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Advanced Principles C > Neuroanesthesia Pt. 3 (Exam I) > Flashcards

Neuroanesthesia Pt. 3 (Exam I) Flashcards

1
Q

Sharp spiking waves noted on an EEG would make the CRNA consider what phenomenon occuring to the patient?

A

Seizures

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1
Q

Delta waves noted on an EEG would make the CRNA consider what phenomenon occurring to the patient?

A
  • Deep Sleep (or Anesthesia)
  • Tumor
  • Stroke
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2
Q

What are characteristics of delta waves?

A
  • 1-4 hz
  • High amplitude
  • Low frequency
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3
Q

What things can cause interference in an EEG reading?

A
  • Hypoglycemia
  • Body/Eye movement
  • Lights (bright & flashing)
  • Sedatives
  • Caffeine
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4
Q

Why is burst suppression done during aneurysm clip placement?

A
  • Increases exposure
  • Decreases pressure around aneurysm
  • ↓ CMRO₂ = brain protection
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5
Q

What is an analyzed EEG signal over 5-10 seconds called?

A

an epoch

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6
Q

BIS Values:

85 - 100 = ?
40 - 60 = ?

A

85 - 100 = Normal awake cortical activity
40 - 60 = Consistent w/ GETA

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7
Q

Single seizures (meaning one-off episodes of seizures) may result from transient abnormalities such as….

A
  • Hypoglycemia
  • ↓Na⁺
  • ↑Temp
  • Brain injury
  • Drug toxicity
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8
Q

What seizure class can be mistaken for mental illness due to feeling/seeing/hearing things that aren’t there?

A

Focal Seizures

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9
Q

What’s another name for focal seizures?

A

Partial Seizures

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10
Q

What seizures are characterized by affecting both sides of the brain and muscle spasms?

A

Generalized Seizures

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11
Q

What are the subcategories of generalized seizures?

A
  • Tonic-Clonic (Grand Mal)
  • Clonic
  • Tonic
  • Atonic
  • Myoclonic
  • Absence (Petite Mal)
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12
Q

What age group is at higher risk for petit mal seizures?

A

Children

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13
Q

Clonic seizures are defined by…

A

rhythmic jerking

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14
Q

What generalized seizure disorder subtype has the highest risk of falling?

A

Atonic

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15
Q

Which anti-seizure drugs reduce influx of Na⁺ & Ca⁺⁺ ?

A
  • Lamotrigine (Lamictal)
  • Carbamazine (Tegretol)
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16
Q

Which anti-seizure drugs increase GABA?

A

Valproate

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17
Q

Which anti-seizure drugs decrease excitatory neurotransmitter activity?

A

Levetiracetam (Keppra)

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18
Q

How does Keppra work?

A

Decreased glutamate & aspartate activity by binding to SV2A (synaptic vesicle 2A)

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19
Q

What two drugs should be avoided in order to prevent seizure occurrence in neuro patients?

A
  • Etomidate (possibly lowers seizure threshold)
  • Meperidine
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20
Q

What anesthetic drugs are best for seizures?

A
  • Propofol
  • Barbiturates
  • Benzodiazepines
  • Mg⁺⁺
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21
Q

What metabolite of meperidine can build up and cause seizures?

A

Normeperidine

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22
Q

What is status epilepticus?

A
  • Two or more seizures without a return to consciousness
  • Continuous seizure activity

Life-Threatening Emergency

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23
Q

What is the treatment for status epilepticus?

A
  • Airway & Ventilation
  • Treat hypoglycemia
  • Anti-epileptic anesthetics (prop, barbs, bnzos)
  • Muscle relaxants
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24
Q

Which common autoimmune disease affects the CNS via demyelination?

A

Multiple Sclerosis

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25
Q

What gene is MS inherited from?

A

Trick question. Not directly inherited

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26
Q

What disease is characterized by the following:

  • Inflammation
  • Demyelination
  • Axonal damage in the CNS specifically
A

Multiple Sclerosis (MS)

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27
Q

MS is typically a ___ progession, with onset most common after the age of ______.

A

slow progression : age of 35

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28
Q

What demyelinating disease is characterized by symptom development over a few days then stabilization and then temporary improvement?

A

MS

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29
Q

What is a common 1st sign of multiple sclerosis? Why?

A

Visual disturbances from optic nerve demyelination

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30
Q

How efficacious are drugs for MS?

