FINAL 2 Flashcards by Timothy Harris

Lateral and rotational deformity of the thoracolumbar spine

Scoliosis

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Scoliosis: Spinous processes rotate toward the _____ side of the curve

Concave

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Scoliosis: Ribs on convex side push ______ (gibbous deformity) while ribs on the concave side push _____

posteriorly

anteriorly

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Scoliosis may have _____ (humpback) and _____(bent backwards).

Kyphosis

Lordosis

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Scoliosis is measured by the ____ angle, where angle of the curve (____ surface of the top vertebra to ____surface of the bottom vertebra is measured using perpendicular lines from _____points to _____of the curve

Cobb
Upper
Lower
end
center

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The angle is formed by the _______

intersection

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Angle of the Curve and significance
<10
>25
>40
>65
>100
>120

<10=Normal
>25= Echo shows evidence of increased PAP
>40=Need for Surgical Intervention
>65=Restrictive Lung Disease
>100=Symptomatic Lung Disease, Dyspnea on Exertion
>120=Alveolar Hypoventilation

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Which orthopedic surgical corrections have a high anesthetic risk for respiratory complications and vent support, with high expected blood loss? According to that dumbass chart on slide 5-6

Cerebral Palsy
DMD
Spinal muscular atrophy
and infantile < 3 years

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What preoperative test should be performed prior to Scoliosis Surgery?

Chest Xray
ECG
Echo
PFTs
Coags

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Scoliosis is listed among the highest risk for pediatric surgeries. This is due to

Hypotension and CV collapse d/t high blood loss

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Other risk factors associated with Scoliosis surgery

Anaphylaxis
Anesthetic overdose
Pneumothorax
Hemothorax
Impaired venous return from prone positioning
Surgical manipulation
VAE

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She says know these vertebral arteries  From top to bottom on the slide...
=
=
=------A
=------B
=
=
=------C
=
=\_\_\_D
=
=
=

Vertebral Artery
Cervical Radicular Artery
Thoracic Radicular Artery (T7)
Radicularis Magna (Artery of Adamkiwicz) (L1)

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What monitors cortical and subcortical responses to peripheral nerve stimulation and compares it to a baseline value?

SSEPs

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SSEPs monitor the ____ columns of the spinal cord

Dorsal (monitors sensory, not motor)

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Things that effect SSEPs (3)

Anesthesia
BP
Temp

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Inhalational agents effect motor evoked potentials _____ SSEPs.

greater than

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Doses < _____MAC for Sevo and Des have minimal effect on SSEPs

<1.5 Mac

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N2O potentiates volitiles and ___ amplitude of SSEPs by itself

decreases

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IV agents have _______ effect on SSEPS

little

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Maintain ETCO2 ______, Map _____ and _____thermia during SSEPS

All normal
ETCO2 35-45mmHg
MAP > 60mmHg
Normothermia

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With motor evoked potentials keep MAP ___

> 65 mmHg

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During Motor Evoked Potentials, use _____ for maintenance anestheisa

Propofol and Remi Gtts (TIVA)

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Hypotension during Scoliosis surgery…assume it is due to

Blood loss…until proven otherwise

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Some potential intraop complications during scoliosis surgery

ETT malposition- d/t prone positioning
Altered pulm compliance- d/t prone positioning
Bleeding
Excessive Heat loss
Neurologic injuries- d/t positioning and surgery
electrolyte abnormalities

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Static Encephalopathy defined as a nonprogressive posture and movement disorder with poor muscle control, weakness, and increased muscle tone.

Cerebral Palsy

Cerebral Palsy is due to

Injury or abnormal development of immature brain

Cerebral Palsy is a defined as a posture and movement disorder with (3 characteristics)

poor muscle control weakness Increased muscle tone

``` Cerebral Palsy paresis types Single limb= Both limbs on same side= Both lower limbs= 3 limbs= All 4 limbs= ```

``` Single limb=monoparesis Both limbs on same side=hemiparesis Both lower limbs=diparesis 3 limbs=triparesis All 4 limbs=tetraparesis, or quadraparesis ```

Motor deficits of cerebral palsy may manifest as (3 things)

