Nervous System Flashcards
MS GA: avoid inc in what
Temp, promotes exacerbation
MS induction consid
Steroids. ANS dysfunc (low bp induc). No sux (hyperkalemia risk). May have prolonged responses or resistance to NDMR
Ms: line consid, regional consid, exac assoc w
Lower threshold for a line. Avoid regional unless strong reason (OB epidural). Spinals.
GB GA: BP alterations with what, what is mandatory
ANS dysfunc. Low bp w vent/bl/pos change. High bp w DVL, pain, and indirect pressors. A line. Alt temp
GB GA: avoid what, which NDMR
Sux (hyperkalemia risk). Vec- want minimal cv effects
GB regional: what can be beneficial. Caution d/t what. High incidence of what
Epidural opioids. Sensitive to LAs (na ch blocking factor). ANS issues: epidural preferred, slower onset than spinal
PD GA: consider what d/t med reg
Levodopa e 1/2 6 hrs. Give 20 min via OGT before induc or in surgery, can also give SQ apomorphine (dopamine agonist)
PD GA: risk of what, avoid which drugs
Asp risk (RSI). Dopamine antagonists (droperidol, phenothiazines, reglan). Alfentanil and fentanyl- Dystonic rxn
PD GA: expect what w cv sys.
ANS alt- bp labile, dysrhythmias
PD GA: can give what but consid what, aggressive what, extubation consid
Ketamine- inc sns stim. Aggressive fluid plan. Awake extub.
SCI acute alterations
Lose temp reg, dec bp and hr if >t6, pvcs and st changes
SCI acute resp consid: above C4, below C5, when quads breathe best, suctioning
Above: vent assistance. Below: breathe ok but lose accessory muscles. Breathe best supine. High spinal- suctioning can cause low hr/cv arrest esp if hypoxemic
Methylprednisolone dose for SCI
30 mg/kg within 8 hrs. Then 5.4 mg/kg/hr for 1-2 days
Acute SCI ga
Dvl w inline stabilization in emergency. Req vent if abd paralysis and ga. Need a line. Aggressive fluids/blood/pressors. Hd instab.
Acute SCI ga: blood loss not large unless what, which area of spine has more blood loss
Harvesting iliac crest bone graft or vertebral body corpectomy. Thoracic and lumbar > cervical
Acute SCI ga: __ below lesion level, which NMB good/not
Poikilothermic. Panc- sns stim. Sux ok first few hrs then avoid bc high k
Chronic SCI ga: __ failure common, high __ risk, ___ in muscle common
Renal, dvt, spasticity
[chronic SCI ga: concern for what/prevention. Have what available.
AR w/surgery, VAs, epidural/spinal. Have NTP 1-2 mcg/kg iv for persistent htn
Seizure anesthesia: med considerations
Additive fx anticonvulsants and our drugs. They also may cause coag/end organ/enzyme induc. Continue meds am of surgery and in surgery
Seizure anesthesia: avoid which 8 drugs
Methohexital, ketamine, etomidate, meperidine, atracurium, cisatracurium, enflurance, alfentanil
Do what for status epilepticus
TPL, propofol, versed, abg and temp monitor. Blow off CO2
Determinants of CBF
Paco2/02, arterial pressure, autoreg, venous pressure
When anesthetic drugs affect brain autoreg
> 0.5 MAC VAs. Use IV TPL or propofol and hypocapnia to help. N20 interferes less than others
Inc ICP: anesthetic drugs that are good vs bad
Good: propofol and barbs best, versed/etomidate/opioids ok. No ketamine
How to reduce ICP
Posture, hypervent, CSF drain, hyperosmotics, diuresis, steroids, barbs, smooth induc, vae detection
Head injury: maintain what, common meds, where we want c02, hob
Maintain CPP and CBF (dec ICP inc bp). Mannitol, lasix, pressors. CO2 around 30. Barb coma reduce cmro2. Hob 30 degrees
Head trauma: bp goal, when hypervent used
CPP >70. Acute inc ICP, herniation prevention, to minimize retractor pressure, or to imp surgical access
Head trauma: fluids to use or not
Use normal saline, 5% albumin, and blood. Dont use LR or glucose containing solutions
Head trauma: cv consid, do what for cushings triad
Hi hr/bp. Give BB. Reduce ICP: hob 30 degrees, barbs, co2 low normal, consider hypothermia
Head trauma: which lines, induction
A line pre induc, right heart cath. Lidocaine, anything but ketamine, opioids good, avoid histamine rel NMB and sux
Head trauma volatile considerations, emergence avoid what
N20 ok if no pneumocephalus. Volatile until cranium open then base on ICP. Prevent htn and coughing w emergence
Supratentorial intracranial tumor: monitors/iv consid
2 large PIV, blood avail, a line and PNS
Supratentorial tumor induc:
Pre 02 fully, hi dose propofol/lidocaine/fentanyl, use nondepolarizor, consider extra prop bolus before intub, esmolol for hr/bp control
Supratentorial tumors: maintenance
CO2 30-35, can use va and n20, if low compliance TIVA and low dose iso
Supratentorial tumor emergence: no reversal until what
Head dressing applied
VAE which methods most use ful
Tee, then Doppler, then end tidal. Too far gone when bp changes
SAH induction, lines
Prevent hi or low bp. Lido, bb, opioid, hi dose propofol or tpl. A line and maybe cvp
Maintenance for SAH
VA and n20 dep on ICP. TPL/fent/iso.
Maintenance SAH if high ICP:
TPL gtt 1-3 mg/kg/hr after 5 mg/kg gtt, stop after aneurysm clipped. Fent 1-4 mcg/kg/hr gtt plus 1/2 mac iso and 02.
SAH fluid management
Before clipping limit to maintenance and deficit. After clipping inc cvp to 10-12
SAH emergence, which extub or not
1-2 and no complic can be extubated in or. 3-5 or complic remain intubated.
