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SRNA3CoExisting > EXAM 3 REVIEW > Flashcards

EXAM 3 REVIEW Flashcards

1
Q

C5

A

ELBOW FLEXORS

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2
Q

C6

A

WRIST EXTENSORS

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3
Q

C7

A

ELBOW EXTENSORS

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4
Q

C8

A

FINGER FLEXORS

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5
Q

T1

A

FINGER ABDUCTORS (LITTLE FINGER)

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6
Q

L2

A

HIP FLEXORS

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7
Q

L3

A

KNEE EXTENSORS

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8
Q

L4

A

ANKLE DORSIFLEXORS

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9
Q

L5

A

LONG TOE EXTENSORS

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10
Q

S1

A

ANKLE PLANTAR FLEXORS

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11
Q

How long does spinal shock last (hemodynamic disturbances)

A

1-3 weeks

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12
Q

Reduction in BP after acute spinal cord injury due to

A

Loss of sympathetic tone and decreased SVR

Bradycardia from loss of T1-T4 innervation of the heart

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13
Q

Complications 2 years after INJURY in order of from most incidence to least incidence (USCD A-SHPRP)

A 
UTI (59%)
Skeletal muscle spasticity (38%)
Chills and fever (19%)
Decubitus ulcer (16%)
Autonomic hyperreflexia (8%)
Skeletal muscle contractures (6%)
Heterotopic ossicification(3%)
PNA (3%)
Renal dysfunction (2%)
Postop wound infection (2%)
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14
Q

Complications 30 years after INJURY in order of from most incidence to least incidence (DSGC UI-VUMR)

A 
Decubitus ulcer (17%)
Skeletal muscle or joint pain (16%)
GI dysfunction (14%)
CV dysfunction (14%)
UTI (14%)
ID or Cancer (11%)
Visual or hearing disorders (10%)
Urinary retention (8%)
Male GU dysfunction (7%)
Renal Calculi (6%)
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15
Q

Several weeks after acute spinal cord injury, spinal cord reflexes

A

gradually return, and patients enter a chronic stage

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16
Q

After several weeks after Acute SCI patient enters a chronic stage characterized by

A

characterized by overactivity of the sympathetic nervous system and involuntary skeletal muscle spasms

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17
Q

Injury at or above C5 =

A

apnea due to denervation of the diaphragm

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18
Q

Succinylcholine is likely to provoke hyperkalemia

within the

A

first 6 months after injury (Avoid it after 24 hours of injury)

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19
Q

When does Autonomic hyperreflexia appear?

A

Appears AFTER spinal shock in association with

return of spinal cord reflexes

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20
Q

Autonomic Hyperreflexia Can be initiated by

A

cutaneous or visceral stimulation below the level of spinal injury

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21
Q

Autonomic hyperreflexia common stimuli

A

Surgery or distention of hollow viscus (bladder, rectum) are common stimuli

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22
Q

Autonomic hyperreflexia Stimulation does what? then end result is ?

A

initiates afferent impulses that enter the spine, this elicits an increase in sympathetic nervous system activity along the splanchnic outflow tract (in normal patients, this is inhibited by higher centers of the CNS) . End result is a Generalized systemic vasoconstriction occurs BELOW the level of the spinal cord injury

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23
Q

Generalized systemic vasoconstriction occur

A

BELOW the level of the spinal cord injury

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24
Q

Autonomic hyperreflexia patho

A
  1. Stimulus below level of spinal cord transection
  2. Activation of preganglionic sympathetic nerves
  3. Vasoconstriction
  4. Hypertension
  5. Carotid sinus
  6. Vasodilation /Bradycardia
  7. Activation of pre-ganglionic sympathetic nerves
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25
Q

What is the hallmark of autonomic hyperreflexia?

A

Hypertension and REFLEX BRADYCARIDIA (carotid sinus stimulation)

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26
Q

When there is reflex cutaneous vasodilation ?

A

Reflex cutaneous vasodilation ABOVE the level of spinal injury (nasal stuffiness)

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27
Q

Autonomic Hyperreflexia Neuro symptoms

A

Headache, blurred vision = severe hypertension (can lead to LV failure)

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28
Q

Who experienced and DO not experience autonomic hyperreflexia?

A

85% of patients with lesions above T6 exhibit this reflex, unlikely to be associated below T10

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29
Q

Splanchnic nerve and innervations: GREATER SPLANCHNIC NERVE

A

T5-T9

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30
Q

Splanchnic nerve and innervations: LESSER SPLANCHNIC NERVE

A

T10-T11

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31
Q

Splanchnic nerve and innervations: LEAST SPLANCHNIC NERVE

A

T12

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32
Q

Loss of input from higher centers to these nerves

increase risk of exaggerated autonomic reflexes

A

T5-T12

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33
Q

***Management for exaggerated autonomic reflexes

A

prevent it! Have vasodilators available (SNP, hydralazine), can occur in PACU when drugs begin to wear off

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34
Q

Loss of input from higher centers to nerve T5-T9, T10-T11 and T12 leads to

A

Increase risk of exaggerated autonomic reflexes

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35
Q

what happens to the parts of the body ABOVE the level of the spinal cord lesion

A

VASODILATATION

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36
Q

When GA is selected, avoid

A

Succinylcholine 24 hours after injury due to risk of hyperkalemia. use NDNMB agents

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37
Q

Autonomic Hyperreflexia occurs in patients with spinal cord injury what level

A

Above T6

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38
Q

CREST Syndrome

A

Calcinosis: Calcium deposits in the skin
Raynaud’s Phenomenon: Spasm of blood vessels with
cold or stress.
Esophageal dysfunction: Acid reflux and decrease
esophageal motility.
Sclerodactyly: Thickening and tightening of the skin on
fingers and hands.
Telangiectasias: Dilation of capillaries causing red
marks on skin surface

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39
Q

3 main problems with MARFAN (HPK)

A

High Arched palare
Pectus excavatum (spoon chest)
Kyphoscoliosis

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40
Q

Marfan’s syndrome most deaths caused by

A

Cardiovascular

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41
Q

Most common cause of

A

Mitral Prolapse

Mitral Regurgitation

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42
Q

Mitral stenosis

A

Snap

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43
Q

MVP

A

Mid systolic click late systolic murmur

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44
Q

Aortic issue with Marfan

A

Aortic dilation

Aortic dissection or rupture

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45
Q

Issue with Marfan and CT

A

Defective CT in aorta and heart valves.

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46
Q

Cardiac Conduction abnormality with Marfan is

A

BBB common

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47
Q

Respiratory with Marfan 2 common developments

A

Early development of emphysema

High incidence of spontaneous pneumothorax

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48
Q

Marfan’s Syndrome Anesthesia Considerations

Mainly focus on ?

A

CV Focus on cardiopulmonary abnormalities

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49
Q

Marfan’s syndrome patients and AIRWAY

A

Susceptible to temporomandibular joint dislocation

→caution with jaw thrusting

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50
Q

Marfan syndrome and BP considerations

A

AVOID any sustained increase in systemic blood pressure r/t increased risk of aortic dissection

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51
Q

Marfan and monitoring

A

Invasive monitoring including TEE consideration in selected patients

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52
Q

High risk for the development of pneumothorax

What kind of patients –>

A

Marfan’s syndrome

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53
Q

FORMAL DIAGNOSIS of ARF

A

• INCREASED SERUM CREATININE MORE THAN 0.5 MG/DL OF BASELINE
• 50% DECREASE IN CREATININE CLEARANCE
• A CHANGE IN SERUM CREATININE OF GREATER THAN 0.3 MG/DL WITHIN 48 HOURS OF
ACUTE INSULT

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54
Q

RENAL BLOOD FLOW (RBF) (AUTOREGULATED @

A

50 TO 150 MMHG

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55
Q

Most susceptible cause ➔

A

RENAL TUBULE ISCHEMIA (MOST SUSCEPTIBLE) ➔ PROLONGED ➔ IRREVERSIBLE CORTICAL NECROSIS.

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56
Q

Chronic Renal Failure

A

HYPERKALEMIA, HYPERMAGNESEMIA, HYPERPHOSPHATEMIA, HYPOCALCEMIA

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57
Q

CRF METABOLIC ACIDOSIS -ANEMIA

A

INCREASED CO, RIGHT SHIFT OF OXYHEMOGLOBIN DISSOCIATION CURVE

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58
Q

Lumbar lordosis/kyphoscoliosis and neuraxial

A

⇧neuraxial technical difficulty and positioning concerns

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59
Q

EHLERS – DANLOS SYNDROME and neuraxial

A

Bleeding: Avoid IM injections; excessive instrumentation of nose or esophagus; laryngoscopy; A line or CVP (hematoma);
no regional anesthesia (too much bleeding)

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60
Q

Achondroplasia Dwarfism, Small epidural space =

A

difficult to introduce epidural catheter
Osteophytes, prolapsed intervertebral discs, or deformed vertebral bodies also contribute to difficulties with neuraxial blockade

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61
Q

Duschenne Muscular Dystrophy and Regional anesthesia

A

avoids the unique risks of general anesthesia in Duschenne Muscular Dystrophy.

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62
Q

Nemaline Rod Muscular dystrophy Regional anesthesia

A

high motor block could = respiratory compromise

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63
Q

Myotonic dystrophy:

A

GA, regional and NMB do NOT prevent/relieve contraction

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64
Q

High concentrations of VA may

A

decrease contractions but will also cause myocardial depression

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65
Q

What is Nemaline Rod Muscular Dystrophy is a

A

Slowly progressive symmetrical dystrophy of skeletal and smooth muscles.

