Nervous System Review* Flashcards
Avoid increases in body temp (even one degree celsius) can promote exacerbation?
Also avoid emotional stress and infection also may promote exacerbation.
Multiple Sclerosis
Regional - general idea to avoid unless we have a good reason. Obstetrics is a pretty good reason.
In ___ patients will usually be administered an epidural (epidural usually preferred over spinal). Concern you could cause local anesthetic toxicity with the high concentrations with a spinal, the nerves may not be myelinated = easier to reach toxicity. Also spinal anesthetics have been associated with post-op ?
Multiple Sclerosis
exacerbations
If patient having facial paralysis worried about patients ability to protect their airway. Patient at risk for aspiration.
A lot of these patients have a lot of pain (issue with paresthesia) may be on continuous pain infusion. If they are keep them on this.
ANS really impaired can have issues with BP!!
Guillian-Barre Syndrome
- Will probably not tolerate blood loss well, may need to replace blood quickly.
- Patients can become dramatically hypertensive - MUST have an A-line - may need to have both vasopressors and vasodilators ready in case of BP changes.
- With HTN consider ___ before ___.
Guillian-Barre Syndrome
fluids before ephedrine
May keep these patients intubated. If plan to extubate - be prepared for possible reintubation?
-Avoid ___ in these patients!
Guillian-Barre Syndrome
-spinal anesthesia (d/t ANS dysfunction)
Parkinson’s Disease Treatment:
___ = This has a very short half life, usually need to redose at 6 hours (be aware of when patient had their last dose - want to give 20 minutes before induction) may need to redose during case with medication down NG or OG tube)
-If oral dose can not be given give?
___ = also increases norepinephrine transmission.
Levodopa
-Apomorphine SQ
Amantadine
Parkinson’s patients often on these medications ??
*MAOIs concerned about not having MAO which breaks down serotonin and norepi, thus can have too much of them. With ___ would be a disaster (increase norepi can have a fatal hypertensive crisis).
___ completely contraindicated this is a fatal drug reaction.
Anticholinergics and MAOIs
- ephedrine
- meperidine
Parkinson’s Disease AVOID:
- dopamine antagonists - (4)
- Typically with these patients just give ?? combo
~Reported to cause an acute dystonic reaction - (2)
butyrophenones (droperidol) phenothiazines metoclopramide (reglan) phenergan (Promethazine) *Zofran and decadron ~Fentanyl and Alfentanil
Parkinson’s Disease - Isoflurane, Desflurane and Sevorflurane acceptable.
*Avoid ___, Carrie prefers ___ to avoid labile BP issues.
*Desflurane
Sevoflurane
Acute Spinal Cord Injury: If you have paralysis above ___ where cardiac accelerators are, this means the heart will not be able to compensate. Thus they are massively ___ and ___ and the heart can not support. This lasts for about ___. Total absence of ___, lose ___ below the level of the lesion.
- Decreased BP and HR if > than ___.
- During this period greatest threats to life are ????
T4 vasodilated and hypotensive 1-3 weeks sensation, lose temp regulation >T6 alveolar hypoventilation, unprotected airway, pneumonia, PE (DVT and aspiration)
Spinal Cord Injury Treatment:
Give a high dose steroid postop to improve postop outcome. Some improvement for sensory recovery seen. This is being questioned.
Drug and Dose*****
Methylprednisolone
30 mg/kg IV bolus within 8 hours of injury
5.4 mg/kg/hr x 23-47 hours
Big issue with Chronic SC Injury is ___. Paraplegic doing surgery on toe need anesthesia at the same level as everyone else due to AD. SNS below the level of lesion does not have the brain’s inhibitory control anymore. Constant signal coming to SC below the level of the lesion, get a huge reflex. This stimuli can cause ___ below the lesion. The BP goes up and the baroreceptors tell the heart rate to lower. End up with someone with a ___ and a ___, ___ is so high the heart can fail, also the patient can sustain a ___ in their head. Thus this is a life threatening situation and one we want to prevent.
Autonomic Dysreflexia massive vasoconstriction really high BP really low HR afterload hypertensive bleed
5 Determinants of Cerebral Blood Flow (CBF)
1 - direct link with cerebral blood flow
2 - does not really play a role until it drops really low, don’t really alter
3 - typically 80-180 in the brain
4- high PEEP will work against ___
1-PaCO2 2-PaO2 3-Arterial Pressure (Autoregulation) 4-Venous Pressure - venous drainage 5-Anesthetic drugs and techniques
IV Anesthetics are ___ and will decrease CBF and ICP in general.
- ___ is the EXCEPTION = don’t use in the face of ___
- ___ and ___ best
- Midazoolam, opioids and etomidate ok, careful with resp depression!
- ___ - CO2 major manipulator of CBF could end up doubling CBF if resting CO2 went from 30-60 and this could cause major ICP changes
Vasoconstrictors
- Ketamine, increased ICP
- Propofol and barbiturates
- Hypoventilation
___ helpful only in one population - the brain tumor population. This is the only safe population to use them in!
Steroids
