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Neuro (Wolfe 2024) > Week 1 presentations > Flashcards

Week 1 presentations Flashcards

1
Q

Most common manifestation of CP?

A

muscle spasticity
results in contractures and fixed deformities of joints in upper and lower extremities

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2
Q

Extrapyramidal CP is associated with _______ and ________.

A

choreoathetosis (involuntary movements) and dystonia

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3
Q

MAC and Emergence for CP patients

A

LOWER MAC and delayed emergence from GA

-likely from increased sensitivity d/t anti-convulsant meds and preoperative hypothermia

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4
Q

CP patients extremely susceptible to _______ perioperatively d/t thin body habits

A

hypothermia

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5
Q

CP and NMBs/ NDNMBs

A

Slightly increased sensitivity to depolarizing NMBs (succinylcholine), but relative resistance to non-depolarizing NMBs (rocuronium) if taking anticonvulsant medications

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6
Q

Most common anesthesia complications for CP

A

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

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7
Q

CP CV complications

A

-Hypotension one of the most common

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8
Q

CP GI complications

A

Often malnourished and dehydrated to due poor feeding

Decreased lower esophageal tone leads to high risk of GERD and aspiration

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9
Q

Vagus nerve stimulator stimulates the _____ vagus nerve and is used to avoid _______ complications.

A

-left
-cardiac

(left innervates AV node & right innervates SA node)

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10
Q

2 incisions for vagus nerve stimulator:

A

left anterior cervical (C6-C7) and left infraclavicular (placement of pulse generator)

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11
Q

2 type of Epileptic seizures:

A
  1. Focal: starts in one area on one side of brain
  2. Generalized: affects a widespread network of cells on both sides of brain simultaneously
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12
Q

VNS: should patients take seizures meds through the day of surgery?

A

YES

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13
Q

Antiepileptic drugs cause ____ _____induction —-> accelerated drug metabolism with resistance to NMBs

A

hepatic enzyme

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14
Q

VNS:________ may promote seizure activity

A

Hyperventilation

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15
Q

VNS can affect the _____ SLN and RLN, leading to ______, ______, and ______.

A

LEFT
hoarseness, coughing and voice changes

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16
Q

True or False: VNS is considered a first-line treatment for epilepsy

A

False

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17
Q

Does VNS target the right or the left vagus nerve?

A

LEFT

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18
Q

How many incisions are made during VNS implantation?

A

2

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19
Q
  1. All of the following are primary concerns for the cerebral palsy patient during anesthesia except:
    a. Hypotension
    b. Hypothermia
    c. Hyperthermia
    d. Aspiration
A

b. hyperthermia

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20
Q
  1. Cerebral palsy is classified according to
    a. Extremity involvement
    b. Neurologic dysfunction
    c. Both of the above
    d. None of the above
A

c. both of the above

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21
Q
  1. True/False: patients with cerebral palsy typically have lower mean alveolar concentrations (MAC) and delayed emergence from general anesthesia
A

True

22
Q

GB: Weakness typically….

A

ascends from the legs and is symmetrical

23
Q

GB: (respiratory) anesthesia consideration

A

Respiratory muscle weakness = difficult extubation.

24
Q

GB: autonomic dysfunction

A

high risk for hemodynamic instability from anesthesia, position change, PPV, and blood loss.

25
Q

GB: most involved organ systems

A

cardiovascular, respiratory, and gastrointestinal.

26
Q

GB: common cardiac manifestations

A

hypertension, hypotension, and brady/tachyarrytmias.

Some patients may require pacemaker placement.

27
Q

GB: Exaggerated response to ______ ______ ______due to upregulation of postjunctional adrenergic receptors

A

indirect-acting sympathomimetics

28
Q

GB: Treatment

A

includes IVIG& plasma exchange

29
Q
  1. Which of the following medications should be avoided with Guillain-Barre Syndrome?
    a. Fentanyl
    b. Succinylcholine
    c. Rocuronium
    d. Cisatracurium
A

b. Succinylcholine

30
Q
  1. T/F: The primary pathophysiology of Guillain-Barre Syndrome is an immune-mediated response to a prior infection
    a. True
    b. False
A

True

31
Q
  1. 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
A

d. Both A and B

32
Q

What is Myasthenia Gravis?

A

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

33
Q

MG: Autoantibodies are produced that attack the…….

A

POSTSYNAPTIC nicotinic acetylcholine receptors.

34
Q

MG: The primary immunogenic target of MG is the ______ subunits of the ____receptor channel

A

alpha
Ach

35
Q

MG: early symptoms

A

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

36
Q

MG: Common medication treatment

A

Cholinesterase inhibitors

Helps inhibit the hydrolysis of ACh= raises the neurotransmitter’s concentration at the NMJ.

Most common drug is oral pyridostigmine

37
Q
  1. Where do myasthenia gravis antibodies affect?
A

Nicotinic acetylcholine receptors

38
Q
  1. What is one anesthetic consideration for taking care of someone with MG?
A

Respiratory status, cardiac assessment

39
Q
  1. What main gland is associated with being affected by myasthenia gravis?
A

Thymus gland

40
Q

Awake craniotomy: used for?

A

Historically used for the treatment of seizures and epilepsy

41
Q

Most important benefit from awake craniotomy?

A

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

42
Q

Relative contraindications of awake craniotomy?

A

obese, obstructive sleep apnea, difficult airways, chronic cough, anxiety disorder, substance abuse, low pain tolerance, apparent dysphasia

43
Q

Awake Crani: 3 Types of Mapping:

A

Motor, Visual & Language

44
Q

Two Main Approaches for Regional with Awake Craniotomy

A
  1. Scalp block with incision line infiltration
  2. Scalp nerve block for 6 nerves
45
Q

Awake Craniotomy: 6 nerves that are blocked bilaterally

A

Supraorbital
Supratrochlear
Auriculotemporal
Temporozygomatic
Greater Occipital
Lesser Occipital

46
Q

Awake craniotomy: 2 methods

A

MAC or AAA (GA -> Awake -> GA)

47
Q

Awake Craniotomy: AAA (awake - asleep - awake) explain it

A

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

48
Q

Awake Craniotomy: 3 Most Common Simultaneous Infusions

A

Propofol: stop 15 min before EEG recording
Precedex: (0.3-0.7 mcg/kg/hr)
Remifentanil: (0.1-0.2 mcg/kg/min)

49
Q

Awake Craniotomy: AVOID/LIMIT –» may lead to confusion/delirium/ affect intraop mapping

A

Versed
Atropine
Scoplamine
Large doses of fentanyl

50
Q
  1. What is an absolute contraindication of an awake craniotomy?
A

Patient refusal, inability to cooperate or obey commands

51
Q
  1. Which stage of surgery should patients be awake with the MAC or asleep-awake-asleep anesthetic techniques?
A

Patient should be awake for mapping and resection

52
Q
  1. Which anesthetic technique is associated with a lower risk of surgical failure and shorter procedure time?
A

MAC

Neuro (Wolfe 2024) (7 decks)

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