Neuromuscular (Exam III) Flashcards
Multiple Sclerosis pathophys
progressive, autoimmune demylelination of central nerve fibers
onset of MS
20-40
risk factors for MS
1st degree relative
EBV
other autoimmune disorders
smoking
triggers for MS
stress
elevated temps
postpartum period
s/s of MS
motor weakness, sensory disorders, visual impairment, autonomic instability
varies based on site of demyleination
treatment for MS
no cure
managed by corticosteroids, immune modulators, targeted antibodies
pre-anesthetic considerations for MS
assess existing deficits
if respiratory compromise - consider PFTs
Labs: CBC with platelets, BMP w/wo LFT
consider preop steroids
temperature management is crucial
avoid succinycholine
why might you draw a BMP with LFT on a MS patient
on dantrolene and azathioprine - causes bone marrow suppression, liver function impairment
*close attention to glucose and electrolyes as steroids may impact levels
what anesthetic plan might you have for a MS patient
General, regional, peripheral nerve block are acceptable options
what RSI agent would you avoid in MS
succinycholine - may induce HyperK+
what might hyperthemia do to an MS patient
preciptate an exacerbation of MS symptoms
when is maysthenia gravis (MG) muscle weakness exacerbated
w/ exercise
thymic hyperplasia in myasthenia gravis is common at _____% with _____% of patients improving with thymectomy
thymic hyperplasia in myasthenia gravis is common at 10% with 90% of patients improving with thymectomy
what can cause symptom exacerbation with myasthenia gravis
pain, insomnia, infection, surgery
treatment of myasthenia gravis
ACh-E inhibitors (pyridostigmine), immunosuppressive agents, steroids, plasmapharesis, IVIG
*90% of patients improve with thymectomy
MG preanesthetic considerations
assess existing deficits
if respiratory compromise, consider PFTs
optimize respiratory function
Labs: CBC, BMP +/- LFT
counsel pt on increased risk of postop vent support until fully recovered from anesthesia
4 medication considerations with MG
reduce NMB dose to avoid prolonged muscle weakness
caution with opioid to avoid respiratory compromise
ACh-E inhibitors prolong succinycholine and ester LAs (X-caine)
preop steroid with anyone on long term steroids
when would you add an LFT to MG chem panel
if the patient is on azathiporine
eaton-lambert syndrome pathophysiology
autoantibodies against VG Ca++Channels
-reduce Ca++ influx decreasing ACh release
60% of eaton lambert syndrome cases are associated with what
small cell lung carcinoma
s/s of Eaton Lamber Syndrome
progressive limb-girdle weakness, dysautonomia, oculbulbar palsy
treatment for eaton lambert syndrome
Selective K+ channel blocker
“3-4 diaminopyridine”
ACh-E inhibitors
Aziathioprine (immunologics)
Steroids
Plasmapheresis, IVIG
preanesthetic considerations for ELS (Eaton Lambert Syndrome)
assess exsisting deficits
if respiratory compromise - PFTs
optimize respiratory functoin
*extreme caution with NMB and opioid dosing
may need post-op respiratory support until fully recovered from anesthesia
ELS and neuromuscular blockers
VERY SENSITIVE to ND-NMB and D-NMB
*significantly more sensitive to ND-NMB than MG patients