A

Decrease duration of MS relapse but don’t really alter disease progression

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31
Q

What drugs are commonly used for MS?

A
  • Corticosteroids
  • Interferon
  • Azathioprine
  • Methotrexate
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32
Q

How do corticosteroids treat MS?

A
  • Anti-inflammation
  • Restoration (to a degree) of the BBB
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33
Q

What patients are candidates for interferon for treatment of MS? Why?

A
  • Rapidly progessing disease
  • Cardiac toxicity
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34
Q

What type of drug is azathioprine?

A

Purine analogue immunosuppressant

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35
Q

How does methotrexate treat MS?

A

Slows progression through typically immunosuppression/anti-inflammatory effects.

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36
Q

Should MS medications be continued on the day of surgery?

A

yes; typically

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37
Q

What is the anesthetic relevance of baclofen pumps for MS patients?

A

Baclofen will increase sensitivity to non-depolarizing paralytics.

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38
Q

What paralytic should be avoided in MS patients? Why?

A

Succinylcholine

Due to upregulation of extrajunctional ACh receptors

39
Q

What are risk factors for MS relapse? (that anesthesia can help regulate)

A
  • Fever / Hyperthermia
  • Infection
  • Emotional stress (consider versed pre-op)
40
Q

What is another name for Acute Inflammatory Demyelinating Polyradiculoneuropathy?

A

Guillain Barre Syndrome (GBS)

41
Q

Guillan Barre Syndrome (GBS) is oft preceded by an _______.

A

infection

42
Q

What is often the 1st sign of GBS?

A

“Pins & needles” and numbness

43
Q

In GBS, weakness begins in the _____, and then spreads to the ______.

A

begins in the legs and then spreads to the upper body

44
Q

What are the most serious signs associated with GBS?

A
  • Difficulty swallowing
  • Impaired ventilation
45
Q

What drug should absolutely be avoided in GBS? Why?

A

Succinylcholine due to upregulation of ACh receptors

46
Q

Autonomic dysfunction is possible in GBS but not MS. T/F?

A

False. Autonomic dysfunction can occur in both

47
Q
A
48
Q

When is hypertension seen with a GBS patient during an anesthetic case?

A

Laryngoscopy

49
Q

What tends to cause hypotension seen with a GBS patient during an anesthetic case?

A

Positive airway pressure

50
Q

What kind of anesthetic technique is likely inappropriate for GBS patients? Why?

A

MAC

  • Likely to have airway reflex dysfunction & respiratory compromise
51
Q

What paralytic should be avoided with GBS?

A

Succinylcholine

52
Q

What are the three components of Parkinson’s Disease process?

A
  • Loss of dopaminergic fibers of the basal ganglia
  • ↓ NE production
  • Lewy Body development
53
Q

What causes the movement disorder aspect of Parkinson’s?

A

Loss of dopaminergic neurons of the basal ganglia

54
Q

What is the name for the α-synuclein clumps of proteins developed in Parkinson’s disease?

A

Lewy Bodies

55
Q

What is the most important risk factor for development of Parkinson’s Disease?

A

Age

56
Q

What acronym showcases the sign/symptoms associated with Parkinson’s?

A

TRAP

Tremors
Rigidity
Akinesia
Posture

57
Q

Where does muscle rigidity in Parkinson’s patients first appear?

A

Proximal muscles of the neck resulting in “loose arm swinging”.

58
Q

How are the tremors of Parkinson’s disease usually characterized?

A
  • Pill-Rolling = Rhythmic w/ alternating flexion/extension of digits.
  • Shaking that usually starts on one side
59
Q

Tremors in Parkinson’s disease are usually more prominent when moving. T/F?

A

False. Tremors more prominent at rest.

60
Q

Is there an autonomic dysfunction component to Parkinson’s? What is the result?

A

Yes; results in the following being more common:

  • Respiratory obstruction
  • Aspiration pneumonia
61
Q

What are the two treatment goals with Parkinsons?

A
  • Increase Dopamine in basal ganglia
  • Decrease effects of excess ACh
62
Q

How do Levodopa/Carbidopa work?

A
  • Levodopa - crosses BBB and forms into dopamine
  • Carbidopa (decarboxylase inhibitor) prevents levodopa breakdown prior to crossing of BBB.
63
Q

What are the side effects of Levodopa/Carbidopa?

A
  • Dyskinesias
  • Altered heart contractility
  • Orthostatic Hypotension
  • N/V
64
Q

What is the success rate for surgical treatment (DBS) of Parkinson’s disease?
What patients are candidates for surgical treatment?

