Coexisting conditions > Neuro > Flashcards

Neuro Flashcards

(50 cards)

Study These Flashcards
1
Q

What anesthesia would you give to pts with MS?

A
  • Avoid Succ!
  • May have resistance OR prolonged response to NDMR
  • No IV or inhaled anesthetic is superior
    *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are you monitoring for in a pt with MS?

What should you consider with emergence?

A
  • ANS dysfunction- lower threshold for arterial line
  • Consider baseline muscle weakness during emergence; extubate wide awake with full NMB reversal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Would you use regional anesthesia for a pt with MS?

A
  • Best to avoid; may be considered in OB
  • spinal anesthetics have been associated with post-op exacerbations
    • because of damage to nerves, regional anesthesia may cause injury, especially if directly applied as in Spinal
  • epidural anesthetics and peripheral nerve blocks have no reports of exacerbations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Guillian barre expectations during surgery

A
  • 60% have ANS dysfunction- pt does not compensate for physiological stressors normally
  • will need positive pressure ventilation d/t muscle weakness
  • hypotension:
    • positive pressure vent settings
    • blood loss
    • position change
  • hypertension:
    • DVL
    • pain
    • with indirect acting vasopressors and sympathomimetics (fluids first)
  • art line mandatory
  • maintain preload with fluids
  • altered temperature regulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How would you muscle relax a pt with Guillian-Barre?

A
  • Avoid succ!
  • Use a NDMR with minimal CV effects (vecuronium)
    • monitor carefully for increased sensitivity or resistnace
    • avoid NDMR with histamine release
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What should you consider regarding extubation for a pt with Guillian Barre?

A
  • Monitor vigilantly because they are high risk for respiratory failure!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Would you use regional anesthesia for a pt with guillian Barre?

A
  • Epidural opioids can be beneficial for pain and discomfort
  • Regional can be used with caution
    • pts are sensitive to LAs (because of the Na channel blocking factor?)
  • Epidural with slower onset preferred to rapid bolus of spinal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What’s the deal with Levodopa in a pt with parkinson’s?

A
  • Remember E1/2t is short
    • withdrawal effects after 6 hours
  • give levodopa 20 minutes before induction and repeat prn via OG tube and post op
  • If oral dose cannot be given, apomorphine SQ is a dopamine agonist that can be given
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should you consider regarding GA for a Parkinson’s pt?

A
  • Aspiration risk- because of salivation, dysphagia, esophageal dysfunction
    • RSI
  • Avoid dopamine antagonists
    • butyrophenones (droperidol)
    • phenothiazines
    • metoclopramide
    • (unless you are treating L-dopa CV SE at the vasal ganglie)
  • Alfentanil and fentanyl reported to cause an acute dystonic reaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What medications can you use for your GA for a pt with Parkinsons?

inhaled agents?

NMB?

A
  • Ketamine can be used, but can be an issue because it causes SNS/psychosis and so can dopamine
  • Plan for pt to be volume depleted; have aggressive fluid plan
  • Iso, Sevo, and Des acceptable
    • may experience exaggerated BP decrease
  • All types of muscle relaxant acceptable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Do you extubate a parkinson’s pt awake or deeply sedated?

A

Wide awake after full reversal criteria is met because they are likely to have respiratory complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What drugs do you avoid during deep brain stimulation surgery?

What drugs are best?

A
  • Avoid:
    • L-dopa might be held in advance
    • drugs that enhance GABA
  • Best
    • Opioids
    • dexmedetomidine
  • Avoid excessive sedation for neurologic assessment and airway management
  • Communicate about any drug you are giving to the surgeon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How will you intubate a patient with a spinal cord injury?

What if they are awake and alert?

A
  • DVL with in-line stabilization for emergency or unstable/uncertain C-spine stability
  • If awake, alert, and cooperative:
    • Awake fiberoptic intubation
    • blind nasal intubation
    • transillumination with lighted stylet
    • LMA or Bullard laryngoscope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

With what kind of spinal injuries would you expect more blood loss?

A
  • Blood loss not large unless harvesting the iliac crest bone graft or vertebral body corpectomy
  • Thoracic and lumbar regions have more blood loss than cervical
  • expect hemodynamic instability from spinal shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How would you expect to treat hemodynamic instability in a pt with a spinal cord injury?

A
  • Art line required
  • Elderly pts or those with significant hemodynamic lability may require PAC
  • Treat with:
    • aggressive fluids
    • blood replacement
    • continue pre-op vasopressors
      • keep BP robust!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What drugs would you use for GA of a spinal cord injury?

