Week 1 presentations Flashcards
Most common manifestation of CP?
muscle spasticity
results in contractures and fixed deformities of joints in upper and lower extremities
Extrapyramidal CP is associated with _______ and ________.
choreoathetosis (involuntary movements) and dystonia
MAC and Emergence for CP patients
LOWER MAC and delayed emergence from GA
-likely from increased sensitivity d/t anti-convulsant meds and preoperative hypothermia
CP patients extremely susceptible to _______ perioperatively d/t thin body habits
hypothermia
CP and NMBs/ NDNMBs
Slightly increased sensitivity to depolarizing NMBs (succinylcholine), but relative resistance to non-depolarizing NMBs (rocuronium) if taking anticonvulsant medications
Most common anesthesia complications for CP
Respiratory
-recurrent respiratory infections common
-scoliosis of spine cause restrictive lung physiology
-decreased C-spine mobility –> difficult airway
-overproduction of saliva and dysphasia
-increased aspiration risk
-mostly intubate these patients
CP CV complications
-Hypotension one of the most common
CP GI complications
Often malnourished and dehydrated to due poor feeding
Decreased lower esophageal tone leads to high risk of GERD and aspiration
Vagus nerve stimulator stimulates the _____ vagus nerve and is used to avoid _______ complications.
-left
-cardiac
(left innervates AV node & right innervates SA node)
2 incisions for vagus nerve stimulator:
left anterior cervical (C6-C7) and left infraclavicular (placement of pulse generator)
2 type of Epileptic seizures:
- Focal: starts in one area on one side of brain
- Generalized: affects a widespread network of cells on both sides of brain simultaneously
VNS: should patients take seizures meds through the day of surgery?
YES
Antiepileptic drugs cause ____ _____induction —-> accelerated drug metabolism with resistance to NMBs
hepatic enzyme
VNS:________ may promote seizure activity
Hyperventilation
VNS can affect the _____ SLN and RLN, leading to ______, ______, and ______.
LEFT
hoarseness, coughing and voice changes
True or False: VNS is considered a first-line treatment for epilepsy
False
Does VNS target the right or the left vagus nerve?
LEFT
How many incisions are made during VNS implantation?
2
- All of the following are primary concerns for the cerebral palsy patient during anesthesia except:
a. Hypotension
b. Hypothermia
c. Hyperthermia
d. Aspiration
b. hyperthermia
- Cerebral palsy is classified according to
a. Extremity involvement
b. Neurologic dysfunction
c. Both of the above
d. None of the above
c. both of the above
- True/False: patients with cerebral palsy typically have lower mean alveolar concentrations (MAC) and delayed emergence from general anesthesia
True
GB: Weakness typically….
ascends from the legs and is symmetrical
GB: (respiratory) anesthesia consideration
Respiratory muscle weakness = difficult extubation.
GB: autonomic dysfunction
high risk for hemodynamic instability from anesthesia, position change, PPV, and blood loss.
GB: most involved organ systems
cardiovascular, respiratory, and gastrointestinal.
GB: common cardiac manifestations
hypertension, hypotension, and brady/tachyarrytmias.
Some patients may require pacemaker placement.
GB: Exaggerated response to ______ ______ ______due to upregulation of postjunctional adrenergic receptors
indirect-acting sympathomimetics
GB: Treatment
includes IVIG& plasma exchange
- Which of the following medications should be avoided with Guillain-Barre Syndrome?
a. Fentanyl
b. Succinylcholine
c. Rocuronium
d. Cisatracurium
b. Succinylcholine
- T/F: The primary pathophysiology of Guillain-Barre Syndrome is an immune-mediated response to a prior infection
a. True
b. False
True
- Patients with Guillain-Barre Syndrome are at risk for which of the following?
a. Hypertension
b. Hypotension
c. Genetic mutation
d. Both A and B
d. Both A and B
What is Myasthenia Gravis?
A neurological autoimmune disorder
Is an example of an antigen-mediated autoimmune disorder
Antibodies affect the transmission of nerve signals to muscles resulting in decreased muscle contraction
MG: Autoantibodies are produced that attack the…….
POSTSYNAPTIC nicotinic acetylcholine receptors.
MG: The primary immunogenic target of MG is the ______ subunits of the ____receptor channel
alpha
Ach
MG: early symptoms
Eyelid drooping and/or double vision
Also, Fatigue & muscle weakness including difficulty getting out of a chair, climbing stairs, and lifting arms
Slurred or nasal speech
Difficult chewing/choking when swallowing
MG: Common medication treatment
Cholinesterase inhibitors
Helps inhibit the hydrolysis of ACh= raises the neurotransmitter’s concentration at the NMJ.
Most common drug is oral pyridostigmine
- Where do myasthenia gravis antibodies affect?
Nicotinic acetylcholine receptors
- What is one anesthetic consideration for taking care of someone with MG?
Respiratory status, cardiac assessment
- What main gland is associated with being affected by myasthenia gravis?
Thymus gland
Awake craniotomy: used for?
Historically used for the treatment of seizures and epilepsy
Most important benefit from awake craniotomy?
allows the neurosurgeon to maximize tumor resection while preserving neurological function.
Patients undergoing awake craniotomy have fewer neurological deficits and hospital stays vs. those who are under general anesthesia
Relative contraindications of awake craniotomy?
obese, obstructive sleep apnea, difficult airways, chronic cough, anxiety disorder, substance abuse, low pain tolerance, apparent dysphasia
Awake Crani: 3 Types of Mapping:
Motor, Visual & Language
Two Main Approaches for Regional with Awake Craniotomy
- Scalp block with incision line infiltration
- Scalp nerve block for 6 nerves
Awake Craniotomy: 6 nerves that are blocked bilaterally
Supraorbital
Supratrochlear
Auriculotemporal
Temporozygomatic
Greater Occipital
Lesser Occipital
Awake craniotomy: 2 methods
MAC or AAA (GA -> Awake -> GA)
Awake Craniotomy: AAA (awake - asleep - awake) explain it
AAA: Propofol given following insertion of LMA/ETT for positioning and craniotomy portion
Once brain is exposed, airway is removed per surgeon
The brain lacks pain receptors
Surgeon waits for the patient to be awake for mapping and resection
The airway is reinserted for closure
Awake Craniotomy: 3 Most Common Simultaneous Infusions
Propofol: stop 15 min before EEG recording
Precedex: (0.3-0.7 mcg/kg/hr)
Remifentanil: (0.1-0.2 mcg/kg/min)
Awake Craniotomy: AVOID/LIMIT –» may lead to confusion/delirium/ affect intraop mapping
Versed
Atropine
Scoplamine
Large doses of fentanyl
- What is an absolute contraindication of an awake craniotomy?
Patient refusal, inability to cooperate or obey commands
- Which stage of surgery should patients be awake with the MAC or asleep-awake-asleep anesthetic techniques?
Patient should be awake for mapping and resection
- Which anesthetic technique is associated with a lower risk of surgical failure and shorter procedure time?
MAC