Neuromuscular Flashcards
Molecule that works on motor neuron
Calcium
Molecule that works at NMJ/synapse
Acetylcholine
Action at nicotinic muscle fiber end plate
Na/Ca in
K out
Duchene MD characteristics
-X linked
-Degenerative muscle loss, fat replaces muscles
-Leads to CHF, resp. failure, cognitive dysfunction
Muscular Dystrophy Anesthesia
-Avoid Succinylcholine & volatiles (rhabdo)
-sensitive nondepolarizers (1/2 dose)
-Be aware of hyperkalemia
-NO MH correlation
-postop intubation risk
Myotonic Dystrophy characteristics
-delayed relaxation of muscles
-ion channel dysfunction
-calcium metabolism dysfunction
-type 1 worst
Myotonic Dystrophy Anesthesia
-avoid Succinylcholine (exaggerated contraction & muscle wasting)
-sensitive nondepolarizers (1/2 dose)
-cold, pain, stress worsens
-use suggamadex, neostigmine may make worse
-regional okay
Myasthenia Gravis
-autoimmune
-more females
-skeletal muscle weakness
-treated with cholinesterase inhibitors
-associated with thymoma
Myasthenia Gravis anesthesia
-resistant to Succinylcholine
-sensitive to nondepolarizers
-avoid paralytics, use volatiles
-neostigmine reversal not predictable
-regional okay
Eaton-Lambert characteristics
-autoimmune
-more males
-associated with small lung cells cancer
-antibodies against voltage gated Ca channels
-lack if Ach
-proximal limb weakness
Eaton-Lambert anesthesia
-sensitive to Succinylcholine and nondepolarizers
-use suggamadex, anticholinesterase less effective
ALS characteristics
-Degenerative, progressive muscle weakness
-tachycardia, orthostatic
-respiratory failure
ALS anesthesia
-sensitive nondepolarizers and Succinylcholine(never give)
-avoid regional d/t nerve damage
Mitochondrial myopathies characteristics
Respiratory dysfunction
Decreased cardiac function
Metabolic dysfunction
Mitochondrial myopathies anesthesia
-keep well oxygenated
-avoid hypovolemia
-avoid tourniquets
-encourage caloric clear liquids
-IVF with dextrose (NO LR)
-sensitive nondepolarizers and Succinylcholine(never give)
-regional okay