A
  • 70%
  • Reserved for patients w/ disabling & medically refractory symptoms
65
Q

What type of anesthesia should be considered with patients w/ dementia?

A

TIVA

66
Q

Huntington’s Disease is a _______ disorder that is characterized by enlargement of the ____________.

A

Movement disorder (genetic)

Enlargement of lateral ventricles

67
Q

ALS is a disorder characterized by what?

A

Amyotrophic lateral sclerosis

Disorder characterized by progressive degeneration of motor neurons.

68
Q

What is the pathophysiology of myasthenia gravis?

A

Destruction of nACh receptors at the NMJ

69
Q

What are common triggers for development of myasthenia gravis?

A
  • Stress
  • Surgery
  • Infection
  • Pregnancy
70
Q

What are the hallmark symptoms of MG?

A
  • Weakness (centrally first then peripherally)
  • Rapid exhaustion of skeletal muscles followed by partial recovery with rest.
71
Q

How is MG diagnosed?

A
  • Blood Test
  • Edrophonium (Tensilon) test
  • EMG nerve stimulation
72
Q

What autoimmune disorder may result from a tumor forming on the thymus gland?

A

Myasthenia Gravis (MG)

73
Q

What type of drug is edrophonium?

A

Rapid-acting anticholinesterase medication

Have atropine available.

74
Q

What occurs with a tensilon test?

A

Edrophonium is given to a patient with presumed MG, if symptoms improve then MG is diagnosed.

75
Q

What other disorder may be diagnosed with a Tensilon test (other than MG) ?

A

Lambert Eaton Myasthenic Syndrome

76
Q

How is myasthenia gravis treated?

A

Anticholinesterases

  • Pyridostigmine
  • Neostigmine

Make more ACh available at NMJ.

77
Q

What is the pathophysiology of cholinergic crisis?

A

Excess ACh from:

  • Too much AChesterase inhibitors
  • Pesticides
  • Nerve gas (Sarin)
78
Q

What is the deadliest symptom associated with severe cholinergic crisis?

A

Profound muscle weakness/ flaccid paralysis

Due to continuous depolarization of postsynaptic membrane.

79
Q

What acronym describes cholinergic toxicity?

A

Salivation
Lacrimation
Urination
Defecation
GI Upset
Emesis

80
Q

Myasthenic Crisis vs Cholinergic Crisis Chart

A
81
Q

What drug can be used to differentiate Myasthenic vs Cholinergic Crisis?

A

Edrophonium

Edrophonium improves Myasthenic crisis
Edrophonium worsens Cholinergic crisis

82
Q

What drugs should be avoided (besides succinylcholine) in MG patients?

A
  • CCBs
  • Mg⁺⁺
83
Q

When are immunosuppressants indicated for MG treatment?

A

When skeletal muscle weakness is not adequately treated with AChe inhibitors.

84
Q

How does plasmapheresis treat MG? Is this permanent?

A

Plasmapheresis removes antibodies attacking the NMJ from the blood.

Purely a temporary measure.

85
Q

What surgery is used to treat MG?

A

Thymectomy

Treatment of choice for majority of MG patients, 75% show improvement or remission.

86
Q

What type of extubation is required for MG patients? Why?

A

Awake extubation due to ↑ risk of aspiration

87
Q

MG patients are resistant to _______ paralytics but sensitive to _______ paralytics.

A

Resistant to succinylcholine

Sensitive to Non-depolarizing paralytics

Consider using VAA for muscle relaxation.

88
Q

Where do antibodies attack in ELMS (Eaton-Lambert Myasthenic Syndrome) ?

A

Presynaptic Ca⁺⁺ channels at the NMJ

89
Q

With ELMS, muscle strength improvement occurs with….

A

repeated use

90
Q

ELMS is associated with what type of lung cancer?

A

Small-cell lung cancer

91
Q

ELMS patients are sensitive to _______ paralytics.

A

Non-depolarizing

92
Q

Proximal muscles are more effected in ________ than in MG.

A

ELMS

93
Q

Are reflexes increased or decreased in ELMS?

A

Decreased

94
Q

Is autonomic dysfunction a component of ELMS?

A

yes

95
Q

MG vs ELMS Chart

A
96
Q

Is autonomic dysfunction a component of MG?

A

No

Advanced Principles C (5 decks)

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