Neuromuscular - Co- Existing Flashcards

1
Q

SLE Anesthesia Managment:

  • PreInduction: consider meds? infection/preg/position
  • Induction: meds?
  • A/w management (3?)
  • Consider drugs to AVOID in ?
A
  • steroids
  • no one ideal agent, myocardial sparing drugs (propfol, etomidate, ketamine, versed = good)
  • cricoaryternoid arthritis, mucosal ulceration, RLN palsy
  • renal failure
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2
Q

RA Anesthetic Considerations:

  • Joints/Limitations?
  • Concerns with A/W?
  • Preop Imaging - Xray/CT
  • Document - Preop?
  • If difficult a/w then?
A
  • TMJ, cricoarytenoid joint (use smaller tube) and cervical spine
  • difficult intubation and DVL (use cervical collar)
  • neuro fxn
  • awake fiberoptic
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3
Q

RA and Anesthetic Considerations?

PreInduction

  • CV involvement? - Tx influences managment?
  • Resp involvement? - Positioning?
A
  • arrhythmias, aortic insuff- consult
  • RLD - post op vent, ABGs
  • Steroids, ASA, NSAIDs, immune supressants, hepatic and renal dysfxn
  • minimize compression risk and injury
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4
Q

Osteoarthritis - Anesthesia Management:

  • Tx =?
  • affects what important joints?
  • consider drug tx and concerns?
A
  • ASA and NSAIDs (no steroids)
  • knee, hip, cervical/lumbar spine - hard to place epidural
  • bleeding
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5
Q

MG: Anesthetic Considerations:
Induction:
* consider drug therapy? * A/W considerations?
* case scheduled for? * Hold drug on AM of surgery?
* premed: consider? * Use short acting induction meds?

A
  1. steroid therapy
  2. first case of the day
  3. muscle weakness
  4. aspiration risk / RSI
  5. hold pyridiostigmine
  6. propofol or TPL
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6
Q
MG: Anesthetic Concerns
Induction:
*Opioids?
*IAs?
* MRs- succs vs NMDRs?
* Best Reversal?
A
  • limited use
  • IA good for induction and maintenance
  • resistant to succs/sensitive to NMDRs
  • edrophonium
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7
Q

MG: Extubation

  • RA with GA?
  • needs to be responsive/full reversal
  • monitor in PACU/resume pyridostigmine
A
  • good choice for thymectomy
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8
Q

Myasthenic Syndrome:

  • Tx: med?
  • muscle weakness?
  • MRs?
A
  • aminopyridine
  • proximal
  • sensitive to succs and NDMRs
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9
Q

Muscular Dystrophy: Anesthetic Considerations?

  • Induction
    1. intubation? 4. AVOID? 7. RA? y or n?
    2. IAs: cardiac effects? 5. consideration for NDMRs?
    3. susceptible to? 6. Post op pulm dysfunction
A
  1. delayed gastric emptying = RSI
  2. prone to myocardial depressant effects
  3. MH
  4. Succs
  5. prolonged response
  6. RA okay
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10
Q

Anesthetic Concerns: Marfan’s

  1. lung dz severity?
  2. meds to reduce CV workload? 5. med prophylaxis?
  3. A/w management?
  4. Preop focus?
A
  1. RLD (kyphoscoliosis, pneumo)
  2. BB
  3. high palate (vent/oxygenate)
  4. CV involvement
  5. antibiotics (endocarditis)
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11
Q
Anesthetic Concerns: Marfan's
Induction:
1. Intubation: AVOID?
2. DVL?
3. r/o?
A
  1. extreme mvmt of mandible
  2. smooth/avoid SNS stim
  3. pneumothorax
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12
Q

Ankylosing Spondylitis - Considerations?

  1. hallmark sign? 5. treatment?
  2. effects?
  3. cardiac involvement?
  4. pulm involvement?
A
  1. sacroiliac joint pain (improves with mvmt)
  2. lumbar spine -> ascends to upper back and neck
  3. conduction issues
  4. RLD
  5. NSAIDs, methotrexate, spinal fusion
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13
Q

Ankylosing Spondylitis - Anesthetic Considerations?

  • RLD
    1. consider regional?
    2. Intubation?
    3. Induction goals?
A
  1. hard to place epidural into fused space
  2. awake fiberoptic
  3. controlled vent & maintain SVR
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14
Q

Achondroplasia: Anesthesia Management

  1. difficult a/w? 3. temp dysfxn?
    * OSA, central sleep apnea *hydrocephalus
    * facial feature *no change to response to IA/MRs
  2. Pulm picture?
A
  1. upper a/w obstruction, unable to expose glottis, small a/w
  2. RLD
  3. prone to hyperthermia
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15
Q

Anesthesia Management for SLE:

  • consider organ dysfxn - renal, liver (drug clearance), cardiopulm
  • CNS involvement - sz or stroke, neuropathies
  • consider ? for surgery
A
  • stress dose steroids
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