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66
Q

Nemaline Rod Muscular Dystrophy and motor

A

Delayed motor development; muscle weakness; hypotonia, abnormal gait, and loss of deep tendon reflexes

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67
Q

Nemaline Rod Muscular Dystrophy Facial

A

Micrognathia, dental malocclusion

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68
Q

Nemaline Rod Muscular Dystrophy Skeletal abnormalities

A

Kyphoscoliosis and pectus excavatum

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69
Q

Heart and Nemaline Rod Muscular Dystrophy

A

Dilated cardiomyopathy ➔ cardiac failure.

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70
Q

Nemaline Rod Muscular Dystrophy NEURO

A

Normal mentation

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71
Q

Nemaline Rod Muscular Dystrophy Anesthesia Consideration : INTUBATION

A
  • Difficult tracheal intubation due to micrognathia and high arched palate
  • Awake fiberoptic endotracheal intubation may be needed
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72
Q

Nemaline Rod Anesthesia Consideration Respiratory

A

Respiratory depressant effects of drugs may be exaggerated d/t respiratory muscle weakness and chest wall abnormalities

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73
Q

Nemaline Rod Anesthesia Considerations: Ventilation

A

V/Q mismatch increased; ventilatory response to CO2 may be blunted

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74
Q

Nemaline Rod Anesthesia Considerations: MUSCLE RELAXANTS

A

Sux and NDNMB response is unpredictable

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75
Q

Not been reported with Nemaline Rod

A

MH

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76
Q

What is Periodic Paralysis?

A

Intermittent acute attacks to skeletal muscle ➔ weakness or paralysis

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77
Q

Causes of Periodic Paralysis

A

hypo or hyperkalemia

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78
Q

Anesthesia Considerations for PERIODIC PARALYSIS 2 meds

A
  1. Acetazolamide

2. Mannitol

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79
Q

Monitor this and AVOID 2 meds in Periodic Paralysis

A

Frequent K+ monitoring
Avoid potassium solutions
Avoid succinylcholine

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80
Q

Treatment for Periodic Paralysis

A

Administer glucose containing solutions if treating hyperK c/insulin

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81
Q

Clinical Features of Familial Periodic Paralysis Type: HYPOKALEMIA K value

A

<3.0

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82
Q

Clinical Features of Familial Periodic Paralysis Type: HYPOKALEMIA : PRECIPITATING FACTORS
PAMGHHSS- CE

A 
Pregnancy 
Anesthesia
Menstruation
Glucose infusion
HIgh Carb meal
Hypothermia
Strenuous Exercise
Stress

Cardiac Dysrhythmias
ECG signs of Hypokalemia

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83
Q

Clinical Features of Familial Periodic Paralysis Type: HYPERKALEMIA K value

A

> 5.5

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84
Q

Clinical Features of Familial Periodic Paralysis Type: HYPERKALEMIA : PRECIPITATING FACTORS
PHEM

A

Potassium Infusion
Hypothermia
Exercise
Metabolic Acidosis

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85
Q

Clinical Features of Familial Periodic Paralysis Type: HYPERKALEMIA: OTHER FEATURES

A

Skeletal muscle weakness may be localized to tongue and eyelids

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86
Q

MYASTHENIA GRAVIS - What is MG

A

Chronic autoimmune disorder caused by a decrease in functional acetylcholine receptors (AchR) at the NMJ resulting from destruction or inactivation by circulating antibodies

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87
Q

ACH receptor and MG

A

Down regulation of AchR

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88
Q

2/3 of patient with MG have

A

Thymic hyperplasia is present in two thirds of patients with myasthenia gravis, and 10% to 15% of these patients have thymomas

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89
Q

What is the Hallmark of MG:

A

weakness and rapid exhaustion of voluntary muscles with repetitive use
Partial recovery with rest; muscle strength is normal when well rested

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90
Q

MG Initial symptoms:

A

ptosis, diplopia, and dysphagia

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91
Q

MG and Aspiration

A

High aspiration risk (Weak pharyngeal, laryngeal muscles = dysphagia, dysarthria and difficulty handling saliva

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92
Q

MG and heart

A

Myocarditis can result in atrial fib, heart block, or cardiomyopathy

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93
Q

Other autoimmune diseases that may precipitate MG

HPRS

A

Hyperthyroidism
Pernicious anemia
Rheumatoid arthritis
Systemic lupus erythematosus

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94
Q

What are meds that can aggravate muscle weakness

A

Antibiotics, especially aminoglycosides, can aggravate muscle weakness

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95
Q

May precipitate or exacerbate muscle weakness in Myasthenia Gravis (PIESE)

A 
Pregnancy
Infection
Electrolyte abnormalities, 
Surgery 
Emotional stress
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96
Q

Treatment of Myasthenia Gravis PIP-T

A

Pyridostigmine
Immunosuppressive Therapy
Plasmapheresis
Thymectomy

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97
Q

Anesthesia Considerations of Myasthenia GRAVIS

MUSCLE RELAXANTS

A

⇧ sensitivity to NDNMB; decrease dose by ½ to 2/3 Or just avoid it completely
Resistance to succinylcholine Need 2.6 X the ED95

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98
Q

MG and Volatile agents

A

VA have MS relaxation properties

Postpone extubation and ventilator support postop.

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99
Q

MYASTHENIC SYNDROME AKA Eaton-Lambert Syndrome

What is it?

A

Resembles Myasthenia Gravis IgG antibodies attack Ca2+ channels

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100
Q

Treatment of Myasthenic Syndrome

A

3,4 Diaminopyridine

• IgG (6 to 8 weeks).

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101
Q

Myasthenia syndrome Anesthesia Considerations

A

Sensitive to depolarizing and non-depolarizing NMB

Antagonism of NM-Blockade with anticholinesterase drugs may be inadequate.

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102
Q

The potential presence of myasthenic syndrome and the need to decrease doses of muscle relaxants should be
Considered when?

A

considered in patients undergoing bronchoscopy, mediastinoscopy, or thoracoscopy***for suspected lung cancer

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103
Q

Epidermolysis Bullosa Despite

A

dystrophic skeletal muscle, no increased risk of a hyperkalemic response when treated with succinylcholine

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104
Q

Scleroderma Musculoskeletal system:

A

myopathy- weak, mostly proximal skeletal muscle groups

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105
Q

EHLER”S DANLOS SYNDROME Musculoskeletal: Joint

A

hypermobility, musculoskeletal discomfort, susceptibility to osteoarthritis.

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106
Q

DERMATOMYOSIS

A

Abnormal immune responses ➔ Slow, progressive skeletal muscle damage

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107
Q

S/ S of Dermatomyosis S

A

keletal muscle weakness (e.g., difficulty climbing stairs) d/t skeletal muscle destruction ➔ increased serum creatine kinase levels.Neuromuscular junction is not affected

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108
Q

Neuromuscular junction is not affected

A

Dermatomyosis

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109
Q

Marfan’s Syndrome Additional skeletal abnormalities

PKHH

A

Pectus excavatum
Kyphoscoliosis
Hyperextensibility of the joints
High-arched palate

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110
Q

Duschenne Muscular dystrophy Group of

A

hereditary diseases characterized by painless degeneration and atrophy of skeletal muscles

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111
Q

Duschenne Muscular Dystrophy

A

Progressive, symmetrical skeletal muscle weakness and wasting but no evidence of skeletal muscle denervation

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112
Q

Initial symptoms of Duschenne Muscular Dystrophy

A

waddling gait, frequent falling, difficulty climbing stairs, and these reflect involvement of the proximal skeletal muscle groups of the pelvic girdle
Affected muscles become larger as a result of fatty infiltration

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113
Q

Duschenne Muscular dystrophy and ambulation

Predispose to ?

A

Typically confined to a wheelchair by age 8 to 10

Skeletal muscle atrophy can predispose to long bone fractures

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114
Q

PRADER WILLI SYNDROME and skeletal

A

Weak skeletal musculature = poor cough and ⇧pneumonia

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115
Q

Systemic Lupus Erythematous *(SLE) is a

A

Multisystem chronic inflammatory disease characterized by antinuclear antibody production

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116
Q

SLE exacerbated by

A

Exacerbated by infection, pregnancy, surgery

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117
Q

SLE Onset can be drug induced: PHIDA

A 
Procainamide
hydralazine
Isoniazide, 
D - penicillamine
ALpha - methyldopa
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118
Q

Treatment of SLE (CIB)

A

Corticosteroids
Immunosuppressive treatment
Bone marrow transplant

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119
Q

Anesthesia Considerations for SLE

CRML

A

Laryngeal involvement
Mucosal ulceration
Cricoarytenoid arthritis
Recurrent laryngeal nerve palsy, may be present in as many as 1/3 patients

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120
Q

Periodic Paralysis: Avoid

A

Potassium solutions

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121
Q

Periodic Paralysis: CAUSES

A

HYPO and HYPERKALEMIA

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122
Q

Epidermolysis Bullosa and K+ and SUCC

A

NO INCREASED OF HYPERKALEMIC RESPONSE WITH SUX

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123
Q

Duschenne Muscular dystrophy  Succinylcholine

A

contraindicated d/t risk of rhabdomyolysis, hyperkalemia, and/or cardiac arrest -

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124
Q

Duschenne Muscular dystrophy: VA

A

Rhabdomyolysis, with or without cardiac arrest, observed with administration of VOLATILE anesthetics to these patients even in the absence of succinylcholine

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125
Q

What is Mastocytosis

A

Rare; disorder of mast cell proliferation; degranulation of mast cells

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126
Q

Mastocytosis Urticaria pigmentosa is usually

A

benign and asymptomatic

Children are most often affected → resolves by adulthood

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127
Q

Systemic mastocytosis : What happens

A

mast cells proliferate in all organs (especially bone, liver, and spleen, but not in the CNS).

