NEURO Flashcards
40 year old requires a laparotomy ten days after a traumatic spinal cord transection at C6
Outline KEY anaesthetic issues
How will these influence your anaesthetic management
UNSTABLE C SPINE
NEUROGENIC SHOCK
LAPAROTOMY
Cspine- depending on injury may have had fixation and stabilisation
- if incomplete lesion - potential to worsen injury with neck manipulation and laryngoscopy
- Potentially already intubated
- Isolated injury so other facial trauma unlikely
Neurogenic Shock - decreased SNS tone below injury -> vasodilation, decrease inotropy, and potential bradycardia (as above T1-T4 - cardiac accelatory fibres)
Potential bracdycardia/asystole with vagal stimulating procedures eg laryngoscopy, tracheal suctioning
Laparotomy - Unknown aetiology eg bleeding, perforation, obstruction
- May require resuscitation prior to OT
Ventilation - C6 - loss of intercostals - if not already intubated may be post op -> slow wean poor cough etc
CHANGE MANAGEMENT
C-spine - if not already intubated - MILS + videolaryngoscopy to minimise movement
RSI - laparotomy / unfasted / SCI - gastroparesis
- suxamethonium contraindicated post 72hrs due to hyprekalaemia risk
use rocuronium instead
@ laryngoscopy - potential for bradycardia/asystole - predrawn atropine 600mcg, ideally a second person to do airway
Laparotomy - Fluid assessment -> resiscitation with crystalloid and blood as rrquired
Neurogenic Shock - if present may need vasopressor / ionotropes eg norad/adrenaline infusion
Post Op - may not be able to extubate (if previously was) & may need to go to ICU
