Musculoskeletal diseases 3 Flashcards
(53 cards)
Preoperative findings in the patient with Duchenne muscular dystrophy include: (select 2)
a. mitral stenosis
b. pulmonary fibrosis
c. increased creatine kinase
d. deep Q waves in the limb leads
c. increased creatine kinase
d. deep Q waves in the limb leads
The most common skeletal muscle myopathy is
Duchenne Muscular Dystrophy (DMD)
Duchenne muscular dystrophy results from the absence of
dystrophin protein
Patients with DMD are at risk for
an MH-like syndrome characterized by hyperkalemia & rhabdomyolysis (not true MH though)
Best practices for drugs to give and avoid with DMD include
do: TIVA
avoid: succinylcholine & volatile anesthetics
With DMD, there’s a progressive deterioration of
skeletal muscle strength in the first decade of life, culminating in profound weakness
Describe associated issues with DMD.
kyphoscoliosis (restrictive lung disease)
congestive heart failure
risk of aspiration
Describe the pathophysiology of Duchenne muscular dystrophy.
the absence of dystrophin destabilizes the sarcolemma during muscle contraction
the breakdown of the sarcolemma allows creatine kinase and myoglobin to enter the systemic circulation
calcium freely enters the cell, which activates proteases that destroy the contractile elements and cause inflammation, fibrosis, and cell death
Other types of muscular dystrophy include
Becker
Emery-Dreifuss
facioscapulohumeral
limb-girdle muscular dystrophy
Describe the respiratory considerations for patients with DMD.
respiratory muscle weakness
kyphoscoliosis (restrictive lung disease)–> decreased pulmonary reserve–> increased secretions and risk of pneumonia
Describe the cardiac considerations for patients with DMD.
degeneration of cardiac muscle–> reduced contractility, papillary muscle dysfunction, mitral regurgitation, cardiomyopathy, and CHF
s/s of Cardiomyopathy include resting tachycardia, JVD, S3/S4 gallop, and displacement of the point of maximal impulse
Patients with DMD should receive _____ prior to surgery
a cardiac workup
Describe the GI considerations for patients with DMD.
Impaired airway reflexes and GI hypomotility–> increased risk of pulmonary aspiration
Describe the EKG changes for patients with DMD.
impaired cardiac conduction–> sinus tachycardia and short PR interval
scarring of the posterobasal aspect (back/bottom) of the left ventricle manifests as increased R wave amplitude in lead I and deep Q waves in the limb leads
The Cobb angle describes
the magnitude of spinal curvature in a patient with scoliosis
Describe scoliosis.
A lateral and rotational curvature of the spine and ribcage
Describe kyphoscoliosis
a posterior curvature of the spinal column that produces a restrictive ventilatory defect
A Cobb angle > _________ is an indication for surgery
40-50 degrees
Cervicalscoliosis can cause
difficult intubation
A vital capacity of <40% predicted with scoliosis correlates with
requirement for post-op ventilation
Risks for scoliosis surgery include
prepare for significant blood loss
venous air embolism is a risk
monitor end-organ perfusion with serial ABG (risk of metabolic acidosis) and urine output
Thoracic correction of scoliosis higher than _____ may require one-lung ventilation
T8
Describe the etiology of scoliosis.
idiopathic (incidence= 80%)
congenital
myopathic (muscular dystrophy & amyotonia congenita)
neuropathic (cerebral palsy, syringomyelia, Friedreich’s ataxia)
traumatic
Pulmonary symptoms are present at a Cobb angle of
70 degrees