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128
Q

Signs and Symptoms of Mastocytosis

A

Histamine release from mast cells and prostaglandins are involved➔ anaphylactoid responses characterized by pruritus, urticaria, and flushing with hypotension (life threatening) and tachycardia

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129
Q

Mastocytosis and bronchospasm,

A

Low risk of bronchospasm  Bleeding unusual, even though mast cells contain heparin!

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130
Q

Anesthetics Management for MASTOCYTOSIS Influenced by

A

the possibility of intraoperative mast cell degranulation and anaphylactoid reaction
-Have epinephrine readily available

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131
Q

Mastocytosis : Contrast dye

A

has caused profound hypotension- pretreat with H1,H2 blockers and glucocorticoid

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132
Q

Mastocytosis and Cromolyn-

A

inhibits mast cell degranulation, i.e. release of histamine (also used to treat asthma) -

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133
Q

Mastocytosis Safe: VVPF

A

Volatile anesthetics,
Vecuronium.
Propofol
Fentanyl

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134
Q

Mastocytosis Avoid:

A

Succinylcholine and Meperidine may cause mast cell degranulation

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135
Q

Upper cervical spine most at risk

A

(C1-C3)

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136
Q

Morbidity and mortality for cervical injuries include

A

alveolar hypoventilation with inability to clear bronchial secretions, plus the risk of aspiration of gastric contents, pneumonia, and pulmonary embolism (slide 5)

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137
Q

Lateral protrusion of a cervical disk usually occurs at 

A

C5-6 or C6-7 intervertebral spaces

Symptoms can be exaggerated by coughing

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138
Q

CERVICAL INJURY Management of anesthesia: primary concern is

A

airway approach, direct laryngoscopy should only be done if no significant worsening of symptoms occur with neck movement (especially extension)

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139
Q

Management of anesthesia: cervical spine procedures via the anterior approach

A

involves retraction of the airway structures and may result in injury to the ipsilateral recurrent laryngeal nerve and can manifest as hoarseness, stridor, or frank airway compromise

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140
Q

MANAGEMENT OF CERVICAL SPINE PROCEDURES Compression of

A

Recurrent laryngeal nerve fibers can be caused by the endotracheal tube or the inflated cuff. It is common practice to decrease the cuff completely and reinflate it until a leak is no longer heard

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141
Q

Cervical spondylosis =

A

neck pain and radicular pain in the arms and shoulders accompanied by sensory loss and skeletal muscle wasting. Later, sensory and motor signs may appear in the legs producing an unsteady gait

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142
Q

UNSTABLE C-NECK

Sensitivity of plain radiographs for detecting cervical spine _____THEREFORE

A

injury is < 100%, treat all acute cervical spine injuries as potentially unstable

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143
Q

Immediate immobilization to limit

A

neck flexion/extension

Manual in-line stabilization during laryngoscopy

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144
Q

CERVICAL SPINE movement tend to

A

Movement tends to occur in the occipito-atlanto-axial area even with stabilization

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145
Q

Neck hyperextension can further

A

damage the spinal cord

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146
Q

Anesthetic implications for old spinal injury. Chronic spinal cord injuries lead to ICACAA

A 
Impaired alveolar ventilation
Cardiovascular instability 
Autonomic hyperreflexia), 
Chronic pulmonary and genitourinary tract infections, Anemia
Altered thermoregulation
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147
Q

Chronic spinal cord injuries and renal

A

Renal failure can occur

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148
Q

Anesthetic implications for old spinal injury.Immobility leads to

A

osteoporosis, skeletal muscle atrophy, DVT/VTE, pathologic fractures

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149
Q

Several weeks after acute spinal cord injury,

A

spinal cord reflexes gradually return, and patients enter a chronic stage characterized by overactivity of the sympathetic nervous system and involuntary skeletal muscle spasms

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150
Q

Spasm with spinal cord injury Medication to help and how it works

A

Baclofen

potentiates GABA) is useful to treat spasticity (abrupt withdrawal = seizures

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151
Q

Chronic Spinal Cord Injury

Injury at or above C5 there is ______Due to

A

apnea due to denervation of the diaphragm
Even when the diaphragm is intact, coughing and the ability to clear secretions from airway may be impaired due to denervation of intercostal and abdominal muscles

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152
Q

Injury at or above C5 RESPIRATORY CHANGES

What does anesthetist need to do? What can occur?

A

Marked decreased vital capacity, arterial hypoxemia Need to preoxygenate before suctioning (bradycardia or cardiac arrest can occur)

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153
Q

Chronic Spinal Cord Injury Management of Anesthesia

A

Prevent autonomic hyperreflexia

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154
Q

Chronic Spinal Cord Injury Management of Anesthesia; Muscle Relaxant

A

Use NDNMB to prevent reflex skeletal muscle spasms in response to surgical stimulation 

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155
Q

Chronic Spinal Cord Injury Management of Anesthesia: SUCC

A

Succinylcholine is likely to provoke hyperkalemia within the first 6 months after injury (Avoid it after 24 hours of injury)

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156
Q

Chronic Spinal Cord Injury Management of Anesthesia: ANTICIPATE what? What medication not to stop ?

A

Anticipate altered hemodynamics

Continue Baclofen and benzodiazepines perioperatively

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157
Q

What is Amyotrophic Lateral Sclerosis (ALS)    

A

Degenerative disease involving the lower motor neurons in the anterior horn gray matter of the spinal cord and the corticospinal tracts (primary descending upper motor neurons)

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158
Q

ALS produces

A

Produces both upper and lower motor neuron degeneration

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159
Q

Most common affected with ALS

A

Most commonly affects men 40-60 years of age

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160
Q

ALS: Primary lateral sclerosis

A

= limited to the motor cortex of the brain

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161
Q

ALS Pseudobulbar palsy =

A

limitation to the brainstem nuclei

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162
Q

Amyotrophic Lateral Sclerosis  Symptoms reflect and resemble what?

A

upper and lower motor neuron dysfunction (resembles myasthenia gravis)

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163
Q

ALS Begins with

A

Skeletal muscle atrophy
Weakness
Fasciculations in the hands
Eventually includes all skeletal muscles including the tongue, pharynx, larynx, and chest TPLC

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164
Q

ALS Bulbar involvement includes

A

fasciculations of the tongue plus dysphagia, which leads to pulmonary aspiration

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165
Q

With ALS Autonomic nervous system dysfunction can be manifested as

A

Orthostatic hypotension and resting tachycardia 

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166
Q

Muscles Spared with ALS

A

Ocular muscles are spared

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167
Q

Amyotrophic Lateral Sclerosis Anesthesia considerations: RESPIRATORY

A

Exaggerated respiratory depression

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168
Q

Amyotrophic Lateral Sclerosis Anesthesia considerations

Vulnerable to

A

Vulnerable to hyperkalemia following succinylcholine administration

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169
Q

Amyotrophic Lateral Sclerosis Anesthesia considerations NDNMB

A

Prolonged responses to NDNMBA

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170
Q

What predisposes ALS patients to aspiration

A

Bulbar involvement predisposes to pulmonary aspiration

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171
Q

Syringomyelia (syrinx) is a disorder where there is

A

cystic cavitation of the spinal cord

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172
Q

Syringomyelia (syrinx) What is called syringobulbia?

A

Rostral extension into the brainstem

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173
Q

Syringomyelia (syrinx) - Communicating syringomyelia =

A

Either only dilation of the central canal of the cord (hydromyelia) or there is communication between the abnormal cystic lesions in the spinal cord proper and the CSF spaces

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174
Q

Syringomyelia - What is communicating syringomyelia associated with?

A

Associated with basilar arachnoiditis or Chiari’s malformation

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175
Q

Syringomyelia- Noncommunicating syringomyelia =

A

presence of cysts that have no connection to the CSF spaces

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176
Q

Syringomyelia Symptoms:

A

sensory impairment involving pain and temperature sensation in the upper extremities (destruction of neuronal pathways), as cavitation progresses, destruction of lower motor neurons ensues causing skeletal muscle weakness and wasting and loss of reflexes

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177
Q

Syringomyelia Thoracic scoliosis why?

A

Thoracic scoliosis can result from weakness of paravertebral muscles

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178
Q

Syringobulbia

A

paralysis of the palate, tongue, and vocal cords

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179
Q

Syringomyelia Management of anesthesia:

TEAT

A

Thoracic scoliosis can cause V/Q mismatching
Avoid succinylcholine due to lower motor neuron disease
Exaggerated responses to nondepolarizing muscle relaxants
Thermal regulation may be impaired

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180
Q

GFR

A

best measure of renal function • normal: > 90 ml/min

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181
Q

Creatinine clearance •

A

Most reliable measure of GFR

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182
Q

Normal CrCL

A

110-140ml/min

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183
Q

Serum creatinine

A

Normal: 0.6 to 1.3 mg/dl

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184
Q

Blood urea nitrogen (bun) • normal:

A

10 to 20 mg/dl

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185
Q

Function of Renal system

A

Sodium and water removal
Waste removal
Hormone production

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186
Q

Kidney Filter the plasma volume every

A

22 minutes

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187
Q

3 things kidney regulate OVP

A
  1. Regulation of plasma osmolarity
  2. Regulaiton of plasma volume
  3. Regulation of arterial pH (acid-base)
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188
Q

3 things kidney regulate OVP

A

Regulation of plasma osmolarity
Regulaiton of plasma volume
Regulation of arterial pH (acid-base)

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189
Q

Kidney Removal of

A

metabolic water and foreign substances (urea and drugs)

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190
Q

Kidney produces and activation of

A

Production of erythropoietin and renin

Actionvation of Vitamin D 3

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191
Q

Fluid overload problems in kidneys

A

Elevated wastes products (Urea, creatinine, potassium)

