t joint trauma
-stiff, pain = common
Hips/knees often affected
Kyphoscoliosis s/s
Depends on curvature (>40% = severe)
*restrictive lung dx, pHTN (leading to Cor pulmonale)
Kyphoscoliosis pre-op
- baseline ET
- recent URI?
- GERD? (aspiration risk)
Kyphoscoliosis - anesthetic management
- potential for: large blood loss, surgically induced spinal cord damage, intra-op wake-up test
- caution with HOTN
- special attention to: I+Os, pain management
RA
- immune system attacks lining of joints
- W>M
- exacerbations + remissions
- Rheumatoid factor present 90% of time
RA - late physical findings (hands)
- Boutonniere deformity (thumb)
- Ulnar deviation of metacarpophalangeal joints
- Swan-neck deformity of fingers
Hallmark symptom of RA
Morning stiffness
Severe RA
Nearly every joint affected except thoracic + lumbar
+ cervical spine involvement in RA s/s
may have pressure on spinal cord
-parasthesias, weakness
