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Health Assessment Exam 3 > Neurological Diseases in Anesthesia (Part 1) > Flashcards

Neurological Diseases in Anesthesia (Part 1) Flashcards

1
Q

__________________ is modulated by Cerebral Metabolic Rate (CMR), Cerebral Perfusion Pressure (CPP), PaCO2, PaO2, drugs and intracranial pathologies.

A

Cerebral Blood Flow

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2
Q

CBF is ____ml/____g brain tissue per minute

A
  • 50 ml/100g
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3
Q

Cerebral Blood Flow (CBF) is _____ ml/min

A
  • 750ml/min
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4
Q

What percentage % of CO goes to Cerebral Blood Flow (CBF)?

A
  • 15%
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5
Q

Neural tissue (brain + spinal cord), blood, and CSF are all components of the _____________________ .

A

Intracranial and spine vault

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6
Q

The Intracranial & Spinal vault is enclosed by ………..

A
  • dura mater
  • bone
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7
Q

Under normal conditions, brain tissue, intracranial CSF and intracranial blood have a combined volume of ________ .

A
  • 1200-1500 ml
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8
Q

What is a normal ICP

A
  • 5-15 mmHg
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9
Q

____________________ is any increase in one component of intracranial volume must be offset by decrease in another component to prevent an elevated ICP.

A

Monroe - Kellie Hypthesis

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10
Q

Hemostatic Mechanisms can increase MAP to support CPP despite increase in ICP. When these compensations fail, it results in?

A

Cerebral Ischemia

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11
Q

What is shown in this graph?

A

Monroe- Kellie Hypothesis

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12
Q

The intracranial vault is considered ________________.

A
  • compartmentalized
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13
Q

________ barriers seperate the brain contents

A

Meningeal barriers

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14
Q

Name (2) Meningeal Barriers

A
  • Falx cerebri
  • tentorium cerebelli
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15
Q

Name the dura that seperates the 2 cerebral hemispheres

A
  • falx cerebri
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16
Q

Name the dura that lies rostal to the cerebellum and marks the border btw supratentorial and infratentorial cerebelli

A
  • tentorium cerebelli
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17
Q

Increases in contents of one region of the brain causes regional _____ in ICP , and in extreme instance, the contents can herniate into a ________ __________.

A
  • increases
  • different compartments
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18
Q

Herniation syndromes are categorized based on

A
  • region of brain affected.
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19
Q

Name the Herniation:
* Herniates Hemispheric contents under the falx cerebri
* compressing branches of the anterior cerebral artery
* creates a midline shift

A

Subfalcine Herniation

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20
Q

Name the herniation:
* Herniation of supratentorial contents past the tentorium cerebelli
* brainstem compression in a rostal to caudal direction

A

Trantentorial Herniation

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21
Q

_____________ Herniation can cause AMS, defects in gaze and occular reflexes, hemodynamic and respiratory compromise and death.

A

Transtentorial

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22
Q

Name the Herniation:
* subtype of transtentirial herniation
* uncus hernates over the tenrorium cerebelli
* Results in ipsilateral oculomotor nerve dysfunction

A

Uncal Herniation

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23
Q

_____________ Herniation symptoms are pupillary dilation, ptosis, lateral deviation of affected eye, brainstem compression and death.

A

Uncal

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24
Q

Herniation of the ________________ can occur d/t elevated infratentorial pressure, causing cerenellar structure to herniate through the foramen magnum.

A

cerebellar tonsils

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25
Q

Hernaition of the ____________________can cause medullary dysfunction, cardiorespiratory instability and death.

A

cerebellar tonsils

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26
Q

Subfalcine causes a _________ shift.

A

*midline shift

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27
Q

Transtentorial Brain Hernation causes a ____________ down

A
  • subrtentoial down
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28
Q

Cerebellar Herniation shifts contents through _________ ___________.

A
  • formen magnum
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29
Q

Traumatic herniation can cause herniation out of ____________ cavity

A
  • cranial
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30
Q

Tumors, Hematomas, blood in CSF and infections can all cause an ________ ICP

A

Increased

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31
Q

Tumors lead to an _____________ ICP with their size, _______ surrounding brain tissue and by __________ CSF flow.