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192
Q

Changes in hormone control in the kidney (BUM)

A

Blood pressure
Making RBCs
Uptake of calcium

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193
Q

Filtration is

A

movement of fluid from glomerulus to Bowman’s capsule

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194
Q

Tubular Reabsorption is

A

Movement from Bowman’s capsule to Peritubular capillaries

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195
Q

Tubular Secretion is

A

Movement from Peritubular capillaries to Bowman’s capsule

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196
Q

Proximal tubule NaGluKAHPPUH

A 
reabsorption of 
NaCL
Glucose
K
Amino Acids
HCO3
PO4
Protein
Ureak
H2O ( ADH not required)
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197
Q

Tonicity of fluid (within ducts) Proximal

A

Isotonic

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198
Q

Tonicity of fluid (within ducts) Loop of Henle

A

Isotonic, Hypertonic, Hypotonic

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199
Q

Tonicity of fluid (within ducts) Distal

A

Isotonic or Hypotonic

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200
Q

Tonicity of fluid (within ducts) Collecting duct

A

Final Concentration

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201
Q

Proximal tubule Secretion of (HFOI)

A

H+
Foreign Substances
Organic Anions, Catiion
Isotonic

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202
Q

Where is ADH not required

A

Proximal

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203
Q

LOOP of HENLE (CADU)

A

Concentration of urine (countercurrent mechanism)
Ascending loop Na+ Reabsorbed (active transport, water stays in)
Descending loop WATER Reabsorbed Nacl diffuses in
Urea secretion in thin segment

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204
Q

Distal Tubule NHH

KUHNS

A 
Reabsorption of NaCL, H2O (ADH required) HCO3
Secretion of KUHNS
K+ 
Urea
H+
NH3+
Some drugs
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205
Q

Distal Tubule NHH KUHNSI

A 
Reabsorption of NaCL, H2O (ADH required) HCO3
Secretion of KUHNSI
K+ 
Urea
H+
NH3+
Some drugs
Iso or Hypo
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206
Q

Connecting Tubule Reabsorption of

A

H2O (ADH required)

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207
Q

COLLECTING Reabsoprtion OR secretion of NaKHN

A

Na+
K+
H+
NH3+

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208
Q

COLLECTING DUCT urea secretion in

A

Medulla

209
Q

Major sites of exchange within the nephron: Reabsorption in Proximal (NHG)

A

Na+
H2O
Glucose

210
Q

Major sites of exchange within the nephron: Reabsorption in Distal Tubule ()

A

H2O and K+

Secretion NH3

211
Q

Major sites of exchange within the nephron: Secretion in Distal tubule

A

NH3

H+

212
Q

ACUTE RENAL FAILURE (ARF)
• PERIOPERATIVE ANESTHESIA CONSIDERATIONS
Fluids

A
  1. NS VS. LR

• NS ➔ HYPERCHLOREMIC METABOLIC ACIDOSIS ➔ SECONDARY HYPERKALEMIA.

213
Q

Acure Renal Failure, action of ALPHA 1 AGONIST VS. VASOPRESSIN

A

increased systemic pressure is accompanied by reduced renal sympathetic tone and vasodilation

214
Q

ARF Alpha 1 agonist vs vasopressin

A

Alpha 1 agonist: ARF r/t sepsis with renal vasoconstriction ➔ exacerbate tubular injury. • • alpha 1 agonist: arf r/t sepsis with renal vasoconstriction ➔ exacerbate tubular injury. • vasopressin: selectively constrict renal efferent arterioles ➔ preserve gfr and uop.

215
Q

Vasopression is better than alpha 1 agonist why?

A

vasopressin: selectively constrict renal efferent arterioles ➔ preserve GFR and Urine OUTPUT

216
Q

CRF perioperative anesthesia considerations IV access:

A

use temporary hemodialysis catheter (not encouraged) ➔ must be accessed aseptically. • a line: not in same extremity as patent fistula ➔inaccurate arterial pressure and abg concentrations.

217
Q

CRF induction ➔

A

hypovolemia ➔ impaired peripheral vasoconstriction. • give 250ml of 5% albumin via direct ivp using a 60ml syringe before induction.

218
Q

In CRF, Giving Albumin, How does it help?

A

this “somewhat” corrects hypoalbuminemia, giving protein bound drugs something to bind to. it also acts as a volume expander helping to decrease hypotension’

219
Q

RENAL TRANSPLANTATION

• ANESTHESIA CONSIDERATIONS: Fluid and volume

A

A high-normal systemic blood pressure and euvolemia are required to maintain adequate urine output

220
Q

RENAL TRANSPLANTATION

• ANESTHESIA CONSIDERATIONS: VENTILATION

A

surgical retraction in the area of the diaphragm ➔ respiratory mechanics impaired ➔ *** controlled mechanical ventilation preferred •

221
Q

Renal transplant: Old kidney vs new kidney clearance

A

A newly transplanted kidney can clear neuromuscular blockers and anticholinesterase drugs at the same rate as a healthy native kidneys

222
Q

Monitoring and Meds after kidney transplant

A

Cvp monitoring should be used to guide volume infusion

Mannitol is administered to facilitate urine formation in the new kidney and decrease the risk of acute tubular necrosis

223
Q

RENAL TRANSPLANTATION

• RELEASE OF VASCULAR CLAMPS ➔

A

➔ venous drainage from the legs and preservative solutions from the transplanted kidneys are released into circulation ➔ cardiac arrest can occur during this time due to hyperkalemia (potassium-rich preservative solutions)

224
Q

2 reasons Why Hypotension after unclamping during renal transplantation?

A

➔ hypotension can follow unclamping because

  1. there is a 300 ml increase to the intravascular capacity
  2. previously ischemic tissues release vasodilating metabolic byproducts.
225
Q

Anesthesia considerations for someone who has had a kidney transplant: • immunosuppressant drugs have multiple side-effects What are they (SLAT)

A

Systemic hypertension
Lowered seizure thresholds
Anemia
Thrombocytopenia

226
Q

Anesthesia considerations for someone who has had a kidney transplant GFR and RBF.

A

GFR and renal blood flow likely to be lower, activity of drugs excreted by the kidneys may be prolonged •

227
Q

Anesthesia considerations for someone who has had a kidney transplant Minimize

A

minimize drugs that depend on renal clearance, avoid nephrotoxins

228
Q

When should diuretics be administered for someone who has had a kidney transplant

A

diuretics should only be administered after careful evaluation of intravascular volume status • decreases in renal blood flow should be minimized

229
Q

Nephrotic syndrome • definition:

A

daily urinary protein excretion exceeding 3.5 g

230
Q

Nephrotic syndrome associated with (SHIT)

A

Sodium retention
Hyperlipidemia,
Infectious complications
Thromboembolic

231
Q

Nephrotic syndrome most common cause:

A

diabetic nephropathy •

232
Q

Nephrotic syndrome signs and symptoms • revolve around

A

Sodium retention and decreased plasma oncotic pressure leading to intravascular hypovolemia and edema

233
Q

Signs of Nephrotic syndrome (VOPT)

A

Vasoconstriction
Orthostatic hypotension
Peripheral
Tachycardia,

234
Q

To correct hypovolemia with Nephrotic Syndrome

A

Infusion of albumin to correct hypovolemia,

235
Q

Loop diuretics and Nephrotic syndrome

A

Loop diuretics to offset sodium retention (careful to avoid hemoconcentration because patients are at risk for thromboembolic events)

236
Q

How does hypoalbuminemia affect nephrotic syndrome?

A

hypoalbuminemia decreases available binding sites for drugs and increases circulating levels of unbound drugs

237
Q

NEPHROLITHIASIS Assessment: • stones in the renal pelvis are

A

are painless unless complicated by infection or obstruction

238
Q

NEPHROLITHIASIS what happens

A

a stone passage through the ureters produces flank pain radiating to the groin with nausea and vomiting •

239
Q

NEPHROLITHIASIS: What can be seen with passage

A

hematuria can be seen with ureteral passage

240
Q

NEPHROLITHIASIS: Treatment

A

Treat underlying disorder • maintain daily uop > 2-3l/day

241
Q

TURP Hypervolemia can result from ________ leading to HBP

A

absorption of irrigants→

htn, bradycardia, pulmonary edema

242
Q

TURP hyponatremia can result from _______ leading to

CAP-CS

A

absorption of na free irrigants→
Confusion, Agitation, pulmonary edema,
CV collapse, Seizures

243
Q

2 issues that may occur with TURP

A

Hypervolemia

Hyponatremia

244
Q

TURP Ace inhibitors →

A

increased risk of intraoperative hypotension

245
Q

ANESTHESIA AND RENAL DISEASE

Volatile anesthetics →

A

decreased RBF GFR, and UOP by causing a drop in

BP and CO (transient)

246
Q

ARF official diagnosis Criteria

A

FORMAL DIAGNOSIS:
• INCREASED SERUM CREATININE MORE THAN 0.5 MG/DL OF BASELINE
• 50% DECREASE IN CREATININE CLEARANCE
• A CHANGE IN SERUM CREATININE OF GREATER THAN 0.3 MG/DL WITHIN 48 HOURS OF
ACUTE INSULT

247
Q

ANESTHESIA AND RENAL DISEASE: Painful stimuli

A

Painful stimuli → increased ADH secretion

248
Q

ANESTHESIA AND RENAL DISEASE- How PPV impact

A

Positive pressure ventilation→ decreased ANP secretion → oliguria

249
Q

Renal transplantation: Kidney from a cadaver

A

a kidney from a cadaver can be preserved by perfusion at low temperatures for up to 48 hours •

250
Q

Renal Transplantation what must be matched?