A
  • All inhaled and IV agents acceptable
    • N2O if closed air spaces have been ruled out
  • NDMR- all acceptable
    • Pancuronium SNS stimulation desireable
  • Succinylcholine- OK for first few hours after injury but then should be avoided forever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some GA concerns for a pt with a chronic spinal cord injury?

A
  • Renal failure common
  • High DVT risk
  • position carefully- increased risk for fracture/skin break down
  • chronic pain common
  • spacsticity in skeletal muscle, often treated with baclofen
    • can cause sz if interrupted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some medication/anesthetic agent considerations to make regarding a pt with a chronic spinal cord injury?

A
  • Surgery may cause AD even if they have never experienced it before
    • VA, epidural or intrathecal anesthesia are effective in prevention
    • have vasodilator available
  • No Succ! >24 hours after injury
    • use NDMR
  • Pts should be monitored post op for AD
    • can develop after anesthetic wears off
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What dose of Nitroprusside would you administer for AD?

A

1-2 mcg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Anesthetic considerations for pts with seizures

A
  • Consider additive effect of anticonvulsants and sedative/anesthetic drugs (both use GABA)
  • Consider how anti-epileptic meds may affect organs
    • coagulation, CYP450 induction
  • Give anticonvulsant meds morning of surgery, intra-op, and post op
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What medications must you avoid when caring for a pt with seizures?

Study These Flashcards
A
  • Methohexital
  • ketamine
  • etomidate
  • meperidine
  • atracurium and Cisatracurium (Laudanosine)
  • Enflurane
  • Alfentanil
22
Q

How will you notice an intraoperative seizure?

What will you do?

Study These Flashcards
A
  • BP and HR changes, maybe clonic movement depending on NMB
  • IV TPL, propofol or benzos
  • direct application of cold saline to the surface of brain
  • ABG and temp monitoring
    • adjust ventilation to blow off high CO2
23
Q

What are the 5 determinants of CBF?

Study These Flashcards
A
  • PaCO2
    • our bes option for affecting CBF, at least for 6 hrs
  • PaO2
    • the hail mary
  • Arterial pressure, autoregulation- btween 50-150
  • Venous pressure
    • head position
  • Anesthetic drugs and techniques
24
Q

Describe the difference in CBF between a person with normal autoregulation and one without.

(graph)

