Test 3 part 3 Flashcards
_________________ is due to the degeneration of nervous tissue in the spinal cord, particullary with sensory neurons connected with cerebellum. this is often associated with kyphoscoliosis
freidreichs ataxia
what laboratory tests may be done for pt with kyphoscoliosis presenting for surgery?
CBC, BMP, UA
type and screen
for patients with severe scoliosis presenting for major surgery it is reasonable to consider ___________ and _________ tests
PFTs; ABG
anesthesia considerations for pts with kyphoscoliosis
1.postop pulmonary complications are common
2. plan for induction
3. monitoring
4. blood optimization (iron, epo)
5. postop care
what monitoring should be considered for pt presenting with kyphoscoliosis
- a line
- neurologic
- wake up test
_________________ is a rare autosomal dominate inherited disease of connective tissue that affects bone, sclera, and the inner ear
Osteogenesis imperfecta
2 types of osteogenesis imperfecta
OI congenita
OI tarda
OI congenita
fractures will occur in utero, death occurs during the perinatal period
OI tarda
childhood or early adolescence with presence of blue sclera, fractures from trivial trauma, kyphoscoliosis, bowing of femur/tibia, otosclerosis –> deafness
with osteogenesis imperfecta, aside from primary sx, what else may be present?
impaired plt fx
hyperthermia with hyperhidrosis
increased serum thyroxine
Tx of OI
biphosphonates (strengthen bone)
anesthesia mangement of pt with OI
- intubation: decreased ROM C-spine, possible mandibular fx
- kyphoscoliosis and pectus excavatum –> VQ mismatch
- regional anesthesia is acceptable (check plt)
- mild intraoperative hyperthermia
in a pt with OI, using _____________, an common induction agent, may lead to fasiculations which may produce fractures
succ
_______________ is an inherited autosomal dominant connective tissue d/o that is due to a defect in glyocprotein fibrillin-1
marfan syndrome
Clinical features of Marfan syndrome
- tall stature, long tubular bones (“abe lincoln”)
- high arched palate
- pectus excavatum or carinatum
- kyphoscoliosis
- hyperextensibility of the joints
- early development of emphysema
- high incidence of spontaneous pneumo
- ocular d/o
- risk of aortic dissection
if have a patient with marfans syndrome, what is the one prudent thing to avoid during surgery?
any sustained increase in systemic blood pressure d/t risk of aortic dissection
CV complications in pt with marfan
aortic dilation/dissection
prolapsed valves
bacterial endocarditis
for pt with marfan syndrome, they often have what cardiac conduction abnormality
BBB
if pt with marfans has a dilated thoracic aorta, what should they be put on prophylactically
Beta blocker
_______________ poses a unique risk of aortic rupture/dissection in pts with marfans syndrome
pregnancy
anesthesia implications for marfans syndrome
- focus on CV abnormalities w/ high suspicion for pneumothorax
- will have high arched palate –> crowded teeth and TMJ dislocation = airway concern
- aortic dissection prevention
__________________ is a group of inherited connective tissue d/o that are caused by abnormal production of procollagen and collagen
Ehlers-Danlos syndrome
what type of Ehlers Danlos syndrome may be associated with increased risk of death
vascular type
characteristics of Ehlers-Danlos Syndrome
- joint hypermobility
- skin fragility or hyperelasticity
- bruising and scarring
- musculoskeletal pain - susceptible to OA
- GI, uterus, and vasculature have increased type III collagen –> spontaneous rupture
your doing an airway assessment, you ask the patient to open their mouth. you can see the soft palate, fauces, uvula, and the anterior/posterior pillars. What mallampati score would you give this pt?
Class I
what mallampati classification would you give if you can see soft palate, fauces, uvula, but cannot see the tonsillar pillars?
Class II
what mallampati score do you give if you can only see the base of the uvula and the hard palate?
Class III
on assessment, when pt opens their mouth you can only see the hard palate. What mallampati classification is this?
Class IV
what mallampati score is considered a difficult airway
III and IV
what is the LEMON airway assessment?
- Look Externally
- Evaluate the 3-3-2 rule
- Mallampati score
- Obstruction
- Neck mobility
mouth opening should be how wide?
3 finger widths
distance from chin to hyoid bone should be ?
3 fingers width
thyroid cartilage to mouth floor should be how far?
2 fingers width
what are the 4 Ds that suggest a difficult airway?
- dentition - prominent upper incisors, receding chin
- distortion - edema, blood, vomitus, tumor, infection
- disproportion - decreased TMD, large neck, mallampati > 3
- dysmobility - TMJ and limited C spine
_______________ is a disease characterized by diverse combinations of inflmmation, demyelination + demyelinative plaques, and axonal damage in the CNS
multiple sclerosis
what is the cause of MS?
no clear genetic, environmental, or infectious cause has been identified
T/F: pregnancy exacerbates MS
false; reduces exacerbations. Postpartum increases risk of relapse
this disease is characterized by exacerbations and remissions and unpredictable intervals over several years. Sx persist leading to severe disability from visual failure, ataxia, spastic skM weakness, and urinary incontinence
multiple Sclerosis
what is the most common type of MS?
primary progressing
T/F: no treatment is curative for MS
true
tx for MS
- corticosteroids
- interferon beta
- Glatiramer (Copaxone)
- Mitoxantrone
- Baclofen
- Methotrexate
what is the prinicpal tx for actue relapses of MS?
corticosteroids
what is the tx of choice for pts with relapsing-remitting MS?
interferon Beta
___________________ is a drug used for MS once a patient becomes resistant to interferon beta
Glatiramer (Copaxone)
what drug for MS is a mixture of randoms synthetic polypeptides synthesized to mimic myelin basic protein
Glatiramer (Copaxone)
________________ is a drug used for rapidly progressive MS. It is an immunosuppresive drug that fx by inhibiting lymphocyte proliferation
Mitoxantrone
if pt with MS is on Mitoxantrone, you should be concerned with?
cardiotoxicity
subclinical cardiac dysfx
_______________ is a drug used for MS that depresses cell mediated and humoral immunity. decreases rate of relapse but no effect on progression of disability
Azathioprine
if a pt is on baclofen for MS. You should be concerned/aware of
prlonged sedation
increased sensitivity to NDMR
pts with secondary progressive MS may benefit from tx with _______________
methotrexate
anesthesia considerations with MS
- assess and document deficit
- consider PFTs if significant respiratory compromise
- consider blood testing based on medical management
- consider stress dose steroids
- take all MS meds up until DOS
- AVOID HYPERTHERMIA
- AVOID SUCC
- judicious NMB
- General anesthesia
if pt with MS is on steroids and cyclophsphamides for management of the disease; what labs may you consider preoperatively?
electrolytes and blood glucose (spec to steroid)
if pt is on Terflunomide for MS tx, what lab may you consider preoperatively?
LFTs
in a pt with MS even an increase in body temp of ____ C, can exacerbate MS
1
in a pt with MS, what is the most frequently used anesthesia technique d/t no unique interactions btwn MS and drugs with this technique
general
what anesthetic induction agent do you avoid in a pt with MS
succ
_________ anesthesia technique has been implicated in posteroperative exacerbations of MS
spinal anesthesia block
In a pt with MS know that _________________ block are affiliated with postop exacerbations; however, _____________ and ____________ blocks are okay
spinal anesthesia; epidural; peripheral
_____________________ is a progressive and incurable disease characterized by degeneration, dysfunction, and eventual paralysis of upper and lower motor neurons
Amyotrophic lateral Sclerosis (ALS)
what is the only medication approved for ALS disease modification rather than palliation of Sx
Riluzole