A

HLA antigens and ABO blood groups must be matched •

251
Q

Renal transplantation , donor kidney ?

A

donor kidney is placed in the lower abdomen and receives its vascular supply from the iliac vessels •

252
Q

Renal Transplantation , when is immunosuppresion therapy started?

A

immunosuppression therapy is started perioperatively

253
Q

Long-term immunosuppression results in _____And frequency of _______

A

opportunistic infections

frequency of cancer is 30 to 100 times higher

254
Q

Treatment of acute immunologic rejection

A

Removal of the transplanted kidney, especially if accompanied by DIC

255
Q

What are the delayed signs of graft rejection (FLD)

A

Fever
Local tenderness
Decreased UOP

256
Q

Meds and therapy for Treatment of acute immunologic rejection (CAH)

A

Corticosteroids
Antilymphocyte globulin
Hemodialysis

257
Q

ESRD and its effect on oxygen dissociation

CRF Signs and symptoms 1. Electrolyte imbalances:

A

hyperkalemia, hypermagnesemia, hyperphosphatemia, hypocalcemia

258
Q

ESRD and its effect on oxygen dissociation

CRF Signs and symptoms 2. Metabolic acidosis. Anemia

A

a. Anemia • increased co, right shift of oxyhemoglobin dissociation curve

259
Q

ESRD and its effect on oxygen dissociation Bartter syndrome = What is it?

A

Ccongenital hypokalemic alkalosis)- autosomal recessive

260
Q

How oxygen dissociation is affected with Bartter syndrome? KPL-VI

A
  • k+ follows H+
  • pH and O2 dissociation curve→ less O2 available to tissues
  • volume depletion from Na+ wasting
  • increased Prostaglandins → activate renin/angiotensin/aldosterone axis (RAAS)
261
Q

Bartter Syndrome move the O2 dissociation curve to the

A

LEFT

262
Q

Sevoflurane is metabolized to

A

Fluorine (F-)

263
Q

Sevoflurane leads to

A

transient tubular dysfunction (concentrating ability, increased β-n-acetylglucosaminidase) •

264
Q

Effect of renal disease on anesthesia drugs Sevoflurane, is there changes in BUN or Cr? What about compound A?

A

no change in cr- or bun • Compound A- questionable significance •

265
Q

Effect of renal disease on anesthesia drugs: ACE

A

Increased risk of intraoperative hypotension

266
Q

Effect of renal disease on anesthesia drugs disrupted bbb and less protein binding →

A

increased bioavailability of induction drugs

267
Q

Effect of renal disease on anesthesia drugs “ gastric

A

Delayed Gastric emptying

268
Q

K release after succ is how much ? Does defasciculation change K+ release?

A

• k+ release after sux (0.5 to 1.0 meq/l) de-fasiculation does not change k+ release

269
Q

CHRONIC RENAL FAILURE • Perioperative anesthesia considerations AVOID ➔

A

NSAIDS

270
Q

Why do we avoid NSAIDS with CRF? HPI

A

Exacerbate →
HYPERTENSION
PRECIPITATE EDEMA, AND
INCREASE THE RISK OF CV COMPLICATIONS WITH ESRD.

271
Q

Chronic renal Failure and Opioids

A

USE PARENTERAL OPIOIDS JUDICIOUSLY.

272
Q

Acute Renal FAILURE: Give at lower dose based on GFR: CoFeKeMMM

A 
CODEINE
FENTANYL
KETOROLAC, 
MEPERIDINE
METHADONE
MORPHINE.
273
Q

Acute Renal FAILURE Do not require dosage adjustments→ ARS

A

Alfentanil
Remifentanyl
Sufentanyl

274
Q

Acute Renal FAILURE avoid further renal insults

A

hypovolemia, hypoxia, nephrotoxins

275
Q

ARF Perioperative anesthesia considerations dialysis

A

within 24 hours of elective surgery.

276
Q

CHRONIC RENAL FAILURE
• PERIOPERATIVE ANESTHESIA CONSIDERATIONS
13 Drugs that rely heavily on renal elimination: (VENGA- HAMCCPSV)

A 
VECURONIUM
EDROPHONIUM
NEOSTIGMINE, 
GLYCOPYRROLATE,
ATROPINE,  
HYDRALAZINE, 
AMINOGLYCOSIDES
MILRINONE,
CEPHALOSPORINS, 
CODEINE
PENICILLINS
SULFONAMIDES
VANCOMYCIN,
277
Q

Chronic Renal Failure Drugs that have active metabolite and its implications.? MMH

A

Meperidine, Morphine, and Hydromorphone with active metabolites ➔ accumulate in ESRD

278
Q

Chronic Renal Failure Best paralytics ? What may be delayed?

A

Atracurium and cisatracurium (best choice paralytics), but LAUDANOSINE clearance maybe delayed.

279
Q

CRF and serum potassium

A

serum potassium should not exceed 5.5 meq/L

280
Q

LR and CRF

A

LR has 4 meq/L of potassium

281
Q

Reno-protective pharmacological agents Perioperative anesthesia considerations→low dose fenoldopam

A

➔ renal vasodilation

282
Q

Reno-protective pharmacological agents

Perioperative anesthesia considerations mannitol ➔

A

renal prostaglandins produced ➔ renal vasodilation

283
Q

Reno-protective pharmacological agents Perioperative anesthesia considerations N-acetylcysteine ➔

A

free radical scavenger ➔ protect against radiographic dye-induced nephropathy

284
Q

Hemodialysis: mainstay of treatment d/t .

A

volume overload, hyperkalemia, severe metabolic acidosis, symptomatic uremia, and overdose with a dialyzable drug

285
Q

Reno-protective pharmacological agents best choice and why?

A

Selectively constrict renal efferent arterioles ➔ preserve gfr and uop_

286
Q

Reno-protective pharmacological agents best choice and why?

A

Selectively constrict renal efferent arterioles ➔ preserve GFR and UOP

287
Q

2 main things that mannitol doses

A

Scavenges Free radicals

Release prostaglandins, causing vasodilation

288
Q

Herbal Supplements that Decrease Platelet Aggregation

BB D FFF GGGGS

A
  • Bilberry
  • Bromelain
  • Dong Quoi
  • Feverfew
  • Fish oil
  • Flax seed oil
  • Garlic
  • Ginger
  • Gingko biloba
  • Grape seed extract
  • Saw palmetto
289
Q

Herbal Supplements that Inhibit Clotting

DDHCC

A
  • Dandelion root
  • Dong Quoi
  • Chamomile
  • Curcumin
  • Horse chestnut
290
Q

Hemodynamic effects of prone position

Do not administer excessive

A

crystalloid volume to promote urine output.

291
Q

Hemodynamic effects of prone position Urine output is

A

often less than expected when patients are positioned prone

292
Q

Prone CPR and SBP

A

Increase in systolic BP

293
Q

Prone CPR and circulation

A

good circulatory and respiratory support, easy to perform

294
Q

Prone and GFR

A

Increased intra-abdominal pressure may decrease GFR.

295
Q

Prone , Pressure transmitted to

A

epidural veins, increased bleeding.

296
Q

Prone : In the absence of cord compression,

A

modest decrease in BP may be helpful, when extensive surgery is anticipated
This can be accomplished with anesthetics and opioids or by the use of beta blockers and SNP

297
Q

BP approximately

A

20% below patient lowest recorded BP when awake

298
Q

PRONE: MAP

A

> 60 mm Hg in youg patients and

MAP> 80 mm Hg in elderly pts

299
Q

Prone and ↓ BP may be due to

A

abdominal compression and decreased venous return

300
Q

Prone and ↑ Blood loss

A

2º to epidural vein engorgement abdominal compression or vascular injury

301
Q

Acute ↓ BP may be due to a

A

vascular injury either obvious or occult until proven otherwise.

302
Q

Prone: If ↓ BP persists despite vigorous blood and fluid administration, what would you suspect?

A

RETROPERITONEAL BLEEDING

303
Q

Risk Factors for POVL (MOHP)

A

Male
Obese
Hypertension and Peripheral Vascular disease
Prolonged procedures, Substantial bloodloss or Both

304
Q

Recommendations to prevent POVL

Blood pressure management

A

• Assess the patient’s baseline blood pressure.
• Continually monitor systemic blood pressure in high risk patients.
Treat prolonged significant decreases in blood pressure.

305
Q

Recommendations to prevent POVL : Determine

and discuss

A

• Determine on a case-by case basis whether deliberate hypotension should be used in high-risk patients.▪ Discuss with the surgeon whether deliberate hypotension is necessary.

306
Q

Recommendations to prevent POVL Management of Blood Loss and Administration of Fluids Periodically monitor

A

hemoglobin or hematocrit values during surgery in high-risk patients who experience substantial blood loss.

307
Q

Recommendations to prevent POVL : Continual monitoring of

A

▪ Continual monitoring of hydration levels to avoid overhydration
▪ Fluid replacement limitation.

308
Q

Recommendations to prevent POVL

Use of Vasopressors

A

Adrenergic agonists may be used on a case-by-case basis when it is necessary to correct for hypotension

309
Q

Recommendations to prevent POVL Patient and Head Positioning Devices

A

Positioning the patient so that the head is level with

or higher than the heart

310
Q

Recommendations to prevent POVL eyes

A

Avoidance of direct pressure on the globe of

the eye

311
Q

Recommendations to prevent POVL Maintaining of face in a

A

neutral forward position(e.g., without significant neck flexion or extension, lateral flexion, or rotation)

312
Q

Recommendations to prevent POVL Staging of Surgical Procedures

A

Use of staged procedures for spine surgery when

anticipated length is greater than 6 h

313
Q

Rheumatoid arthritis: What is it?

