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Comprehensive > Nervous System - Co- Existing > Flashcards

Nervous System - Co- Existing Flashcards

1
Q

MS and GA considerations:

  • IV or IA?
  • MR? prolonged response? resistance?
  • ANS dysfunction?
  • steroids?
A
  • no one agent preferred
  • increased sensitivity to MR, AVOID Succs
    * prolonged response w/ NDMR w/ decreased muscle mass
    * may be resistant to NDMR
  • labile pt : increased hypotension with PPV, VAs, position changes
  • suppl corticosterooids
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2
Q

MS: Maintenance and Emergence

  • monitor for?
  • what to consider during emergence?
  • extubation?
  • post op?
A
  • ANS dysfunction - Aline
  • baseline muscle weakness
  • fully awake - completely reversed
  • neuro eval - exacerbation?
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3
Q

MS and RA:

  • ideal RA?
  • spinal anesthesia?
  • epidurals/PNBs?
A
  • best avoided if no strong reason (OB and pain syndrome)
  • assoc with exacerbations
  • not assoc with exacerbations
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4
Q

GB: Preop considerations?

  • aspiration risk d/t?
  • ventilation?
  • ett?
  • BP?
A
  • weak pharyngeal muscles
  • vent support (if VC less than 15ml/kg)
  • cuffed ett (prevent aspiration)
  • treat hypo/HTN w/ BB, vasopressors
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5
Q

GB and GA:

  • hypotension/HTN?
  • mandatory monitoring?
  • MR? avoid/use (resistance?)?
  • temp?
A
  • hypo - with PPV, position changes
  • HTN - w/ indirect acting agents (ephedrine), pain, DVL - Give FLUIDS 1st
  • Aline
  • AVOID SUCCs/use CV stable NDMR (increased sensitivity and resistance)
  • altered temp
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6
Q

GB and RA:

  • _____ can be used for sensory pain, pts sensitive to LAs
  • spinal vs epidural?
A
  • epidural opioids

* epidural preferred (slow onset) d/t ANS dysfunction

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7
Q

Major Drugs in Parkinson’s:

  • Levodopa - implications?
    - alternate drug?
  • MAOIs - implications?
  • Anti-cholinergics
A
  • short 1/2 life redose in OR (OG) - will see skeletal muscle rigidity (with MV)
    - drug: apomorphine
  • inhibit reuptake of serotonin and NE - AVOID meperidine and ephedrine
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8
Q

PD and GA:

  1. aspiration risk?
  2. avoid (certain drugs)?
    - ANS dyfxn - labile
  3. VAs and MRs
  4. emergence? (resp complications - upper a/w obstruction)
A
  1. consider RSI (dysphagia, difficulty swallowing)
  2. DA anatg (droperidol, reglan, phenothiazines) and fent/alfent?
  3. iso, des, sevo - all MRs (succs?) - are OK
  4. extubate wide awake after full reversal
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9
Q

SC injury - Intubation:

  • technique?
  • emergency intubation? meds?
  • awake/cooperative pt?
A
  • immobilize C spine, log roll, manual inline stabilization
  • DVL with inline stabilization/ methylpred 30mg/kg
  • awake fiberoptic intubation
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10
Q

Acute SC with GA:

  • temp?
  • agents?
  • MRs: desired? avoid?
  • monitoring?
A
  • pokliothermic
  • N2O (if closed air spaces), IAs and IV agents all acceptable
  • NMDR (pancuronium=SNS desired), AVOID succs after 24hrs
  • Aline (need blood, fluid and pressors)
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11
Q

Chronic SC injury GA: HTN (vasoconstriction) and bradycardia (BR) d/t stimulus below the injury

  • considerations of chronic SC pt? muscle, positioning etc.
  • treatment for autonomic hyperreflxia?
  • treatment for muscle spasms in the OR
A
  • chronic UTIs, DVTs, pain, bone fractures/skin, spasticity
  • VAs, epidural or intrathecal anesthesia - preventative
    - vasodilators (SNP)
  • NDMR (good for DVL)
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12
Q

VAs at 0.5 MAC cause uncoupling which means?

- how to compensate for this effect?

A
  • increase CBF (vasodilation) with decrease metabolic demand (CMRO2)
    * IV agents (decrease CBF & ICP) and hyperventilate
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13
Q

Goal for Head Injury treatment?

