Pathyophys final review part 3 Flashcards
What product carries the lowest risk for patients with hemophilia A?
desmopressin b/c it is synthetic rather than cryo and factor concentrates as they carry risk of infectious disease transmission
FFP contains
all of the clotting factors
does not have RBCs/Hgb so it does not increase oxygen carrying capacity & is not indicated for plasma volume augmentation
Cryoprecipitate contains
fibrinogen, VII, XIII, and vWF
Treatment of vWF can contain
desmopressin, factor VIII, cryo, & FFP
Erythropoietin is formed in the
kidneys
Methemoglobinemia producing oxidizing agents include
LAs, nitrates, & nitric oxide
nitrous oxide does not produce methemoglobinemia
Methemoglobinemia is a disorder characterized by
the presence of >1% metHb in the blood
methemoglobin is an oxidized form of hemoglobin (contains Fe3+ in place of Fe2+ in Hb) & has slightly greater affinity for oxygen due to its chemical structure
Double vision and worsening weakness can be indicative of
myasthenia gravis
The treatment of choice for myasthenia gravis is
anticholinesterase inhibitors
Describe the use of paralytics for patients with myasthenia gravis.
sensitive to rocuronium, resistant to succinylcholine
Anesthetic management of a patient with mitochondrial disease includes
no need to reduce opioid requirements regional & locals are controversial avoid nitrous LR & propofol infusions can still use volatiles Ketamine> propofol for induction
______ should be avoided in patients with Parkinson’s
metoclopramide- dopamine antagonist
Any condition that decreases oxygen transport to tissues will stimulate
erythropoietin
Chronic blood loss is the result of
inability to absorb enough iron from the gut to make hemoglobin as rapidly as it is lost
Acute blood loss.
body replaces fluid portion of plasma in 1-3 days
RBCs within 3-6 weeks
There is clear evidence to support hemoglobin levels below ________ benefit from transfusion
6 mg/dL
The lifespan of RBCs is
120 days
Blood tests for hemolytic anemia include
increased immature erythrocytes, unconjugated hyperbilirubinemia/jaundice, increased lactate dehydrogenase, decreased haptoglobin
For patients with sickle cell, blood transfusion
before surgery desires more HbA than HbS
The sickle cell trait
does not increase morbidity & mortality
With erythroblastosis fetalis, the fetus is
RhD-antigen positive and the mother is RhD antigen negative
Rhesus factor is
a protein found on the surface of RBCs (antigen)
Anesthetic risks for development of hemolysis for patients with G6PD deficiency includes
metoclopramide
penicillin
sulfa
methylene blue
Concentrated polycythemia is a result of
dehydration, diuretics, or vomiting
Physiologic polycythemia
does not result in symptoms
its an environmental adaption
Polycythemia vera may be as high as 60-70% instead of normal & many die from
thrombus complications
Hemoglobin A is made up of
2 alpha & 2 beta
Methemoglobin is formed when
the iron in HB is oxidized from the ferrous (Fe2+) to the ferric (Fe3+) state
_________ is contraindicated in someone with G6PD deficiency
methylene blue
Anesthesia management for the patient with thalassemia includes
risk of difficult intubation due to oro-facial malformations, risk for infection-broad spectrum antibiotics, DVT prophylaxis, blood bank alerted that patient has thalassemia
Sickle cell disease is when
the amino acid valine is substituted for glutamic acid at one point in each of the 2 beta chains
Factor VIII level should be brought to at least
> 50% prior to surgery
The half life of factor VIII is approximately
12 hours in adults, 6 in children
The treatment for hemophilia can include
FFP, cryo, TXA, desmopressin, & factor VIII concentratie
Treatment for vWF includes
FFP, cryo, & factor concentrate
Causes of DIC include
sepsis, burns, trauma, & obstetric complications
Blood tests in DIC show
low platelets, low fibrinogen, high INR & PT, High PTT, high d-dimer
In presenting hyperfibrinolysis DIC
give TXA with blood products
In presenting procoagulant DIC
consider anticoagulation first & blood product support for bleeding or invasive procedures
Upper motor neurons are
motor pathways that begin in the cerebral cortex & end in the ventral horn of the spinal cord
The corticospinal tract
supplies the voluntary muscles of the trunk & extremities
75-90% of the corticospinal tract
decussates in the medulla & forms the lateral corticospinal tract
The corticobulbar tract
supplies the voluntary muscles of the head & follows the corticospinal tract until they reach the brainstem
Lower motor neurons are
located in the brain stem or spinal cord
Lower motor neurons send axons out through
nerves in the peripheral nervous system to synapse & control skeletal muscles
The lower motor neurons that pass through the spinal nerves
primarily control muscles of the limbs & the trunk
The lower motor neurons that pass through cranial nerves
primarily control the skeletal muscles of the head & neck
The upper motor neuron motor cortex is
muscle groups affected
minimal disuse muscle atrophy
hypertonia
spasticity & babinski
The lower motor neuron cortex involves
individual muscles may be affected marked muscle atrophy fasciculations decreased muscle stretch reflex hypotonia flaccidity
Cerebral palsy does not
cause progressive intellectual disability
This type of anesthetic technique should be avoided for patients with MS
spinal
Succinylcholine should be avoided in patients with
MS, Huntington’s & LEMs
Treatment for myasthenia gravis includes
cholinesterase inhibitor
The difference between Duchenne’s & Becker’s is
the age of diagnosis