A

it is a autoimmune condition, immune mediated joint destruction with chronic and progressive inflammation of synovial membranes

314
Q

RA patients implications

A

these are the really involved and difficult patients,

affects multiple organ systems

315
Q

RA and Cardiovascular – PMCCVA

A 
Pericardial thickening and effusion
Myocarditis
Coronary arteritis
Conduction deficits, 
Vasculitis and cardiac valve fibrosis 
Aortic regurgitation)
316
Q

RA and stress test Arthritis

A

limits exercise probably cant get treadmill ECHO, so dobutamine ECHO may be needed

317
Q

RA → HTN / cardiovascular disease and c

A

Conduction defects common in elderly leads to dysrhythmias leads to falls then Hip fracture

318
Q

If patient has RA, at a minimum get

A

get EKG at minimum , if tamponade or severe CV disease suspected - ECHO

319
Q

RA and respiratory what is common, and what is rare, and if rare presents, what are the symptoms (CDS) Get these tests___

A

Pulmonary effusions common, rare to have Pulmonary fibrosis, if present will have cough, dyspnea, SOB-
PFTs,

320
Q

RA and airway derangements

A

Cricoarytenoid joints

Glottic narrowing

321
Q

Arthritis and TMJ

A

Arthritis of TMJ – limited mouth opening

322
Q

Arthritis of TMJ implications? What is needed.?

A

making direct laryngoscopy difficult and may need fiberoptic if intubating

323
Q

RA have cricoarytenoid joings, glottic narrowing, anesthesia considerations?

A

– Use smaller ETT – presenting sign hoarseness, worry about post extubation stridor even with smaller ETT

324
Q

Neurological and RA

A

Check for Full ROM –

nerve root compression and cerebral ischemia from vertebral artery compression

325
Q

RA : Position and Musculoskeletal

A

Pain and arthritis make positioning and regional uncomfortable and more difficult

326
Q

RA and small joints and implications

A

Affect small joints causing deformity like in hand, wrist and feet - Difficult to place arterial line or IV

327
Q

Hematologic and RA

A

Anemia from NSAID gastritis and renal toxicity

Eosinophilia

328
Q

RA HGB if less than 12

A

HGB if less than 12 consider autologous blood donation as Hip fracture has the potential for large volume loss +1 L

329
Q

RA has PLT dysfunction why?

A

from aspirin therapy and thrombocytopenia

330
Q

RA and Endocrine

A

adrenal insufficiency ( from glucocorticoid therapy and impaired immune system

331
Q

RA and Dermatological

A

Thin and atrophic skin from the disease and immunosuppressive drugs so just make sure pressure points are padded well so don’t get skin breakdown

332
Q

RA –If pt has severe RA: Means patient is on

A

steroids, immune therapy or methotrexate

333
Q

RA patient get xrays ? which type and why?

A

Especially lateral views of neck
Atlantoaxial subluxation instability, which is diagnosed by an x-ray, can compromise vertebral blood flow and compress spinal cord and brainstem,

334
Q

RA patients with Xray showing Atlantoaxial subluxation instability, What do you do?

A

Intubate one of these patients - do so using fiberoptic laryngoscope.

335
Q

PTS W/RHEUMATOID ARTHRITIS MAYBE ON

A

ORAL CORTICOSTEROIDS AND SUPPLEMENTAL PERIOPERATIVE STEROIDS

336
Q

RA and Adrenal insufficiency

A

Adrenal insufficiency from steroids therapy, supplemental intraoperative steroids

337
Q

AC and Regional Warfarin

A

Hold for 4-5 days prior to block

Removed catheter with INR < 1.5, INR >3 hold dose

338
Q

AC and Regional→ ASA

A

NO CONTRAINDICATIONS

339
Q

AC and Regional→Clopidogrel

A

stop 7 days prior, if neuraxial considered between 5-7 days,restoration of platelet function should be confirmed.

340
Q

AC and Regional→ Prasugrel ,

A

stop 7-10 days, wait 9 hours after neuraxial block or catheter removal before administration of drugs

341
Q

AC and Regional → Ticagrelor

A

stop 5-7 days prior to neuraxial ,wait 10 hours after neuraxial block or catheter remove before administration of drug

342
Q

AC and Regional→ Ticlopidine

A

Stop 14 days prior to neuraxial block

343
Q

AC and Regional→ LMWH : Preop

A

wait 10-12 hours after prophylactic dose, 24 hours after tx dose

344
Q

AC and Regional→ LMWH Post op

A

catheters removed at least 2 hours prior to initiation of dose of 2x daily

345
Q

AC and Regional→ For single daily dose of LMWH ,

A

catheters can be maintained but should only be removed 10-12 hours after last dose

346
Q

AC and Regional →Heparin SC < 10000 units per day

A

NO contraindications

347
Q

AC and Regional→ Heparin SC >10000 Units per day

A

use caution- Check platelet if on heparin > 4 days

348
Q

AC and Regional→ Dabigatran

A

stop 5 days prior to neuraxial block, wait 6 hours after neuraxial block or catheter removal before adminis ofdrugs

349
Q

AC and Regional→ Apixaban,

A

Stop 3 days prior to neuraxial block, wait 7 hours after neuraxial block or catheter removal

350
Q

AC and Regional→ Rivaroxaban

A

stop 3 days prior to neuraxial block, wait 8 hours after neuraxial block or catheter removal

351
Q

AC and Regional Thrombolytics/Fibrinolytics, thrombin inhibitors:

A

CONTRAINDICATED

352
Q

Regional contraindicated

A

TPA contraindicated

353
Q

Bone Cement Implantation syndrome. Methymethacrylate (MMA): Cause is not completely known. Some speculate it

A

from micro emboli forming during cementing, others believe its from histamine release, complement activation, and vasodilation.

354
Q

In BCIS, Intense

A

exothermic reaction causes heat and results in intramedullary hypertension which can cause fat, bone marrow, cement and air embolization into venous circulation.

355
Q

MMA is not usually used in

A

younger patients and those physically active, just press fit which means just forcibly seated with mallet into femur opening.

356
Q

BCIS Etiology

A

not completely understood

357
Q

BCIS Most common with

A

hip arthroplasty, but also can occur with knee cementing and vertebroplasty.

358
Q

BCIS Occurs in

A

2-17% of cementing surgeries

359
Q

BCIS Risk factors – PPAD

A

preexisting CV disease
preexisting Pulm. HTN,
ASA 3 or greater,
depends on type of fracture and surgical technique

360
Q

S/S of BCIS : HIHAP-D

A 
Hypoxia
Increased pulmonary shunt)
Hypotension
Arrhythmias (including heart block and sinus arrest), Pulmonary hypertension (increased pulmonary vascular resistance)
Decreased cardiac output.
361
Q

BCIS Treatment: Cementing time

A

should be recorded in chart and communication at cementing time is crucial as prior to cementing,

362
Q

BCIS Treatment BP needs to be

A

optimized, FiO2 100% and pressure bags for fluids if needed.

363
Q

BCIS Treatment If hypotension occurs use

A

Alpha agonist – phenylephrine for hypotension and aggressive fluid resuscitation

364
Q

DVT Venous Thromboembolism /PET

Without prophylaxis – DVT in

A

40-80% of orthopedic pts.

365
Q

Multimodal prophylaxis protocol for THA in one study had DVT and PE rates of

A

2.5% and 0.6% which much lower than the numbers above.

366
Q

DVT Risk factors include OPAULI

A 
Obesity
Procedures lasting more than 30 min
Age greater than 60 years
Use of a tourniquet
Lower extremity fracture
Immobilization for more than 4 days.
367
Q

Patients at greatest risk for DVT include those undergoing

A

hip surgery and knee replacement or major operations for lower extremity trauma

368
Q

DVT and Preventative:

A

America College of Chest Physicians guideline recommend a minimum 14 days of pharmacologic thromboprophylaxis and / or SCD device to decrease risk

369
Q

DVT and regional anesthesia

A

The use of neuraxial anesthesia, which causes vasodilation in the lower extremities, reduces the incidence of DVT by 50% in comparison to general anesthesia.

370
Q

Complications: BLEEDING: Deliberate Hypotension

A

Deliberate hypotension using neuraxial anesthesia during hip surgery decreases blood loss and intraoperative transfusion needs when compared to general anesthesia

371
Q

Tranexamic acid (TXA) can be

A

given intravenously or topically in the perioperative setting to decrease blood loss and transfusion requirements

372
Q

What can improve intraoperative coagulation?

A

Maintaining normothermia improves intraoperative coagulation

373
Q

Orthopedic syndrome Fat embolism syndrome classically presents

A

within 72 h following long-bone or pelvic fracture,

374
Q

TRIAD of PE (PCD)

A

Petechiae
Confusion
Dyspnea

375
Q

Fat embolism Petechia location (ACU)

A

Axilla, Chest, UE

376
Q

FAT embolism signs w/ GETA –P

A

decline in ETCO2

decline arterial oxygen saturation and rise in PA

377
Q

FAT embolism mortality

A

10-20% mortality

378
Q

FAT embolism Treatment: SOPR

A

Stabilization and surgery on fracture,
Oxygen therapy especially CPAP to prevent hypoxia, Pressors in hypotension and vasodilators may help
Pulmonary HTN
Respiratory support

379
Q

FAT embolism useless and controversial

A

steroids are controversial and heparin is not effective

380
Q

What is Venous Air embolism ?

A

Potential hazard whenever the operative site is above the level of the heart such as a shoulder surgery in beach chair position, or hip replacement when pt. is on their side.