  • hyperdynamic circulatory response (HTN, ^CO, ^HR)
    1. CPP?
    2. PaCO2?
A
  1. maintain CPP (>70mmHG) and CBF (decrease ICP and increase BP)
  2. 30mmHg (low nml)
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14
Q

GA for Head Injury:

  • Induction agents?
  • Treat Cushing’s syndrome?
  • MRs to avoid?
  • Monitors?
  • Fluids: Avoid? Prevent?
A
  • IV anesthetics (except KETAMINE) and Lidocaine, or Opioids
  • incr HOB, barbs, diuretics, PaCO2 30, drain CSF, hypothermia?
  • AVOID succs and histamine release
  • ALINE, R heart cath (VAE)
  • AVOID: LR (hyperosmolar) and glucose containing solutions- (NS, blood, albumin are good) PREVENT - decreased serum osmolarity
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15
Q

GA for Maintenance and Emergence: Head Injury

Maintenance: Emergence:

  1. IAs? when? 2. swelling?
    3. AVOID?
A
  1. N20 (if no pneumocephalus) and VA until cranium open (ICP ok?)
  2. 12-72hrs (stay intubated)
  3. coughing and bucking (HTN) - BB, TPL
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16
Q

Supratentorial Tumors:

  • Monitors and Equip?
  • Induction: Goal? Meds?
  • MR?
  • HR and BP control?
A
  • 2 large IVs, PRBCs, Aline, temp, PNS, CVP?PA?
  • blunt SNS with DVL and decrease ICP
    • osmotherpay, propofol, TPL, opioids, lidocaine
  • NDMR
  • esmolol
17
Q

Maintenance for Supratentorial Tumor?

  • PaCO2?
  • VA + N20?
  • low brain compliance?
A
  • 30-35
  • depends in compliance and ICP
  • use TIVA will low Iso
18
Q

Emergence of Supratentorial Tumor Pt?

  1. AVOID? 4. HOB
  2. extubate? 5. risk for?
  3. meds?
A
  1. bucking, coughing, HTN
  2. fully awake and reversed
  3. lido, antiHTN
  4. HOB 30*
  5. VAE
19
Q

Anesthesia for CVA pt?

  • What anesthesia is contraindicated in these pts?
  • NMB monitor?
A
  • neuraxial in para/hemiplegia or active anticoagulant

* monitor on UNAFFECTED side

20
Q

Preop CVA pt Considerations?

  • Pt needs to be?
  • AVOID?
  • MAP?
A
  • sedated on stool softeners & anticovulsants
  • HTN and rebleeding
  • maintain tight control of MAP
21
Q

Induction for CVA?

  • AVOID HTN/hypo and control ICP- meds for induction?
A
  • lido + BB + opioids + TPL (or propofol)
22
Q

Maintenance for CVA

  • Meds?
  • Meds if high ICP?
  • Fluids?
A
  • VA and N2O or TPL/fent/iso/ O2 = maintain MAP and ICP
  • TPL (propofol) gtt/ fent/ O2 and 0.5 MAC iso
  • limit fluid replacement prior to clipping
23
Q

Emergence of CVA pt:

  • AVOID?
  • Grade 1-2?
  • Grade 3-5?

Post - op: AVOID?

A
  • coughing, bucking, HTN and increased CO2
  • extubate
  • keep intubated

AVOID HTN/hypo/vasospasm - causes cerebral edema and hematoma

24
Q

MS: major things to AVOID/try to decrease?

A
  • surgical stress
  • infection
  • emotional stress
  • increases in temp
25
Q

Anesthetic Considerations: Seizures

  1. Anticonvulsants/effects? 3. Tx for Status Epilecticus?
    • considerations (3?)
    • con’t on day of surgery?
  2. AVOID which drugs? (8)
A
  1. additive effects with anesthetics
    • enzyme induction, coagulation, end organ
    • yes - con’t preop, intraop, postop
  2. methohexital, ketamine, etomidate, meperidine, atracurium, cisatracurium, enflurane, alfentanil
  3. TPL, propofol, benzos
26
Q

5 determinants of CBF?

A
  1. PaCO2
  2. PaO2
  3. arterial pressure (autoregulation 80-180mmHg)
  4. venous pressure
  5. anesthetic drugs & techniques
27
Q

GOLD standard for VAE detection?

A
  • doppler, PAP, etCO2

Comprehensive (7 decks)

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