Quiz 1 Flashcards
What drug may cause a modest transient increase in ICP?
succs
What do you want to ensure before laryngoscopy for a crani and why?
adequate depth of anesthesia and profound skeletal muscle paralysis to prevent noxious stimulation or movement that can increase BF, CBV, ICP
Why might you use propofol or barbiturates to induce a crani patient?
decreases CMR, CBF, CBV and ICP; can be used to induce isoelectric EEG
What may be a downside to using propofol or barbiturates for induction of a crani patient?
can cause hypotension (decreased perfusion)
When would you avoid using etomidate in a crani patient?
if you suspect cerebral vasospasm or other conditions associated with cerebral ischemia- also higher rate of PONV
What does etomidate do to CMR and ICP?
dose dependent decreases
What does ketamine do to CBF, CMR, and ICP?
increases all
Do opioids have a significant effect on cerebral physiologic parameters?
no, as long as MAP is maintained
If you use remi for induction for a crani, what should you also use?
infusion of remi to avoid abrupt offset and resultant HTN and tachycardia
Why might you use lidocaine for a crani patient?
suppress cough reflex during laryngoscopy and blunt hemodynamic response
Why might you avoid atracurium and mivacurium as your NDMRs for induction during a crani?
cause histamine release and may cause reduction in CPP from decreased MAP and increased ICP
How can you offset the transient rise in ICP while using succs?
give defasciculating dose of NDMR
In an adult, describe the distribution of the “rule of 9s”
anterior+posterior head: 9% anterior torso: 18% posterior torso: 18% each anterior leg: 9% each posterior leg: 9% anterior+posterior arm: 9% genitalia/perineum: 1%
In a child, describe the distribution of the “rule of 9s”
anterior head: 9% posterior head: 9% anterior torso: 18% posterior torso: 18% each anterior leg: 6.75% each posterior leg: 6.75% anterior+posterior arm: 9% genitalia/perineum: 1%
Identify the subdural vs epidural bleed
How much cardiac output does the brain receive?
15%
What is normal total CBF?
50 ml/100 g/min
CBF parallels ?
metabolic activity
What are the 5 determinants of CBF?
CMR, CPP, venous pressure, PaCO2, PaO2
What is the order of CSF flow?
choroid plexus -> lateral ventricles -> foramina of monroe -> 3rd ventricle -> aqueduct of sylvius -> fourth ventricle -> foramina of luschka and magendie -> subarachnoid space -> brain -> arachnoid villi
What is the Parkland formula?
fluid resuscitation for burns: 4 ml x weight in kg x % of burn give half over 8 hours and the second half over 16 hours
What kind of fluids should you avoid in the 1st 24 hours of thermal injury?
colloids
What is the detection window for alcohol?
2-12 hours
What is the detection window for benzos?
72 h
What is the detection window for cocaine?
48-72 hours
What is the detection window for meth?
48 hours
What is the detection window for heroin?
48 hours
What is the detection window for methadone?
72 hours
What is the detection window for prescription opioids?
6-96 hours
What is the detection window for marijuana?
7 days to 2 months with chronic use
What is the detection window for ecstasy?
48 hours
What is the detection window for LSD?
36-96 hours
What is the detection window for PCP?
8-14 days
What is the detection window for ketamine?
7-14 days
What is the detection window for y-hydroxybutyric acid (date rape drug)?
12 hours
What are your anesthetic considerations for myasthenia gravis?
reduce dose of succs (may be on AChE drugs), reduce dose of NDMRs, caution with respiratory depressants
What is myasthenia gravis?
autoimmune destruction of postsynpatic ACh receptors- generalized muscle weakness and myocarditis
What is muscular dystrophy?
X linked recessive disorder- absent dystrophin- disruption of outer muscle membrane that leads to weakening and muscle wasting
What are some anesthetic considerations for muscular dystrophy?
avoid succs (can cause exaggerated K release), increased sensitivity to NDMRs, increased incidence of MH, delayed gastric emptying, exaggerated response to inhaled agents, check cardiac function
What is Parkinson’s disease?
degenerative disorder of CNS that affects motor function and speech- decreased dopamine in substantia nigra in basal ganglia (imbalance between inhibitory dopamine and excitatory ACh)
What are some anesthetic considerations for Parkinson’s?
continue pharm therapy throughout periop period, avoid drugs that reduce dopamine (phenergan, metaclopramine, droperidol), may use anticholinergics for tremor, may have severe hypo/hypertension on induction, use direct acting pressors as opposed to indirect; NMBs usually unaffected
What is Alzheimers?
neurodegenerative disease- fewer nicotinic cholinergic receptors and reduced ACh
What are some anesthesia considerations for Alzheimers?
anesthesia may worsen preexisting dementia, avoid sedative drugs, avoid centrally acting anticholinergic drugs (glyco is safe to use because ionized), may be taking AChE that influence NDMRs
What is Huntington’s?
mutant Huntington results in neuronal cell death- uncoordinated jerky movements and decline in mental abilities
What are anesthetic considerations for Huntington’s?
can use droperidol or haldol for preop sedation, may have increased sensitivity to succs and NDMRs, prevent shivering
What is cerebral palsy?
upper motor neuron dysfunction related to anoxic cerebral damage
What are anesthetic considerations for cerebral palsy?
intubation is required (decreased laryngeal reflexes and GERD), succs is okay, avoid hypothermia
What are some anesthetic considerations for denervation injury?
use direct arterial dilators and alpha blockers (have nipride and nitro readily available), use nondepolarizers over succs (which can cause K release)
What is multiple sclerosis?
autoimmune disease characterized demyelination and axonal damage
What are some anesthetic considerations for MS?
may have exaggerated response and K release to succs, may have prolonged response to NDMRs, spinal anesthesia may cause exacerbation, avoid increases in body temperature
What is GBS?
autoimmune disease where the body’s immune system attacks the peripheral nervous system, often after virus
What are anesthetic considerations for GBS?
avoid succs (hyperkalemia), sensitive to NDMRs, may need stress dose steroids, expect labile autonomic nervous system function (A-line)
What are some concerns for all neuromuscular diseases?
respiratory dysfunction, risk of aspiration, delayed gastric emptying
