Peds Scoliosis / DMD Flashcards
1
Q
What is Cobb angle? What does it mean with different angles?
A
- Cobb angle used to measure severity of scoliosis
- measure of angle of perpendicular lines from upper surface of most cephalad tilted vertebrae and the lower surface of the most caudad tilted vertebrae
- 10+ = abn
- 40 - 50+ = abn and surgery needed
- 60 - 65+ = pulm dysfunction
- 70+ = pulm HTN during exercise
- 110 + = pulm HTN at rest
2
Q
What is DMD?
A
- X- linked recessive, mutation of dystrophin gene
- Dystrophin connects the actin cytoskeleton of each muscle fiber to extracellular matrix. No dystrophin = excess calcium penetrates the sarcolemma and bursts mitrochondria
- need to avoid sux and inhalational, does not cause MH, but can cause rhabdo, hyperK, muscle rigidity, myoglobinuria, arrhythmias, cardiac arrest
3
Q
What concerns you about providing anesthesia to patient with DMD?
A
- DMD a/w macroglossia, difficulty swallowing –> increased risk of aspiration
abn production of dystrophin causes - cardiomyopathy
- ventricular dysrhythmias
- mitral regurg 2/2 replacement of myocardium with fat
- decreased pulm reserves
- chronic aspiration 2/2 impaired laryngeal reflexes
- sleep apnea –> pulm HTN
4
Q
What concerns you about providing anesthesia to patient with kyphosis?
A
chest wall abn --> impaired pulm development restrictive lung dx decreased chest wall compliance V/Q mismatching all leading to pulmHTN and RHF
5
Q
What monitors do you need for scoliosis surgery?
A
- art line
- CVC and PAC
- SSEP, MEPs
- precordial doppler on R of sternum between 2nd and 4th ribs for detecting VAE (can aspirate air with CVC)
6
Q
How should patient be positioned for scoliosis surgery?
A
- minimize pressure on abdomen which causes increased shunting of blood through vertebral venous plexus and increases venous bleeding during procedure
- pad ulnar nerve and direct pressure
- be aware of contractures and limitations in ROM when positioning
