Musculoskeletal Flashcards
SLE pt presents w what on dx
Antinuclear antibodies, rash, low plt ct, serositis, nephritis
SLE: occurs mostly in who, can be induced by what
Young women. Drugs: hydralazine, procainamide, isonizid, methyldopa, slow acetylators at inc risk
What SLE inflammation and vasculitis does
Vessel wall thickening, weakening, narrowing, and scarring: CAD, Stroke risk etc. HTN, pulmonary HTN, Thromboembolism, Hypercoagulable state
SLE how skin and membranes affected
Butterfly rash, nasal erythema, oral and pharyngeal ulcers
How joints and muscle affected by SLE
Symmetrical arthritis, cricoarytenoid arthritis, myopathy, tendon rupture
How lungs affected by SLE
Lupus pna, restrictive, atelectasis (phrenic nerve neuropathy)
How kidneys and heart affected by SLE
Glomerulonephritis leading to nephrotic syndrome and RF. Pericarditis and valvular disease
How CNS and liver affected by SDLE
Cognitive symptoms, biliary cirrhosis, autoimmune hepatitis
SLE tx: mild
NSAIDs, low dose steroids, hydroxychloroquine for skin and arthritis
Severe SLE tx
High dose steroids (stress dose intraop), methotrexate
Stress dosing for small,m moderate, or major surgery
None. 25 mg hydrocortisone q8 then taper 1-2 days. Major 50 mg q8 then taper 2-3 days
Anesthesia consid w airway management SLE
Laryngeal erythema and edema common, CA arthritis, ulcers, laryngeal nerve Palau
Consid for regional SLE
Coagulopathy or on anticoagulants. May have nerve lesion
How SLE affects anesthesia drug choices
Which SLE drugs on, if renal imp, hepatic clearance, cardiopulm involvement.
SLE drugs for altered renal function
Propofol and etomidate good. Benzos prolonged, urine elim. Opioids- demerol and morphine metabolites, resp dep in RF. VA ideal d/t no dep on renal elim
Where early RA appears
Hands, wrists, ankles, feet
Where late RA appears
Knees, elbows, shoulders
RA fx on lung and heart
Effusions, pulm fibrosis (restrictive pattern), pericarditis, tamponade, coronary arteritis, aortic insufficiency, dysrhythmias from nodes
RA drugs to tx RA
DMARDS slow progression. Methotrexate, axothioprine, sulfasalazine, TNF inhibitors/monoclonal antibodies
RA document what pre op.
ROM limits, baseline pain, numbness, weakness
RA airway consid/management
Assess TMJ. If ltd and cervical spine immobile may do awake fiberoptic. Cricoarytenoid- hoarseness, can make glottic opening stenotic, smaller tube size, edema can lead to obstruc postop
RA atlantoaxial subluxation: what it is, interferes w what
Anterior arch of atlas to odontoid process, >3 mm. Risk of SC/medulla compression, interferes w vertebral artery flow.
RA atlantoaxial subluxation: how to handle
Determine awake head positions tolerated. Ask about tingling in hands, feet, pain, ROM. Avoid excessive movements w laryngoscopy
Where OA occurs
Middle/lower cervical spine and lower lumbar. Weight bearing joints (hips, fingers, knees, feet)
OA anesthesia consid
Positioning, support to joints. Dont need to give steroids. Bleeding potential from asa and nsaids
Complication from joint surgery in OA
Bone cement can cause fat and marrow embolisms (implantation syndrome). Hypoxia, hypotension, dysrhythmias, pulm htn, dec CO
OA complic from pneumatic tourniquets
Prolonged inflation can cause pain and nerve damage. Dont overdo opioids. Deflation- hemodynamic changes and washout of metabolic wastes
MG clinical features
Ptosis, diploplia, bulbar involvement (aspiration), myocarditis (afib,hb), proximal muscle weakness (neck, shoulders, resp muscles)
How MG drugs effect our drugs
On cholinesterase inhib. Prolonged sux, mivacurium, ester LAs
MG. What can enhance weakness. Med consid
Aminoglycosides. Propofol (short acting). Maybe no NMB, lidocaine to a/w. RSI if aspiration risk, give sux but may be prolonged
MG maintenance
Deep w VA, enough relaxation
MG emergence
Greater risk postop RF. Awake w ETT in. Head lift 5 sec. clos obs
Myasthenia syndrome clinical features
Proximal muscle weakness, bottom to top. Can affect resp muscles. Autonomic dysfunc: hemodynamic variability
Myasthenia syndrome anesthesia consid
Sensitive to all NMBs. Anticholinesterase drugs may not reverse them. VA alone may provide enough relaxation. Small doses NMBs
DMD CM
Hyphoscoliosis, weakness and contracture. Muscle weakness in proximal extrem. Degen of heart muscle, dec ability to cough, resp muscle weakness, delayed gastric emptying (aspiration risk)
MD cardiac abn
Atrial arrythmia, prolonged PR, dec myo contractility and cardiomyopathy, mitral regurg
MD resp fx
Weakness, infections, restrictive pattern, pulm htn
MD anesthesia consid
Heart and lung involvement. Avoid pre op meds d/t aspir risk. Premed w GI meds, maybe glyco too for secretions. Positioning
MD infduction: what is contraindicated
Sux, unpredictable. Risk of hyperkalemia, rhabdo, cv arrest, MH
MD maintenance. What is preferable
Cardiopulm depression w VA, prolonged response to NMB. Regional
Marfans CM
Long tubular bones, hyperextensible joints, high arched palate, crowded teeth, pectus excavating, kyphoscoliosis
Marfans CV fx
Aortic aneurysm and dissection, AV valves affected, MV prolapse, BBB, aortic and aV valve calcification
Marfans lung involvement
Pectus excavating/scoliosis, restrictive pattern. Dec compliance, inc PVR nad pulm htn
Marfans tx
BB to reduce heart workload. Aortic repair, spinal fusion
Marfans anesthesia consid preop and a/w
Cardiac abn focus on preop. Rarely hard laryngoscopy. TMJ dislocation, do assessment. Tracheomalacia (floppy- can collapse)
Marfans: prevent what intra op, do what
Prevent sudden inc contractility, avoid catecholamines, tx hypertension. VAs good
Ankylosing spondylitis airway consid
Difficult intub d/t cervical spine and TMJ involvement. Risk of neuro injury w neck extension. Kyphosis limits intub. Cricoarytenoid arthritis
Akylosing spondylitis cv involv
Aortic regurg (avoid sudden inc SVR, keep HR <90, low normal BP), BBB, cardiomegaly
Ankylosing spondylitis pulm abn
Fibrosis, apical cavity lesions, pleural thickening (like TB), dec compliance of chest, dec VC
Ankylosing spondylitis anesthesia consid
Restrictive disease, a/w involvement, may do awake fiberoptic intub. Epidurals are difficult, do paramedical
Achondroplasia anesthesia consid
Difficult IV and CVL placement, pulm htn common, restrictive vent, OSA common, upper a/w obstruc
Achondroplasia airway management consid
May be difficult mask, larynx may be small (hard to expose glottis, base on weight rather than age). Avoid hyperextension