Hypotonia Spasticity Extrapyramidal features like choreoathetoid/dystonic movements or ataxia.

``` Functional Capacity Classification for Cerebral Palsy Class 1 Class 2 Class 3 Class 4 ```

Class 1- No limitation of activity Class 2- Slight to moderate limitation Class 3- Moderate to great limitation Class 4- No useful physical activity

4 Classification systems for Cerebral Palsy

Physiology (type of muscle tone) Topography (Area affected, like mono or quadriplegia) Etiology (like prenatal, perinatal or postnatal) Functional Capacity (Type 1,2,3,4)

Comorbidities with CP and anesthetic concerns (3)

Pulmonary- frequent respiratory infections GI- Gerd- prone to aspiration Neurologic- SCZ disorders, so avoid etomidate, ketamine, methohexital, EMLA, normeperidine.

CP: These patients are often on baclofen or dantrolene for spasicity, should you discontinue it?

nope, may need a decreased dose of NMBAs

CP: Can you give these patients Succs?

Yup- b/c these muscles are not denervated

CP: Avoid _______ in presence of VP shunt

caudal/epidural

CP: can these patients communicate pain

may not

This is a dwarfing syndrome that manifests as bone fragility and risk for multiple fractures

Osteogenesis Imperfecta (Mr. Glass from "unbreakable")

4 types of Osteogenesis Imperfecta

Type 1- mildest form Type 2 - most severe form (lethal) Type 3- Progressively deforming form Type 4- mild to moderate bone fragility

Main anesthetic consideration with Osteogenesis Inperfecta

Handle Gently

What is the most common progressive muscular dystrophy?

DMD

DMD have a waddling gait and ______ _______ (location and type of spinal curvature).

Lumbar Lordosis

DMD Pts have difficulty climbing _____

stairs

Avoid ____ with DMD d/t risk of hyperkalemia

Sux

DMD have _____ and _____ compromise

respiratory and CV

DMD have ______ of the tongue, leading to difficult intubations

hypertrophy

DMD have ____ blood loss during surgery

greater

NMBAs have ____ onset and ____duration of action with DMD patients.

slow | prolonged

____ is contraindicated with DMD d/t hyperkalemia, muscle rigidity rhabdomyolysis, myoglobinuria, arrhythmias and cardiac arrest.

Succs

DMD, best to ____ inhalational agents, d/t association with ____

avoid | MH

Cystic Fibrosis is a autosomal _______ disorder

recessive

What is the most common life-limiting inherited disorder among Caucasians?

Cystic Fibrosis

Patho of Cystic Fibrosis

Disruption of electrolyte transport in epithelial cells of sweat glands, airways, pancreatic ducts, intestine, biliary tree and vas deferens.

Sx of Cystic Fibrosis

Increased sweat chloride concentraiton (>60mEq/L) viscous mucus production, lung disease, intestinal obstruction, pancreatic insufficiency, biliary cirrhosis, and congenital absence of vas deferens.

Normal sweat chloride levels = | Dx for Cystic Fibrosis =

``` Normal = 40mEq/L CF= > 60 mEq/L ```

What is the most common cause of death and morbidity for CF patients?

Pulmonary disease

CF: enhanced absorption of ____ in the airway epithelium and failure to secrete ____ and ____

Na+ | Cl- and fluid

CF: ______ leads to thickening of mucus, inflammation and infection

dehydration

CF: early signs of pulmonary dysfunction ____ in max expiatory flow rates at low lung volumes ___ in ratio of RV to TLC

Decreased | Increased

CF: Neonatal surgical indications (Hint* all GI related)

Meconium ileus Meconium peritonitis Intestinal Atresia

CF: Children/Teenager surgical indications (hint ENT and IV)

Nasal polypectomy IV access ENT surgery

CF: Adult surgical indications

Esophageal Varices Recurrent pneumothorax Cholecystecomy Liver or Lung transplant

CF anesthetic management. Schedule surgery _____

later in the day. allows pt to be up moving to loosen secretions

CF: avoid _____ventilation

hyper

Avoid this induction agent with CF

Ketamine- due to increased secretions

____ and ______ anesthetic gases with CF

heat and humidify

Disadvantage of LMA in CF

inability to suction secretions | risk of laryngospasm and aspiration

FINAL 2 Flashcards

(66 cards)