Neuromuscular - Co- Existing Flashcards
1
Q
SLE Anesthesia Managment:
- PreInduction: consider meds? infection/preg/position
- Induction: meds?
- A/w management (3?)
- Consider drugs to AVOID in ?
A
- steroids
- no one ideal agent, myocardial sparing drugs (propfol, etomidate, ketamine, versed = good)
- cricoaryternoid arthritis, mucosal ulceration, RLN palsy
- renal failure
2
Q
RA Anesthetic Considerations:
- Joints/Limitations?
- Concerns with A/W?
- Preop Imaging - Xray/CT
- Document - Preop?
- If difficult a/w then?
A
- TMJ, cricoarytenoid joint (use smaller tube) and cervical spine
- difficult intubation and DVL (use cervical collar)
- neuro fxn
- awake fiberoptic
3
Q
RA and Anesthetic Considerations?
PreInduction
- CV involvement? - Tx influences managment?
- Resp involvement? - Positioning?
A
- arrhythmias, aortic insuff- consult
- RLD - post op vent, ABGs
- Steroids, ASA, NSAIDs, immune supressants, hepatic and renal dysfxn
- minimize compression risk and injury
4
Q
Osteoarthritis - Anesthesia Management:
- Tx =?
- affects what important joints?
- consider drug tx and concerns?
A
- ASA and NSAIDs (no steroids)
- knee, hip, cervical/lumbar spine - hard to place epidural
- bleeding
5
Q
MG: Anesthetic Considerations:
Induction:
* consider drug therapy? * A/W considerations?
* case scheduled for? * Hold drug on AM of surgery?
* premed: consider? * Use short acting induction meds?
A
- steroid therapy
- first case of the day
- muscle weakness
- aspiration risk / RSI
- hold pyridiostigmine
- propofol or TPL
6
Q
MG: Anesthetic Concerns Induction: *Opioids? *IAs? * MRs- succs vs NMDRs? * Best Reversal?
A
- limited use
- IA good for induction and maintenance
- resistant to succs/sensitive to NMDRs
- edrophonium
7
Q
MG: Extubation
- RA with GA?
- needs to be responsive/full reversal
- monitor in PACU/resume pyridostigmine
A
- good choice for thymectomy
8
Q
Myasthenic Syndrome:
- Tx: med?
- muscle weakness?
- MRs?
A
- aminopyridine
- proximal
- sensitive to succs and NDMRs
9
Q
Muscular Dystrophy: Anesthetic Considerations?
- Induction
1. intubation? 4. AVOID? 7. RA? y or n?
2. IAs: cardiac effects? 5. consideration for NDMRs?
3. susceptible to? 6. Post op pulm dysfunction
A
- delayed gastric emptying = RSI
- prone to myocardial depressant effects
- MH
- Succs
- prolonged response
- RA okay
10
Q
Anesthetic Concerns: Marfan’s
- lung dz severity?
- meds to reduce CV workload? 5. med prophylaxis?
- A/w management?
- Preop focus?
A
- RLD (kyphoscoliosis, pneumo)
- BB
- high palate (vent/oxygenate)
- CV involvement
- antibiotics (endocarditis)
11
Q
Anesthetic Concerns: Marfan's Induction: 1. Intubation: AVOID? 2. DVL? 3. r/o?
A
- extreme mvmt of mandible
- smooth/avoid SNS stim
- pneumothorax
12
Q
Ankylosing Spondylitis - Considerations?
- hallmark sign? 5. treatment?
- effects?
- cardiac involvement?
- pulm involvement?
A
- sacroiliac joint pain (improves with mvmt)
- lumbar spine -> ascends to upper back and neck
- conduction issues
- RLD
- NSAIDs, methotrexate, spinal fusion
13
Q
Ankylosing Spondylitis - Anesthetic Considerations?
- RLD
1. consider regional?
2. Intubation?
3. Induction goals?
A
- hard to place epidural into fused space
- awake fiberoptic
- controlled vent & maintain SVR
14
Q
Achondroplasia: Anesthesia Management
- difficult a/w? 3. temp dysfxn?
* OSA, central sleep apnea *hydrocephalus
* facial feature *no change to response to IA/MRs - Pulm picture?
A
- upper a/w obstruction, unable to expose glottis, small a/w
- RLD
- prone to hyperthermia
15
Q
Anesthesia Management for SLE:
- consider organ dysfxn - renal, liver (drug clearance), cardiopulm
- CNS involvement - sz or stroke, neuropathies
- consider ? for surgery
A
- stress dose steroids
