Spinal cord 3

Question 1

A patient with a two-year-old C7 spinal cord transection presents for cystoscopy under general anesthesia. Insertion of the cystoscope causes the heart rate to decrease from 75 to 30 bpm. Which statements are MOST likely to be true? (select 2)
a. ephedrine is a better option than atropine
b. nitroprusside is a better option than hydralazine
c. the patient is at risk for intracerebral hemorrhage
d. the Bezold-Jarisch reflex caused the heart rate to decrease

Answer 1

b. nitroprusside is a better option than hydralazine
c. the patient is at risk for intracerebral hemorrhage

Question 2

After the spinal shock phase ends, there’s a return of _________________ below the level of injury which places the patient at risk for ________

Answer 2

sympathetic reflexes; autonomic hyperreflexia

Question 3

The classic presentation of autonomic hyperreflexia is

Answer 3

hypertension and bradycardia

Question 4

Up to 85% of patients with injury above _____ will develop autonomic hyperreflexia.

Answer 4

T6

Question 5

Select conditions that increase the risk of autonomic hyperreflexia include

Answer 5

bladder catheterization, surgery (cystoscopy, colonoscopy), bowel movement, cutaneous stimulation, and childbirth

Question 6

The best anesthetic option for patients with spinal cord injury is

Answer 6

general or spinal anesthesia to prevent autonomic hyperreflexia

Question 7

Hypertension resulting from autonomic hyperreflexia is best treated by

Answer 7

removing the stimulus, deepening the anesthetic, and administering a rapid-acting vasodilator

Question 8

Bradycardia from autonomic hyperreflexia can be treated with

Answer 8

an anticholinergic

Question 9

Autonomic hyperreflexia is very unlikely to occur in patients with an injury below

Answer 9

T10

Question 10

Describe how autonomic hyperreflexia affects the vascular system.

Answer 10

vasoconstriction below the level of injury
vasodilation above the level of injury

Question 11

Administration of _________ will worsen hypertension

Answer 11

positive chronotrope with vasoconstrictive properties

Question 12

__________________ to the cystoscope or foley catheter does not prevent AH.

Answer 12

adding lidocaine jelly

Question 13

___________ is contraindicated in patients with chronic SCI

Answer 13

succinylcholine

Question 14

AH may be present in

Answer 14

the postoperative period as the effects of anesthesia wear off

Question 15

Consequences of amyotrophic lateral sclerosis include all of the following EXCEPT:
a. hyperkalemia with succinylcholine
b. cardiomyopathy
c. risk of pulmonary aspiration
d. increased sensitivity to nondepolarizing neuromuscular blockers

Answer 15

b. cardiomyopathy

Question 16

ALS causes progressive degeneration of

Answer 16

motor neurons in the corticospinal tract (sensory function remains intact)

Question 17

The most common cause of death in ALS patients is

Answer 17

respiratory failure

Question 18

_________ is contraindicated in patients with ALS

Answer 18

Succinylcholine due to risk of lethal hyperkalemia

Question 19

Patients with ALS have _____________ to nondepolarizing neuromuscular blockers

Answer 19

increased sensitivity

Question 20

___________- increases the risk of pulmonary aspiration for patients with ALS

Answer 20

bulbar muscle dysfunction

Question 21

Chest weakness in patients with ALS leads to

Answer 21

reduced vital capacity and maximal minute ventilation

Question 22

For patients with ALS, we should consider ______________ postoperatively

Answer 22

mechanical ventilation

Question 23

Upper neuron involvement with ALS presents as

Answer 23

spasticity, hyperreflexia and loss of coordination

Question 24

Lower motor neuron involvement with ALS presents as

Answer 24

muscle weakness, fasciculations, and atrophy