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Autonomic Nervous System > Sympathetic Nervous System > Flashcards

Sympathetic Nervous System Flashcards

1
Q

Peripheral collection of nerve cell bodies

A

Ganglion

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2
Q

Number of paired sympathetic ganglia

A

22

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3
Q

SNS preganglionic pathway to sympathetic chain

A

Myelinated B fibers exit spinal cord via ventral nerve roots > white communicating rami > sympathetic chain

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4
Q

Preganglionic sympathetic axons (C fibers) that traverse uninterrupted through the sympathetic trunk form____

A

Splanchnic nerves

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5
Q

Collection of plexuses that surrounds the abdominal aorta

A

Abdominal prevertebral plexus

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6
Q

Abdominal prevertebral plexuses

A

Celiac plexus
Aortic plexus
Superior hypogastric plexus
Inferior hypogastric plexus (pelvic)

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7
Q

Location of cell bodies of preganglionic sympathetic fibers

A

Interomediolateral horn of the spinal cord (Rexed’s lamina 7)

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8
Q

Inferior cervical ganglion + T1 ganglion

A

Stellate (cervicothoracic) ganglion

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9
Q

SNS innervation of the stellate ganglion

A

Ipsilateral head, neck, and upper extremity

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10
Q

Indications for blocking stellate ganglion

A

Treatment of:
Upper extremity sympathetic dystrophy
Complex regional pain syndrome
Increase blood flow to the upper extremity
Provide relief from intractable post-MI pain

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11
Q

Horner’s syndrome symptoms

A

Ipsilateral ptosis, miosis, anhidrosis, flushed skin, nasal congestion, and enopthalmos

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12
Q

Alternate name for adrenal glands

A

Surarenal glands

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13
Q

Two divisions of adrenal glands

A

Medulla
Cortex

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14
Q

Adrenal medulla function

A

Secretes catecholamines

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15
Q

Adrenal cortex function

A

Secretes glucocorticoids, mineralcorticoids, and androgens

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16
Q

Autonomic innervation of adrenal glands

A

Preganglionic sympathetic nerves T5-T9

No postganglionic nerves

17
Q

Mechanism of adrenal stimulation

A

Preganglionic fibers release ACh onto chromaffin cells > NnACh receptor stimulaiton > chromaffin cells release epinephrine and norepinephrine directly into circulation

18
Q

Rate/ ratio of catecholamine release from adrenal medulla at rest

A

Epi: 0.2mcg/ kg/ min (80%)
NE: 0.05mcg/ kg/ min (20%)

19
Q

Catecholamine- secreting tumor usually arising from the adrenal gland or extra chromaffin tissue

A

Pheochromocytoma

20
Q

Pheochromocytoma triad of symptoms

A

Headache
Diaphoresis
Tachycardia

21
Q

Pheochromocytoma diagnostic

A

Elevated level of VMA

22
Q

Pheochromocytoma preoperative treatment

A

Alpha blockade THEN beta blockade

23
Q

Non-selective alpha blockers

A

Phenoxybenzamine
Phentolamine

24
Q

Alpha-1 selective blockers

A

Doxazosin
Prazosin

25
Q

What happens if beta is blocked before alpha in the presence of pheochromocytoma?

A

Heart failure

26
Q

Anesthetic considerations for pheochromocytoma removal surgery prior to tumor ligation

A

Treat hypertension
Treat tachycardia
Monitor serum glucose throughout (anticipate hyperglycemia)

27
Q

Intraoperative/ preoperative treatments for htn in patients undergoing pheochromocytoma removal surgery

A

Sodium nitroprusside
nitroglycerine
Clevidipine
Nicardipine
Deepening anesthetic

28
Q

Intraoperative/ preoperative treatments for tachycardia in patients undergoing pheochromocytoma removal surgery

A

Short-acting beta blockers like esmolol (caution with cardiomyopathy)

29
Q

Intraoperative/ preoperative considerations following removal of a pheochromocytoma

A

Hypotension = tx with phenylephrine, NE, vasopressin, or IVF

Consider steroid supplementation if both adrenal glands were removed or manipulated during surgery

30
Q

Drugs to avoid in pheochromocytoma removal surgery

A

Histamine- releasing drugs (succinylcholine, atracurium, mivacurium, morphine)

Indirect-acting sympathomimetic agents

SNS activators: desflurane, ketamine, pancuronium, naloxone

31
Q

SNS activation effects on serum glucose and potassium

A

Stimulates hepatocytes to release more glucose and potassium

32
Q

SNS activation effects on insulin

A

Stimulates pancreatic beta cells to increase insulin output

33
Q

Two phases to K+ response to SNS stimulation

A

Initial rise (short-lived)

Longer term effect is decreased K+

34
Q

Why does K+ decrease with SNS stimulation

A

Adrenal medulla secretes catecholamines > epi binds to beta-2 receptors on skeletal muscle and erythrocytes = Na+/K+ pump activation = decrease in K+ concentration

35
Q

Factors that impact serum K+ concentration

A

Beta-2 agonism (Epi, albuterol)

Methylxanthines (Theophylline)

Nicotinic type-M agonism (succinylcholine)

Destruction of cell membranes (rhabdomyolysis)

Activating H+/K+ exchanger (acidosis)

Hyperventilation (alkalosis)

Activating the Na+/ K+ exchanger (Epi, insulin)

Autonomic Nervous System (13 decks)

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