ANS Flashcards by Bryan Groff

What function is lost if the artery of Adamkiewicz has disrupted blood flow? Upper? Lower? Motor? Proprioception?

Lower Motor
Pain
Temperature
ED
Urinary and fecal

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What tracts are the lower motor?

Corticospinal tract and anterior horns?

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What part of the spinal cord does the artery of Adamkiewicz supply? What level ?

Anterior 2/3 of the spinal cord, T9-T12

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What is preserved when the artery of Adamkiewicz is blocked?

Proprioception, fine touch, vibrations because they are perfused by the posterior spinal cord

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What is the best anesthetic for a patient with autonomic hyperreflexia?

Neuraxial with local or general

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Which drug class does not work with autonomic hyperreflexia?

Intrathecal opioids

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When does autonomic hyperreflexia occur?

Cutaneous or visceral stimulation below the spinal cord injury

Bowel or bladder stimulation
Cystoscopy
Uterine contraction
Lower extremity burns

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Vasoconstriction vs vasodilation what occurs above and below the injury of the spinal cord in AH?

Vasoconstriction below the level of injury

Vasodilation above the level of injury

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S&S of Autonomic hyperreflexia?

Acute HTN
Reflex bradycardia
MI
Headaches
Retinal hemorrhages
Pallor and coolness in LE
Sweating in uppers

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How is AH treated?

**Stopping the triggering agent

Avoid beta blockers

Fast acting vasodilators

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When does AH susceptibility begin ?

2 weeks to 6 months

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What is Horner syndrome?

Stellate ganglion blockade

Mad as a hornet

Miosis on ipsilateral side
Ptosis
Anhidrosis
Pseudoenophthalmos
Hyperemia

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When producing a stellate ganglion block, what complication may produce a seizure?

Vertebral artery injection

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Sings of a successful stellate ganglion block?

Flushing of the face
Horner syndrome
Nasal congestion
Temperature increase in the ipsilateral arm

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In the elderly do they have an increase or decrease in SNS? What about PNS?

Increased resting SNS tone

Decreased resting PNS tone

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In the elderly, what happens to their arteries?

Decreased compliance due to stiff arteries thug increasing systolic BP

However no change in systolic function

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How does the HR of the elderly respond to catecholamines?

Decreased response to catecholamines

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CO and circulation time in the elderly?

Decreased CO

Increased circulation time (takes longer to circulate)

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Do the elderly have a decreased ability to respond to hypotension, hypovolemia, and hypoxia?

Yes they have a decreased response

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Elderly response to beta stimulation and baroreceptors?

Decreased

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Filling pressures in the elderly?

Increased due to less compliant heart

Elderly ischemic preconditioning response?

Decreased

Does the ejection fraction change in a healthy elderly person?

Which substances increase during surgical stress?

Antidiuretic
Renin
Cortisol
Ang 2
Aldosterone

Which substances are decreased during surgical stress?

Secretion of insulin Gonadotropin releasing hormone

When may thyroid storm be triggered?

Surgical stress in patients with hyperthyroidism

What happens with gastric section when acetylcholine binds to muscarinic receptor?

Increases

Is ephedrine effective in a heart transplant?

Is dobutamine effective in a denervated heart?

Yes

What does 2 P waves on a EKG indicate?

Heart transplant (residual atrial tissue)

Where do first order neurons synapse?

Dorsal Root Ganglion

Where do second order neurons synapse?

Dorsal horn

Where do third order neurons synapse?

Thalamus

Where is the primary control center for the descending pain pathway?

Periaqueductal gray area

What is the heart rate of most Heart transplant patients?

90-110

Will the Valsalva maneuver affect the transplanted heart?

HR and BP for autonomic hyperreflexia?

HTN and bradycardia

Will smaller children have more or less heat loss?

Less because of a increased surface area-to-body ratio and small amount of subq fat

What type of fat in infants helps achieve Non shivering thermogenesis?

Brown fat

What is MAC BAR? What does it blunt?

1.5 - blunts autonomic responses

What is MAC-Awake?

50% of patients will not respond to a command Usually 0.15-.5 MAC

What is MAC?

50% of patients will not move at surgical incision

What is the earliest feature that can be seen in diabetic autonomic neuropathy?

Tachycardia

What a major risk of diabetic autonomic neuropathy?

Silent MI because the heart can become denervated

What level for a sensory blockade is most at risk for bradycardia?

T4 - because of the cardioaccelerator fibers

What type of fibers are blocked first?

B fibers - preganglionic autonomonic

Which type of fibers are blocked second?

C fibers - dorsal root Postganglionic autonomic + slow pain, temperature and touch

Which type of fibers are blocked last?

A Beta - touch and pressure

Which two diseases have a high risk of gastroparesis?

DM Opioids

How does Tetanus affect neurons?

-Inhibit the release of inhibitory neurotransmitters

Which organ is blocked during a celiac plexus block?

Adrenal