A
  • Increased
  • edema
  • obstructing
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32
Q

How can blood in CSF cause an increase ICP

A
  • ex: Subarachnoid hemorrhage
  • lead to obstruction of CSF reabsorption
  • granulations
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33
Q

Name (2) Infections that can cause an increased ICP

A
  • meningitis
  • encephalitis
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34
Q

Elevation of head, hyperventilation, CSF drainage, hyperosmotic drugs, diuretics, corticosteroids, cerebral vascostricting anesthetics (propofol) and surgical decompression can call cause a ______________ ICP.

A

Decreased

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35
Q

Elevation of the Head decreases ICP by _______ jugular venous outflow.

A
  • encouraging
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36
Q

hyperventilation causes a decrease in ICP by __________ PaCO2.

A
  • lowering PaCO2
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37
Q

Name (1) way to drain CSF to decrease ICP

A
  • External ventricular drain (EVD)
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38
Q

How can hyperosmotic drugs cause a decrease in ICP?

A
  • increase osmolarity
  • draws fluid across BBB
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39
Q

How can corticosteroids cause a decrease in ICP?

A
  • decrease swelling
  • enhances integrity of the BBB
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40
Q

These seven components are part of a _____________ Assessment:
* basic pathology for neurological disorder
* pt’s history, symptoms and baseline deficits
* imaging and available neurological results
* pts current drug and treatments
* evaluate risks/benefits of various anesthetic options
* pre-op optimize patients condition prior to anesthesia
* clear pre-op documentation and rational for anesthesia pains

A

Neurologic

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41
Q

Name the cause of Multiple Sclerosis

A
  • No know cause
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42
Q

___________ ___________ is a progressive, autoimmune demyelination of central nerve fibers.

A

Multiple Sclerosis (MS)

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43
Q

Onset of MS

A
  • 20 -40 years
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44
Q

Name (5) Risk Factors for Multiple Sclerosis

A
  • female
  • 1st degree relative
  • Epstein-Barr Virus (EBV)
  • other Autoimmune disorders
  • smoking
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45
Q

Multiple Sclerosis is characterized by periods of _______ and _________.

A

exacerbation and remissions

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46
Q

Name (3) Triggers for Multiple Sclerosis (MS)

A
  • stress
  • elevated temps
  • postpartum periods
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47
Q

Symptoms of ______ __________:
* motor weakness
* sensory disorders
* visual impairments
* autonomic instabolity
* symptoms vary d/t site of demyelination

A

Multiple Sclerosis

48
Q

There is no ________ for Multiple Sclerosis, but it can be treated with corticosteroids, ________________, and targeted antibodies.

A
  • No Cure
  • immune modulators
49
Q

MS Pre-Op Considerations

A
  • existing deficits
  • PFT
  • CBC, BMP, LFT
  • Pre-Op Steroids
50
Q

Why is temperature management important for MS?

A
  • increase in body temp can exacerbate MS symptoms
51
Q

Name (3) Anesthesia options for MS

A
  • GA
  • RA
  • PNB
52
Q

You want to avoid ________ in MS patients because of induced hyperkalemia d/t ____ N-ach receptors

A
  • Succinylcholine
  • upregulation N-ach receptors
53
Q

____________________ is an autoimmune disorder with antibodies generated against N-ACH Receptors at skeletal muscle endplates.

A

Myasthenia Gravis

54
Q

Myasthenia Gravis affects ________ muscles and is ________ with exercise.

A
  • Skeletal Muscles
  • Exacerbated with exercise
55
Q

Myathenis Gravis can cause ________ and ________ when it involves the Ocular Nerve

A
  • diplosia
  • ptosis
56
Q

Laryngeal/pharyngeal weakness, Repiratory insufficency and aspiration can occur with ________ involvement of Myasthenia Gravis?

A

Bulbar

57
Q

Thymic-hyperplasia is common in ____% of MG

A

10%

58
Q

Myasthenia Gravis Symptoms are exacerbated by

A
  • pain
  • insomnia
  • infection
  • surgery
59
Q

Myasthenia Gravis can be treated with Ach-E ________ (pyridostigmine), immunosuppressive drugs, steroids, ______________ and IVIG.