381
Q

VAE: Most sensitive monitor

A

TEE

382
Q

VAE of S/S: (SIRI)

A

Sudden decrease in ETCO2
Increase in PAP, RV
Decrease in CO and BP
Increased dead space

383
Q

Treatment of VAE (IFLAT) TAGS

A

Inform surgeon
Flood area with saline
Lower preoperative sites
Apply occlusive dressing to all bone edges if possible Try to identify air entry, if possible

Try aspiration thru right atrial catheter
Avoid PEEP
Give O2
Stop nitrous if on

384
Q

VAE treatment Support hemodynamics with

A

Pressors and fluids

385
Q

Lateral position and air exchange

A

Pulmonary shunting involved in lateral position

386
Q

Positioning and how it affects MAP in different organs

A

Decreased CI, CVP, PCWP, and increased SVR

387
Q

MAP and SITTING UP

A

Increases SVR

Postural DECREASE IN BP

388
Q

45 degree head up and hemodynamics

A

(minimal hemodynamic changes)

389
Q

90 degree head up and hemodynamics

A

CO decrease by 20% due to venous pooling of blood in legs

390
Q

Excessive flexion of neck can

A

impede arterial and venous blood flow and cause hypoperfusion and inadequate drainage of the brain

391
Q

Kinked tube due to neck flexion,

A

risk of tube pressure on tongue leading to macroglossia. Keep two fingerbreadths between chin and sternum

392
Q

The sitting position interferes

A

the least with ventilation and has less influence on lung volumes

393
Q

With flexion of the hips and elevation of the legs

A

abdominal contents may shift caudally and limit the diaphragm, which will decrease FRC

394
Q

Arm support to prevent stretching

A

of brachial plexus

395
Q

Leg support/flexion of knees to prevent

A

stretching of sciatic nerve

396
Q

Venous pooling in lower extremities

VPQP

A

Venous Air Embolism (VAE),
Pneumocephalus
Quadriplegia
Peripheral nerve injuries

397
Q

Conversion factor: 1 cm rise =

A

0.75 mmHg drop in MAP

MAP 5020 cm rise = 15mmHg DROP in MAP = 65mmHG

398
Q

Patients in the deck chair position are prone to .

A

hypotension, mainly due to venous pooling in the extremities and lack of surgical stimulation with an effective block.

399
Q

The angle of elevation from the waist should be

A

increased slowly in the compromised patient, thus allowing time for haemodynamic equilibration

400
Q

Intra-operative cerebral ischemia has been reported, probably through changes in

A

cerebral blood flow from a combination of postural hypotension and excessive head and neck manipulation

401
Q

MAP increases or decreases by

A

0.75mmHg for each cm change in height between heart and a body region.

402
Q

MAP increases or decreases by 0.75mmHg for each cm change in height between heart and a body region. Therefore region

A

elevated above the heart in the sitting, head-up or lithotomy position may be at risk for hypoperfusion and ischemia, especially with hypotension.

403
Q

Try to elevate torso in increments

A

giving the body time to adjust.

404
Q

Often used to support head using straps or tape to secure head to the headrest - note risk of brachial plexus injury with manipulation of limbs/head

A

Horse shoe head rest

405
Q

TURP and Spinal

A

Spinal is considered the anesthetic of choice

406
Q

Why is spinal better for TURP?

A

Early signs and symptoms of TURP syndrome, hypervolemia, and bladder perforation can be easily detected in a responsive patient.

407
Q

Other benefits of SPINAL In TURP (LDE)

A

Less blood loss
Decreased incidence of postoperative venous thrombus
Embolus

408
Q

Spinal anesthesia level for TURP

A

T10 sensory level is a must for adequate anesthesia

409
Q

Incidence of PDPH

A

very low in this age group

410
Q

Spinal for TURP Medication:

A

0.75% bupivacaine, 12 mg in 7.5% dextrose solution (1.6 mL)

411
Q

The nerve supply to the prostate originates from the

A

inferior hypogastric plexus and carries both sympathetic fibers from T11 to L2 and parasympathetic fibers from S2 to S4.

412
Q

Pain signal from bladder distension travels along with

A

T11 to L2 sympathetic fibers.

413
Q

Considering this innervation, height of regional block up to

A

T10 is sufficient for TURP

414
Q

Jaffe recommends T9 level, but Higher level of block may

A

mask the pain if perforation of the prostatic capsule should occur.

415
Q

TURP Spinal meds commonly included with LA.

A

Intrathecal opioids (fentanyl or sufentanil)

416
Q

TURP and Continuous lumbar epidural anesthesia

A

has no advantage during TURP-procedure relatively short and supplemental dose usually not necessary

417
Q

TURP and Fluids

A

Cautious fluid loading may be used to minimize spinal anesthesia-induced hypotension, but if patients cant tolerate this or need pulmonary support perform GA

418
Q

TURP Advantage of Regional anesthesia- In the awake patient-classic Triad of symptoms- TURP syndrome

A

increase in both systolic and diastolic pressures (increase in PP), bradycardia, and mental status changes.

419
Q

Advantage of Regional for TURP

GAPU

A

Good post op analgesia
Allows to monitor level of consciousness and detect early signs of TURP syndrome
Possible reduced blood loss
Useful in patient with significant respiratory disease

420
Q

Regional advantage with perforation

A

Earlier recognition of bladder perforation or CAPSULAR TEAR

421
Q

Disadvantage of Regional

A

Does not prevent penile erection which can interfere with surgery.

422
Q

High Prevalence of BPH is in which zone

A

transitional ZONE

423
Q

MOST BLOOD

A

Dorsal VENOUS COMPLEX-

424
Q

Anesthetic approach to TURP

Respiratory

A

COPD common-if patient has a > 50 pack-year history, or any respiratory symptoms-consider PFTs, ABG, or CXR

425
Q

Anesthetic approach to TURPCardiovascular

A

CAD, CHF-exercise tolerance needs to be assessed-

426
Q

TURP and Cardiac patient should be able to

A

Climb a flight of stairs without difficulty or SOB, EKG, check history of pacemaker.

427
Q

TURP Neurologic

A

CVD or Alzheimer’s common-assess baseline mental status to guide evaluation of any intraop or postop changes.

428
Q

TURP and Renal

A

Renal impairment should be anticipated secondary to chronic obstruction. Check BUN, Cr, Cr clearance, and electrolyte values.

429
Q

Hematologic and TURP

Moderate blood loss should be expected with l

A

Larger glands and T and C is indicated.

430
Q

TURP, when is Type and cross NOT NECESSARY

A

If gland < 80 g, not necessary. Check CBC/coags

431
Q

TURP premedication CV : Continue those medications DiNB and which medication for anxiety

A

Continue commonly used drugs (digitalis, BB, NTG) to prevent CV problems.
Midazolam 1-2 mg IV prn for anxiety.

432
Q

TURP preop evaluation goal

A

Surgical population generally elderly may have preexisting medical problems-preop evaluation should be directed toward detection and treatment of these conditions.

433
Q

TURP and Pacemaker-must be

A

converted to a fixed rate unless they are designed to operate in presence of applied currents.

434
Q

TURP Induction:

A

Can use LMA, but lithotomy position with head down tilt decreases FRC and has increased risk for aspiration.

435
Q

TURP and Maintenance-muscle relaxation a

A

not mandatory,

436
Q

TURP, what must be avoided and why?

A

patient movement during procedure must be avoided-can lead to perforation or injury to the external sphincter-postop incontinence.

437
Q

TURP and The obturator

A

The obturator nerve passes in close proximity to the inferolateral bladder wall, bladder neck and lateral prostatic urethra.

438
Q

During TUPR resection in these areas may result in

A

stimulation of the obturator nerve, causing adductor contraction (obturator reflex) and possible inadvertent bladder perforation.

439
Q

Shortcoming with subarachnoid block with TURP is

A

sparing of this nerve (Obturator nerve)

440
Q

To successfully prevent this injury to Obturator nerve

A

Ultrasound guided obturator nerve block or injecting a local anesthetic into the sensitive area through a special needle passed through the resectoscope

441
Q

TURP If using GA consider

A

succinylcholine or rocuronium-can be rapidly reversed using Sugammadex (4-8mg/kg).

442
Q

With TURP Want to give minimal amounts of IV fluids why?

A

Minimize fluid overload due to possible irrigation absorption.

443
Q

TURP Anticipate decrease BP

A

when legs are repositioned from lithotomy position.

444
Q

TURP Avoid stress on lumbar spine by

A

Slowly and simultaneously bringing legs together and returning to supine position

445
Q

With TURP Solutions should

A

not be hung higher than 30 cm above the operating table at the beginning of the procedure and higher than 15 cm during the final stages-decreases fluid absorption.

446
Q

TURP Should

A

not exceed 2 hrs-Uptake of 1 L of irrigant into the circulation within 1 hour can decrease the serum sodium 5-8 mEq/L-limiting resection time to 1 hours is ideal.

447
Q

TURP, May want to avoid this position and why ?

A

Tredenlenburg; promotes fluid absorption

448
Q

Questions to consider with TURP

A
  1. What is the irrigation fluid?
  2. What is the bag height over the prostate?
  3. What is the size of the prostate?
  4. What is the expected duration of procedure?
  5. What is the surgical operating position?
449
Q

Systemic absorption of the irrigation fluid directly through

A

the prostatic venous plexus, or more slowly through the retroperitoneal and perivesical spaces.

450
Q

TURP and fluid reabsorption Average of

A

10-30 mL of fluid can be absorbed per minute of resection time, and 6-8 L can be absorbed in cases that last up to 2 hours.

451
Q

TURP Complications of absorption: HDVCRT

A

Hypoosmolality
Dilutional hyponatremia
Volume overload with pulmonary edema,
Cardiac effects
Retinal toxic effects (with glycine), and
Transient hyperglycemia/hypokalemia with glucose
irrigation solutions.

