Skin & Musculoskeletal Dz Flashcards
The main anesthetic concerns in pts with _________ center on the serious complications that can occur if proper precautions are not taken during any form of pt manipulation or instrumentation
Epidermolysis bullosa
Anesthetic concerns for epidermolysis bullosa:
Avoidance of trauma to the skin & mucous membrane is crucial;
Bulla formation can be caused by trauma from tape, BP cuff, tourniquets, adhesive electrodes, & rubbing of skin with alcohol wipes;
BP cuffs should be padded w/ a loose cotton dressing;
Electrodes should have the adhesive portion removed (petroleum jelly guaze to hold in place);
Anything that touches a pt should be well padded;
IV and art lines should be sutured in place or guaze wraps;
Nonadhesive pulse ox;
Place soft foam, sheepskin, or gel pad under pt
H1 & H2 receptor antagonist should be given preop to decrease clinical response to histamine relaese in ________?
Mastocytosis
What drugs should be avoided with mastocytosis? Why?
Morphine, benzylisoquiniloniums. B/c they stimulate histamine release
All pts with chronic urticaria should be advised to avoid which drugs?
ACE inhibitors, aspirin, & NSAIDs
Scleroderma is characterized by what 3 interrelated processes?
1) inflammation and autoimmunity;
2) vascular injury w/ eventual vascular obliteration;
3) fibrosis and accumulaiton of excess matrix in many organs & tissues
CREST syndrome a/w scleroderma
Calcinosis, Raynaud’s phenomenon, Esophageal hypo motility, Sclerodactyly, Telangiectasia
A connective tissue disorder d/t defects in large glycoprotein fibrillin-1 inherited as autosomal dominant . Pts have long tubular bones and an “Abe Lincoln” appearance
Marfan Syndrome
What is the main cause of all premature deaths in pts with Marfan syndrome?
Cardiovascular abnormalities
Management of anesthesia must consider the vulnerability of pts with polymyositis to _____
Pulmonary aspiration
Are NDNMBs and sux safe with polymyositis?
Responses are normal, however w/ skeletal muscle weakness there is concern. Give half dose and check tiwtches before giving more
A group of hereditary diseases characterized by PAINLESS degeneration of muslce fibers
Muscular dystrophy
What age does duchenne muscular dystrophy become apparent?
2-5 yr old boys
Children with duchenne muscular dystrophy are typically confined to a wheelchair by ______
8-10
Intellectual disability is often present with which muscular disorder?
Duchenne muscular dystrophy
_________, __________, & ________ are not able to prevent or relieve skeletal muscle contraction with myotonic dystrophy
General anesthesia, regional anesthesia, & nueromuscular blockade
The inability of skeletal muscle to relax after voluntary contraction or stimulation results from _______? (Myotonic dystrophy)
Abnormal calcium metabolism
Hereditary degenerativ diseases of skeletal muscle characterized by persistent contracture after voluntary contraction of a muscle or following electrical stimulation
Myotonic dystrophy
A decrease in functional ACh receptors at the NMJ resulting from their destruciton or inactivation by circulating antibodies leading to marked sensitivity to non-depolarizing muscle relaxants
Myasthenia Gravis
Who are most often affected by MG?
Women aged 20-30; men are often older than 60
The clinical course of MG is marked by?
Periods of exacerbation & remission
________, especially ________ can aggravate muscle weakness a/w MG
Antibiotics, aminoglycosides
Anticholinesterase drugs effective in the treatment of MG do NOT produce improvement in which pts?
Eaton-Lambert Syndrome (myasthenic syndrome)
Proximal limb weakness (legs > arms), exercise improves strength, muscle pain common, reflexes absent or decreased;
Affects males more than females;
Co-exists w/ small cell lung cancer;
Sensitive to Sux & NDNMB w/ poor response to anticholinesterase
Myasthenic Syndrome