A
  • Ach-E inhibitors (pyridostigmine)
  • plasmapheresis
60
Q

Name (2) Types of Medications you need to use with caution in patient’s w/ MG

A
  • Paralytics: prolonged respiratory compromise
  • Opioids: Respiratory compromise
61
Q

What medication that you give an MG patient that will prolong Succinycholine and Ester LA’s?

A
  • Ach-E inhibitors
62
Q

What do you need to counsel MG patients on before they have surgery?

A
  • increased risk of needing post-op Respiratory support/ventilation
63
Q

____________________ is a disorder that causes developement of antibodies against VG calcium channels.

A

Eaton-Lambert Syndrome

64
Q

________ ________ can cause progressive limb-girdle weakness, dysautonomia, and oculobulbar palsy.

A

Eaton- Lambert

65
Q

> 60% of Eaton-Lambert cases area associated with

A
  • small cell lung carcinoma
66
Q

What Neurologic Disease is treated with:
* Selective K Channel blocker (3-4 diaminopyridine)
* Ach-E inhibitors
* immunologics (Azathiprine)
* steroids
* plasmapheresis
* IVIG

A

Eaton-Lambert

67
Q

Name the Lab that you need to check for any patient who is taking the immunologic Azathioprine

A

LFTs

68
Q

Name the medications that Lambert-Eaton Syndrome patient’s are very sensitive

A
  • Non-depolarizing NMB
  • Depolarizing NMB

more sensitive to ND-NMB than MG pts

69
Q

Extreme caution needs to be use with what (2) classifications of medications with Lambert-Eaton patients?

A
  • Parlytics
  • opioids
70
Q

What do you need to councel your Eaton Lambert Patients on before surgery?

A
  • Need of post-op respiratory support until fully recovered from anesthesia
71
Q

Name the prefered anesthesia for Lambert Eaton patients

A
  • Regional > General
72
Q

Muscular Dystrophy is a hereditary disorder of muscle fiber degeneration caused by the ________ of dystrophin-glycoprotein complex.

A
  • breakdown
73
Q

_________________ can lead to myonecrosis, fibrosis and skeletal muscle membrane permeability.

A

Muscular Dystrophy

74
Q

How many types of Muscular Dystrophy exist?

A
  • 6 types
75
Q

Name the most common and severe form of Muscular Dystrophy

A
  • Duchenne MD
76
Q

Summarization of Duchenne MD:
* boys
* onset ____ years
* wheelchair bound by ____ years
* dead by ____ d/t cardiopulmonary complications

A
  • onset 2-5 years
  • wheelchair bound by 8-10
  • dead by 20-25 d/t cardiopulmonary complications
77
Q

Symptoms of _________________ include:
* progressive muscle weakness w/out motor/sensory abnormalities
* kyphoscoliosis
* long bone fragility
* respiratory weakness
* frequent pneumonia
* EKG changes

A

Muscular Dystrophy

78
Q

Reason for an increased serum creatine kinase in MD patients.

A
  • Muscle Wasting
79
Q

________ syndrome can occur in MD patient when given succs and volatile anesthetics, that mimics Malignant Hyperthermia.

A
  • Hypermetabolic Syndrome
80
Q

Name the (4) conditions that Hypermetabolic syndrome can lead to

A
  • rhabdomyolysis
  • hyperkalemia
  • Vfib
  • cardiac arrest
81
Q

How is Hypermetabolic Syndrome treated?

A
  • Dantrolene
82
Q

Name the preferred anesthesia for patients with Muscular Dystrophy and Duchenne

A
  • Regional Anesthesia over General Anesthesia
83
Q

If General Anesthesia has to be given to a patient with Muscular Dystrophy, what is your plan?

A
  • TIVA and low dose rocuronium
84
Q

Name the (4) Types of Myotonic Dystrophies

A
  • Myotonia
  • Mytonic Dystrophy
  • Myotonia Congenita
  • Central Core disease
85
Q

_____________ is a prolonged contraction after muscle stimulation that is seen in several muscle disorders.

A

Myotonia

86
Q

________________ ____________ is the most common type of myotonia and onsets in 20-30 years.

A

Myotonic Dystrophy

87
Q

Myotonic Dystrophy Symptoms

A
  • muscle wasting in face, masseter, hand and pre-tibial muscles
88
Q

Name (3) specific muscle that Myotonic Dystrophy can affect

A
  • Pharyngeal
  • Laryngeal
  • diaphragmatic muscles
89
Q

____ % of Myotonic Dystrophy patients will have Mitral Valve Prolapse

A

20%

90
Q

______________________ is a milder form that involves skeletal muscles only. It spares the smooth and cardiac muscles.

A

Mytonia Congenital.