25
What is the affect of volatile agents CBF?
* All volatile agents 0.6-1.0 MAC "uncouple" CMRO2 and cerebral blood flow * vasodilation in the face of decreased metabolic need * the greater the concentration, the more pronounced the uncoupling * us IV agents (propofol) and hypocapnia to help compensate * N2O has less interference with autoregulation compared with sevo/des/iso * pt should have no recall with anything above 0.5 MAC
26
What is the affect of IV anesthetics on CBF and ICP? What is the exception to the general rule?
* General rule: IV anesthetics are vasoconstrictors and will decrease CBF and ICP in general * **Ketamine** is exception- DO NOT use in the face of inceased ICP * Propofol and barbs are best * Midaz, opioids and etomidate OK * watch for resp. depression
27
What are the important principles about managing the anesthetic of a patient with increased ICP?
* Reduce ICP * posture, hyperventilation, CSF drainage, hyperosmotics, Diuresis, Corticosteroids, barbs * reduce CMRO2 * premedication * smooth induction, maintenance, and emergence * Venous air embolism detection
28
What are some ways to achieve a smooth emergence?
* Give large bolus of opioids at beginning of surgery * pre inject lidocaine directly onto vocal cords (LTA)
29
How will you care for patients with intracranial tumors? monitors, etc non anesthetic medications/fluids
* Monitors/IV * 2 large bore IV- expect lots of bleeding * PRBC available * Use Normasol or plasmalite (if unavailable, alternate LR and NS) * Standard monitors * Art line, temp, and PNS mandatory * zero the art line at the circle of Willis * Consider CVP or PA- depending on pt baseline status * Meds- careful with sedative pre-medication * corticosteroids!
30
How would you induce a pt with an intracranial tumor?
* Goal is to blunt the hemodynamic changes caused by DVL * Optimize ICP pre-induction with osmotherapy, etc * pre oxygenate pt fully * TPL or propofol- deep! * opioid * NDMR * Lidocaine * consider extra TPL after twitch response disappears and before intubation * esmolol infusions are also recommended for HR and BP control
31
What are the dosed you would give during induction of pts with intracranial tumors? TPL propofol fentanyl lidocaine
* TPL: 3-5 mg.kg * Propofol: 1.25-2.5 mg/kg * Fentanyl: 3-5 mcg/kg * Lidocaine 1.5 mg/kg
32
What should you consider during maintenance of a pt with an intracranial tumor?
* Ventilation controlled PaCO2 between 30-35 mmHg * Consider baseline intracranial compliance when determining how much VA to use * 0.6-1.0 MAC * if low compliance consider TIVA + low dose iso for amnesia * Avoid pt movement
33
Why is it important to have a smooth emergence for a pt with an intracranial tumor? How can this be done?
* Bucking can cause HTN and ICP elevation = cerebral edema and hemorrhage * No reversal until head dressing applied * IV lidocaine 1.5 mg/kg * antihypertensives * extubate when fully reversed and responsive * leave ETT in place until following commands * HOV 30 degrees * warm pt to comfortable temp to avoid shivering
34
Which procedures have higher risk of Venous air embolism?
* posterior fossa * upper c-spine procedures * supratentorial procedures * parasagittal or meningiomas near sagittal sinus, craniosynestosis
35
Describe the Venous air embolism monitoring chart
36
How are acute VAEs managed?
* Prevent further air entry * notify surgeon- flood or pack surgical field * jugular compression * lower head * Treat intravascular air * aspirate via right heart catheter * discontinue N2O * FiO2 100% * turn lateral with right side up * pressors/inotropes/CPR
37
How should you manage the anesthesia for Head trauma? BP ventilation fluids
* Maintain CPP 50-70 mmHg * Hyperventilation * used for acute ICP management * Fluids to maintain intravascular volume * prevent reduced serum osmolarity (NS, Normosol/plasmalyte, 5% albumin, blood all better than LR) * avoid dextrose (keep glucose \<180)
38
What monitors are needed for pts with head trauma?
* Standard * Art line- pre induction is best, but do not delay an emergency craniotomy for a line placement * +/- R heart catheter (manage hemodynamics and VAE risk)
39
How should you induce a pt with head trauma?
* lidocaine 1-1.5 mg/kg * IV anesthetics EXCEPT Ketamine * consider hemodynamic stability needs * opioids are a good choice * NDMR- avoid histamine, avoid Succ if non-emergent * succ will increase ICP
40
How should you emerge a patient with head trauma?
* transport intubated to ICU because max swelling is 12-72 hours post injury * avoid HTN, coughing * labetalol, esmolol, TPL or propofol helpful
41
What do you need to ask of a pt with a history of CVA?
* How long ago? * any deficits? * increased risk of adverse outcomes within **first 9 months** of CVA * What meds do they take? * BP, anti-thrombotic, anticoagulant, anti-platelet
42
What anesthetic technique is contraindicated in pts who have had a CVA? PNS?
* neuraxial in para/hemiplegia or active anticoagulant use * Do not monitor neuromuscular blockade on affected extremity
43
What are the important aspects of BP management in a pt who has had an intracranial aneurysm or sub arachnoid hemorrhage? What is the major complication?
* Acute hypertension causes risk of rerupture which is often FATAL * Brain relaxation will help make surgery easier * mannitol or hyperventilate * High-normal MAP to prevent critical reduction of CBF to ischemic area * tight control of MAP as the surgeon clips the aneurysm and/or controls bleeding * major intraoperative complication is **hemorrhage**, rebleeding kills!
44
How would you monitor a pt with intracranial aneurism/ SAH?
* Art line pre-induction * +/- CVP, depending on amt of mannitol, fluid replacement, vasospasm * +/- EEG or SSEP/MEP
45
How would you induce a pt with Intracranial aneurysm or SAH?
* Smooth induction CRITICAL * prevent hypertension and hypotension and maintain good ICP control * lidocaine + esmolol/labetalol + opioids + high dose TPL or propofol
46
If your pt with an intracranial aneurysm or SAH has a high ICP, what would you use for their maintenance anesthesia?
* propofol gtt- 100-300 mcg/kg/hr after bolus * Fentanyl- 1-4 mcg/kg/hr * \<10 mcg/kg if extubation planned * 0.5 MAC Iso and O2 * All of the above meds together
47
How long can a clamp remain on the parent artey that supplies the aneurism?
\<10 minutes
48
How should you administer fluids to a pt with intracranial hemorrhage and SAH?
* prior to clipping, only administer maintenance and deficit * PRBC should be immediately available * after clipping, CVP can increase to 10-12 mmHg
49
How should you plan to emerge a pt with intracranial aneurism or SAH?
* avoid coughing, straining, hypercarbia, and HTN * grade 1-2 with no intra-op complications can be extubated in OR * Grades 3-5 or intraop complications should remain intubated on mechanical ventilation
50
What are important post op considerations for the pt with intracranial aneurysms or SAH?
* **control HTN** to avoid cerebral edema and hematoma * control pain * avoid increased PaCO2 * antihypertensive drugs * vasospasm remains a threat * high-normal intravascular volume, avoid hypotension
Coexisting conditions
flashcards
Decks in class (34)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions