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Flashcards in Neuromuscular - Co- Existing Deck (15):
1

SLE Anesthesia Managment:
*PreInduction: consider meds? infection/preg/position
*Induction: meds?
* A/w management (3?)
* Consider drugs to AVOID in ?

* steroids
* no one ideal agent, myocardial sparing drugs (propfol, etomidate, ketamine, versed = good)
* cricoaryternoid arthritis, mucosal ulceration, RLN palsy
* renal failure

2

RA Anesthetic Considerations:
* Joints/Limitations?
* Concerns with A/W?
* Preop Imaging - Xray/CT
* Document - Preop?
* If difficult a/w then?

* TMJ, cricoarytenoid joint (use smaller tube) and cervical spine
* difficult intubation and DVL (use cervical collar)
* neuro fxn
* awake fiberoptic

3

RA and Anesthetic Considerations?

PreInduction
* CV involvement? - Tx influences managment?
* Resp involvement? - Positioning?

* arrhythmias, aortic insuff- consult
* RLD - post op vent, ABGs
* Steroids, ASA, NSAIDs, immune supressants, hepatic and renal dysfxn
* minimize compression risk and injury

4

Osteoarthritis - Anesthesia Management:
* Tx =?
* affects what important joints?
* consider drug tx and concerns?

* ASA and NSAIDs (no steroids)
* knee, hip, cervical/lumbar spine - hard to place epidural
* bleeding

5

MG: Anesthetic Considerations:
Induction:
* consider drug therapy? * A/W considerations?
* case scheduled for? * Hold drug on AM of surgery?
* premed: consider? * Use short acting induction meds?

1. steroid therapy
2. first case of the day
3. muscle weakness
4. aspiration risk / RSI
5. hold pyridiostigmine
6. propofol or TPL

6

MG: Anesthetic Concerns
Induction:
*Opioids?
*IAs?
* MRs- succs vs NMDRs?
* Best Reversal?

* limited use
* IA good for induction and maintenance
* resistant to succs/sensitive to NMDRs
* edrophonium

7

MG: Extubation
* RA with GA?
* needs to be responsive/full reversal
*monitor in PACU/resume pyridostigmine

* good choice for thymectomy

8

Myasthenic Syndrome:
*Tx: med?
*muscle weakness?
* MRs?

*aminopyridine
* proximal
* sensitive to succs and NDMRs

9

Muscular Dystrophy: Anesthetic Considerations?
*Induction
1. intubation? 4. AVOID? 7. RA? y or n?
2. IAs: cardiac effects? 5. consideration for NDMRs?
3. susceptible to? 6. Post op pulm dysfunction

1. delayed gastric emptying = RSI
2. prone to myocardial depressant effects
3. MH
4. Succs
5. prolonged response
7. RA okay

10

Anesthetic Concerns: Marfan's
1. lung dz severity?
2. meds to reduce CV workload? 5. med prophylaxis?
3. A/w management?
4. Preop focus?

1. RLD (kyphoscoliosis, pneumo)
2. BB
3. high palate (vent/oxygenate)
4. CV involvement
5. antibiotics (endocarditis)

11

Anesthetic Concerns: Marfan's
Induction:
1. Intubation: AVOID?
2. DVL?
3. r/o?

1. extreme mvmt of mandible
2. smooth/avoid SNS stim
3. pneumothorax

12

Ankylosing Spondylitis - Considerations?
1. hallmark sign? 5. treatment?
2. effects?
3. cardiac involvement?
4. pulm involvement?

1. sacroiliac joint pain (improves with mvmt)
2. lumbar spine -> ascends to upper back and neck
3. conduction issues
4. RLD
5. NSAIDs, methotrexate, spinal fusion

13

Ankylosing Spondylitis - Anesthetic Considerations?
* RLD
1. consider regional?
2. Intubation?
3. Induction goals?

1. hard to place epidural into fused space
2. awake fiberoptic
3. controlled vent & maintain SVR

14

Achondroplasia: Anesthesia Management
1. difficult a/w? 3. temp dysfxn?
*OSA, central sleep apnea *hydrocephalus
* facial feature *no change to response to IA/MRs
2. Pulm picture?

1. upper a/w obstruction, unable to expose glottis, small a/w
2. RLD
3. prone to hyperthermia

15

Anesthesia Management for SLE:

* consider organ dysfxn - renal, liver (drug clearance), cardiopulm
* CNS involvement - sz or stroke, neuropathies
* consider ? for surgery

* stress dose steroids