91
Q

________________ is very Rare and is characterizes by core muscles that lack mitrochondrial enzymes.

A

Central Cores Disease

92
Q

Central Core Disease symptoms are _______ muscle weakness and ___________.

A
  • Proximal muscle weakness
  • scoliosis
93
Q

Myotonias are triggered by ____________ and ___________ temperatures.

A
  • stress
  • cold temperatures
94
Q

Treatment of Myotonic Dystrophyies

A
  • No cure
  • Quinine
  • Procanamide
  • Steroids
95
Q

Anesthetic Considerations for Myotonic Dystrophies

A
  • Cardiac and pulmonary abnormalities
  • GI hypomotility -↑aspiration risk
  • Keep pts warm
96
Q

Myotonic Dystrophies are at a higher Risk for ________ abnormalities

A
  • endocrine
  • monitor thyroid and glucose levels
97
Q

Why would you avoid Succinylcholine in Myotonic Dystrophies

A
  • fasciculations trigger myotonia
98
Q

Myotonic Dystrophy patients are at an increased risk of what post-op?

A
  • Respiratory Weakness
99
Q

Name (3) Major Dementia Syndromes

A
  • Alzeheimers (70%)
  • Vascular Dementia (25%)
  • Parkinsons (5%)
100
Q

Dementia patient’s might have issue giving consent for surgery. What should you look for in their charts?

A
  • medical PoA
  • Advance Directives
101
Q

Name (3) medications a patient with Dementia might be on that can affect anesthetics

A
  • AchE-I
  • MAOI’s
  • psych meds
102
Q

Why would you consider a TIVA for Dementia patient’s?

A
  • ↑risk for post-op delirium with general anesthesia
103
Q

What are Dementia patient’s at a high risk for during intubation?

A
  • Aspiration
104
Q

What are we trying to avoid post-op by balancing anesthetics and opiods through Regional anesthesia or TIVA?

A
  • Post-Op delirium
105
Q

_________________ is a degeneration of dopaminergic fibers of basal ganglia.

A

Parkinsons Disease

106
Q

_________ regulates extrapyramidal motor system, which is stimulated by ACH and inhibits excess stimulation.

A

Dopamine

107
Q

The cause of Parkisons Disease is ______, but the biggest risk factor is _______ ____.

A
  • Unknown Cause
  • Advance age is the biggest risk factor
108
Q

Skeletal Muscle tremors, rigidity and akinesia are the Triad of Symptoms associated with ___________________.

A

*Parkinsons Disease.

109
Q

Motor neurons in Parkinson’s Disease are overstimulated and lack __________.

A
  • lack Dopamine
110
Q

Below are the classic symptoms of _____________.
* Rhythmic pill rolling
* facial rigidity
* slurred speech
* difficulty swallowing
* respiratory difficulty
* depression
* dementia

A

Parkisons

111
Q

Treatment for Parkinson’s Disease includes ___________ (crosses BBB), anticholinergics, MAOIs and __________________.

A
  • Levadopa (crosses BBB)
  • Deep Brain stimulator
112
Q

Parkinson’s Pre-anesthesia testing

A
  • pulmonary compromise
  • home meds
  • labs w/ PFTs
  • EKG and ECHO
113
Q

Parkinson’s patient are at an increased risk of ___________ during intubation due to _________ and possible _______________

A
  • aspiration
  • dysphasia
  • dementia
114
Q

Name the Parkinson’s Medication that needs to be continued to avoid unstable extreme extrapyramidal effects such as chest wall rigidity

A
  • PO Levadopa
115
Q

Name (4) Medications to avoid in Parkinson’s patients.

A
  • Reglan
  • Phenothiazines
  • Butyrophenones
  • Demerol – if on MAOI
116
Q

If your patient has a deep brain stimulator and cautery needs to be used, you should _________ the deep brain stimulator and use a ________ cautery.

A
  • disable
  • Bipolar cautery

Health Assessment Exam 3 (5 decks)

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