452
Q

TURP signs and Symtpoms

General Anesthesia-CNS symptoms

A

are hidden under general anesthesia.

453
Q

TURP SYNDROME Can see (ABC-VA)

A 
Arrhythmias
Bradycardia 
Cyanosis,
Vagal response
And unexplained hypotension or hypertension
454
Q

TURP Intravascular Volume Expansion

A

Systemic HTN and reflex bradycardia-pulmonary edema

455
Q

TURP and Intravascular Volume Loss

A

H20 flux along osmotic and hydrostatic pressure gradients out of the intravascular space and into lungs-pulmonary edema and hypovolemic shock

456
Q

TURP and Dilutional Hyponatremia

A

Osmotic shift of fluid->cerebral edema, increase in ICP, and CNS symptoms.

457
Q

TURP and Hypoosmolality

A

BBB freely permeable to water->cerebral edema, increased ICP->bradycardia and HTN

458
Q

TURP Hyperammonemia

A

Oxidative deamination of glycine to glyoxylic acid and ammonia

459
Q

TURP and Hyperglycinemia

A

Deterioration of vision-transient blindness.

460
Q

Robotic surgery Positioning

Different positioning

A

increases risk for nerve injury

Improved nerve sparing

461
Q

Robotic surgery Positioning

Different positioning Taped or strapped to bed frame to

A

prevent movement in steep Trendelenburg, increased risk for pressure points/nerve damage

462
Q

Robotic surgery Positioning Trocars ? what is crucial

A

are fixed and can cause injury if patient moves-NMB crucial

Increased risk of aspiration

463
Q

Robotic surgery Trendenlenburg Respiratory stress –

A

patients with significant hx of lung disease cannot tolerate

464
Q

Robotic surgery Trendelenburg position -

A

CO decreased by 10-30%, pts with preexisting HD can lead to ischemia/dysrhythmias

465
Q

Robotic surgery Pneumoperitoneum can cause

A

extreme brady or asystole

466
Q

Robotic surgery Trendelenburg RBF and GFR

A

decreased/ADH and aldosterone increased

467
Q

Lithotomy with stirrups/boots (Less extreme than Trendelenburg)
CC300

A

Compartmentsyndrome/thrombus/Sciatic/obturator/femoral/peroneal/saphenous
Cephalad movement of diaphragm/ck ETT
300 ml auto return

468
Q

Steep Trendelenburg

A

(more extreme changes from Lithotomy)

469
Q

Lithotomy with stirrups/boots

A

(Less extreme than Trendelenburg)

470
Q

Steep Trendelenburg advantage

A

Optimizes organ visualization

471
Q

Steep Trendelenburg Hemodynamic changes CARDIAC (LSV)

A

Left ventricular filling pressure and CO decrease
Systemic vascular resistance and MAP increase
VQ mismatch

472
Q

Steep Trendelenburg Hemodynamic changes RESPIRATORY D-CLF LVUPR

A

Decreased compliance
Decreased lung volume
Decreased FRC

Limited diaphragm movement
VQ mismatch
upper airway edema
pulmonary edema
Regurgitation – place OGT
473
Q

Steep Trendelenburg CNS

A

Increased intracranial/Brain edema and intraocular pressure

474
Q

Steep Trendelenburg- 3 extra interventions with arms (BBP)

A

Bilateral arms tucked at sides
Beware of fingers/table down
Padded arms/ulnar nerve/eyes (also taped)

475
Q

Steep Trendelenburg/Pneumoperitoneum/Respiratory compromise Intervention: (PDI)

A

Pressure control
Decreased tidal volume,
Increased RR to maintain ETCO2

After intervention,
watch for decrease in insufflation or
change from Trendelenburg to flat -> decrease pressure!

476
Q

Facial and airway swelling (Steep Tren) -

A

confirm airway movement BEFORE extubating

477
Q

What happens with Spondylothesis

A

Anterior Subluxation

478
Q

Epidermolysis BULLOSA which anesthesia preferred

A

Regional Anesthesia

479
Q

Myotonic Dystrophy

A

General anesthesia doesn’t stop contraction

480
Q

Clinical Features of Familial Periodic Paralysis : Factor with Both HYPOKALEMIA and HYPERKALEMIA

A

Hypothermia

481
Q

Good response to anticholinesterase (MG vs MS)

A

MG

482
Q

Sensitive to both succ and NDNMB (MG vs MS)

A

Myasthenia Syndrome

483
Q

How does kyphoscoliosis affect ?

A

Anterior + Lateral flexed spinal column

484
Q 
Manifestations of Myasthenic Syndrome
ProLA
ES
MC
RAD
A

Proximal limb weakness (Legs more than arms)
Exercise Improves stength
Muscle pain common
Reflexes absent or decreased

485
Q 
Manifestations of Myasthenia Gravis
FOB
EF
MU
RN
A

Extraocular,bulbar and facial muscle weakness
Exercise causes fatigue
Muscle pain uncommon
Reflexes normal

486
Q

Myasthenic syndrome Gender more affected M/F

A

Affect males more often than females

487
Q

Myasthenia Gravis more affected M/F

A

Affect females more often than males

488
Q

Myasthenic syndrome Co-Existing Pathologic conditions

A

Small cell lung cancer

489
Q

Myasthenia Gravis Co-Existing Pathologic conditions

A

Thymoma

490
Q

Myasthenic Syndrome RESPONSE to muscle relaxants

A

Sensitive to succ and NDNMB

491
Q

Myasthenic Syndrome RESPONSE to Anticholinesterases

A

POOR

492
Q

Myasthenia GRAVIS RESPONSE to muscle relaxants

A

Resistant to Succ, Sensitive to NDNMB

493
Q

Myasthenia GRAVIS RESPONSE to Anticholinesterases

A

GOOD

494
Q

H2 Blockers

A

Cimetidine, famotidine, -tidine

495
Q

ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITORS and ANGIOTENSIN RECEPTOR
BLOCKERS (ARB) ➔

A

MPROVE INTRARENAL HEMODYNAMICS and HAVE RENOPROTECTIVE QUALITIES.

496
Q

During a renal transplant which vessel supply the new graft?

A

Iliac artery

497
Q

Where in the nephron is most of the blood reabsorbed?

A

PCT

498
Q

What is spondylolisthesis?

A

Anterior subluxation of vertebrae

499
Q

A patient with CREST syndrome is at risk for what during anesthesia?

A

Aspiration

500
Q

What is a clinical feature of Myasthenia Gravis

A

Bulbar muscle weakness

501
Q

CURCUMIN effects

A 
Increase (Prolonged) aPTT, PT significantly 
Inhibit thrombin (II)  and Factor Xa
502
Q

Complications of Prone position with Airway

A

ETT kinking, dislodgment

Upper airway edema.

503
Q

Complications of Prone position with NECK

A

Hyperextension or hyperflexion.

-Cervical rotation: compromised blood flow to brain

504
Q

Complications of Prone position with EYES

A

-Orbital pressure->central retinal artery occlusion,
supraorbital nerve.
-Corneal abrasion

505
Q

Complications of Prone position with ABDOMEN

A

Pressure transmitted to epidural veins, increased bleeding.

506
Q

Complications of Prone position with UE

A

Brachial plexus stretch. -Ulnar nerve compression.

507
Q

Complications of Prone Position with LE

A

Flexion of hips: occlusion of femoral vein, DVT, kinking of vascular grafts
–Pressure lateral to fibula: peroneal nerve palsy
Pressure on iliac crest—lateral femoral cutaneous nerve.

508
Q

In Prone position , Flexion of hips lead to (KOD)

A

Kinking of Vascular grafts
Occlusion of femoral vein
DVT

509
Q

In Prone position, Pressure lateral to fibula leads to

A

peroneal nerve palsy

510
Q

In Prone Position, Pressure on Illiac Crest leads to

A

Lateral femoral cutaneous nerve damage

511
Q

TURP Important to determine

A

Size of the enlarged prostate or adenoma must be carefully assessed before the surgery, usually with cystoscopy, to determine if the procedure can be completed within two hours (ideally 1 hr or less). If unable, open prostatectomy should be performed to prevent TURP syndrome

512
Q 
ROBOTIC SURGERY ADVANTAGE
BIS
Improved nerve sparing
 Blood loss
Hospital time
\_\_\_\_\_\_continence
Improved \_\_\_\_\_\_\_\_rate
Incisions? Scaring
 post op pain?
 infection?
omplications?
A 
Improved nerve sparing
< Blood loss
< Hospital time
Enhanced continence
Improved impotency rate
Small incisions/Less Scarring
Less post op pain
Decreased infection
Fewer complications
513
Q

Ascending permeable to _____and not to _______

A

NaCL not to H2O

514
Q

Region permeable to Water?

A

PCT and descending

515
Q

Water and% absorption in each section

A

PCT 60-70% and NaCL
Loop 25% and NaCL
DCT 5% influenced by ADH
Collecting Variable influenced by ADH

516
Q

3 most common complications of Prone

A

Post Operative vision loss
Cardiovascular compromise
Venous Air Embolism

517
Q

Myasthenic Syndrome suspected for lung cancer patients undergoing, bronchoscopy, thoracoscopy and mediastinoscopy and WHAT ELSE SHOULD BE CONSIDERED> ?

A

Need to decrease doses of muscle relaxants should be

518
Q

T10 for TURP why

A

T10 level, because the stretch receptors in the distended bladder cause pain higher than the coverage needed for bladder surgery.

519
Q

Na replacement for TURP syndrome

A

100ml/hr of 3% hypertonic saline

D/C when Na>120

SRNA3CoExisting (16 decks)

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