Nervous System

Question 1

MS GA: avoid inc in what

Answer 1

Temp, promotes exacerbation

Question 2

MS induction consid

Answer 2

Steroids. ANS dysfunc (low bp induc). No sux (hyperkalemia risk). May have prolonged responses or resistance to NDMR

Question 3

Ms: line consid, regional consid, exac assoc w

Answer 3

Lower threshold for a line. Avoid regional unless strong reason (OB epidural). Spinals.

Question 4

GB GA: BP alterations with what, what is mandatory

Answer 4

ANS dysfunc. Low bp w vent/bl/pos change. High bp w DVL, pain, and indirect pressors. A line. Alt temp

Question 5

GB GA: avoid what, which NDMR

Answer 5

Sux (hyperkalemia risk). Vec- want minimal cv effects

Question 6

GB regional: what can be beneficial. Caution d/t what. High incidence of what

Answer 6

Epidural opioids. Sensitive to LAs (na ch blocking factor). ANS issues: epidural preferred, slower onset than spinal

Question 7

PD GA: consider what d/t med reg

Answer 7

Levodopa e 1/2 6 hrs. Give 20 min via OGT before induc or in surgery, can also give SQ apomorphine (dopamine agonist)

Question 8

PD GA: risk of what, avoid which drugs

Answer 8

Asp risk (RSI). Dopamine antagonists (droperidol, phenothiazines, reglan). Alfentanil and fentanyl- Dystonic rxn

Question 9

PD GA: expect what w cv sys.

Answer 9

ANS alt- bp labile, dysrhythmias

Question 10

PD GA: can give what but consid what, aggressive what, extubation consid

Answer 10

Ketamine- inc sns stim. Aggressive fluid plan. Awake extub.

Question 11

SCI acute alterations

Answer 11

Lose temp reg, dec bp and hr if >t6, pvcs and st changes

Question 12

SCI acute resp consid: above C4, below C5, when quads breathe best, suctioning

Answer 12

Above: vent assistance. Below: breathe ok but lose accessory muscles. Breathe best supine. High spinal- suctioning can cause low hr/cv arrest esp if hypoxemic

Question 13

Methylprednisolone dose for SCI

Answer 13

30 mg/kg within 8 hrs. Then 5.4 mg/kg/hr for 1-2 days

Question 14

Acute SCI ga

Answer 14

Dvl w inline stabilization in emergency. Req vent if abd paralysis and ga. Need a line. Aggressive fluids/blood/pressors. Hd instab.

Question 15

Acute SCI ga: blood loss not large unless what, which area of spine has more blood loss

Answer 15

Harvesting iliac crest bone graft or vertebral body corpectomy. Thoracic and lumbar > cervical

Question 16

Acute SCI ga: __ below lesion level, which NMB good/not

Answer 16

Poikilothermic. Panc- sns stim. Sux ok first few hrs then avoid bc high k

Question 17

Chronic SCI ga: __ failure common, high __ risk, ___ in muscle common

Answer 17

Renal, dvt, spasticity

Question 18

[chronic SCI ga: concern for what/prevention. Have what available.

Answer 18

AR w/surgery, VAs, epidural/spinal. Have NTP 1-2 mcg/kg iv for persistent htn

Question 19

Seizure anesthesia: med considerations

Answer 19

Additive fx anticonvulsants and our drugs. They also may cause coag/end organ/enzyme induc. Continue meds am of surgery and in surgery

Question 20

Seizure anesthesia: avoid which 8 drugs

Answer 20

Methohexital, ketamine, etomidate, meperidine, atracurium, cisatracurium, enflurance, alfentanil

Question 21

Do what for status epilepticus

Answer 21

TPL, propofol, versed, abg and temp monitor. Blow off CO2

Question 22

Determinants of CBF

Answer 22

Paco2/02, arterial pressure, autoreg, venous pressure

Question 23

When anesthetic drugs affect brain autoreg

Answer 23

> 0.5 MAC VAs. Use IV TPL or propofol and hypocapnia to help. N20 interferes less than others

Question 24

Inc ICP: anesthetic drugs that are good vs bad

Answer 24

Good: propofol and barbs best, versed/etomidate/opioids ok. No ketamine

Question 25

How to reduce ICP

Answer 25

Posture, hypervent, CSF drain, hyperosmotics, diuresis, steroids, barbs, smooth induc, vae detection

Question 26

Head injury: maintain what, common meds, where we want c02, hob

Answer 26

Maintain CPP and CBF (dec ICP inc bp). Mannitol, lasix, pressors. CO2 around 30. Barb coma reduce cmro2. Hob 30 degrees

Question 27

Head trauma: bp goal, when hypervent used

Answer 27

CPP >70. Acute inc ICP, herniation prevention, to minimize retractor pressure, or to imp surgical access

Question 28

Head trauma: fluids to use or not

Answer 28

Use normal saline, 5% albumin, and blood. Dont use LR or glucose containing solutions

Question 29

Head trauma: cv consid, do what for cushings triad

Answer 29

Hi hr/bp. Give BB. Reduce ICP: hob 30 degrees, barbs, co2 low normal, consider hypothermia

Question 30

Head trauma: which lines, induction

Answer 30

A line pre induc, right heart cath. Lidocaine, anything but ketamine, opioids good, avoid histamine rel NMB and sux

Question 31

Head trauma volatile considerations, emergence avoid what

Answer 31

N20 ok if no pneumocephalus. Volatile until cranium open then base on ICP. Prevent htn and coughing w emergence

Question 32

Supratentorial intracranial tumor: monitors/iv consid

Answer 32

2 large PIV, blood avail, a line and PNS

Question 33

Supratentorial tumor induc:

Answer 33

Pre 02 fully, hi dose propofol/lidocaine/fentanyl, use nondepolarizor, consider extra prop bolus before intub, esmolol for hr/bp control

Question 34

Supratentorial tumors: maintenance

Answer 34

CO2 30-35, can use va and n20, if low compliance TIVA and low dose iso

Question 35

Supratentorial tumor emergence: no reversal until what

Answer 35

Head dressing applied

Question 36

VAE which methods most use ful

Answer 36

Tee, then Doppler, then end tidal. Too far gone when bp changes

Question 37

SAH induction, lines

Answer 37

Prevent hi or low bp. Lido, bb, opioid, hi dose propofol or tpl. A line and maybe cvp

Question 38

Maintenance for SAH

Answer 38

VA and n20 dep on ICP. TPL/fent/iso.

Question 39

Maintenance SAH if high ICP:

Answer 39

TPL gtt 1-3 mg/kg/hr after 5 mg/kg gtt, stop after aneurysm clipped. Fent 1-4 mcg/kg/hr gtt plus 1/2 mac iso and 02.

Question 40

SAH fluid management

Answer 40

Before clipping limit to maintenance and deficit. After clipping inc cvp to 10-12

Question 41

SAH emergence, which extub or not

Answer 41

1-2 and no complic can be extubated in or. 3-5 or complic remain intubated.