What is a Heller myotomy for?
To correct achalasia, or, difficulty swallowing The muscular ring of the LES does not relax properly and may result in esophageal dilation. Incisions are made to the muscular ring.
What causes the LES failure to relax?
possibly the loss or damage of ganglion cells in the myenteric plexus
What procedure may also be performed with the Heller myotomy?
Toupet fundiplication to prevent reflux but is most oftentimes not performed because it may cause an obstruction to swallowing. However, some cases require this.
What is Reglan?
GI prokinetic dopamine antagonist promotes gastric motility
When is Reglan contraindicated?
Parkinson's pts GI obstruction
*What does Reglan do to lower esophageal tone?*
Increases lower esophageal tone to further decrease risk of aspiration
What are some side effects of giving Reglan?
Dry mouth Abdominal cramping Extrapyramidal effects Prolactin associated effects such as enlarged breasts, irreg. menstrual cycles
Does Reglan cross to the placenta?
Yes but it usually doesn't have an effect on the baby
How can you treat sphincter of oddi spasm resulting from narcotic administration? (5)
Glucagon 2 mg Atropine Narcan Nitroglycerin Calcium channel blockers
*During general anesthesia for a laparoscopic cholecystectomy, the following data are obtained. What lab findings are abnormal?* PeCO2: 48 mmHg PaO2 = 84 mmHg SaHbO2 = 0.2% SaHbMet = 0.2% SaHbCO2 = 2% PaCO2 = 2% paCO2 = 64 mmHg pH = 7.28
Increased alveolar deadspace ventilation
When is aspiration pneumonitis a high risk? (2)
Volume > 25 cc pH < 2.5
*What are the fasting recommendations for: Clear liquids Breast milk Non-human milk and light meals*
Clear liquids: 2 Breast milk: 4 Non-human milk and light meals: 6
What can easily increase the aspiration risk in a healthy pt?
Chewing gum It increases the gastric volume and decreases gastric pH through vagal stimulation.
Toradol is as effective for post-op pain. True or false?
Toradol is not effective for pain in what area of the body?
How much insulin is a pt instructed to take in the AM of surgery?
1/2 of intermediate insulin
How much does 1 unit of insulin decrease blood sugar levels (in mg/dL)?
How do you determine the rate of an insulin infusion?
What is propylthiouracil used for?
decreases thyroid hormone synthesis
What does propylthiouracil decrease the synthesis of specifically? What does it not do?
T3 It does not decrease the T3 already circulating in blood
What is thyroxine?
T4 which is converted to T3 (triiodothyronine)
What drug is effective for preventing thyroid storm?
What is the most serious threat in hyperthyroid pts?
What are clinical manifestations of thyroid storm? (4)
hyperpyrexia tachycardia hypotension altered consciousness
How do you treat thyrotoxicosis?
hydration and cooling esmolol infusion or propanolol (0.5 mg until HR < 100) propylthiouracil (250-500mg q 6 hrs orally or NG)
What should you also give concomitantly with propylthiouracil?
Cortisol 100 mg to prevent complications with coexisting adrenal suppression
*What position are the vocal cords after a RLN INTERRUPTION?*
paramedian position to DAMAGE of the recurrent laryngeal
What may occur after RLN interruption? (2)
"If bilateral recurrent laryngeal nerve INJURY occurs during thyroidectomy, what are he most probable inermediate and long-term outcomes of the pt?"
Adduction of vocal cords --> acute airway obstruction --> trach
What is Addison's Disease?
glucocorticoid deficiency due to destruction of the adrenal gland leading to both glucocorticoid and minerocorticoid deficiencies.