Neuromuscular Diseases Flashcards Preview

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Flashcards in Neuromuscular Diseases Deck (23)
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1
Q

Muscular Dystrophy

A

Hereditary
Painless degeneration and atrophy of skeletal muscles

Hyperkalemia with Sux
May be susceptible to MH

2
Q

What is the most common and most severe muscular dystrophy?

A

Duchenne’s Muscular Dystrophy

3
Q

Duchenne’s Muscular Dystrophy

A

X-linked recessive
Diagnosed in early childhood

TLC and RV are decreased
Recurrent pulmonary infections
Risk for aspiration
Myocardial dysfunction

Hyperkalemia with Sux
May be susceptible to MH

4
Q

Multiple Sclerosis

A

Random and multiple sites of demyelination of corticospinal tract neurons in the brain and spinal cord - EXCLUSIVE of the peripheral neurons
Autoimmune

5
Q

What are the s/s of multiple sclerosis?

A
Visual disturbances
Ataxia
Limb paresthesia and weakness
Spastic paresis of skeletal muscles 
Exacerbations and remission
6
Q

Management of Anesthesia: Multiple Sclerosis

A
Identify exacerbations 
Supplement steroids 
Avoid marked temp changes 
Subarachnoid block is questionable ???
Not concerned about aspiration risk 
Hyperkalemia with Sux
7
Q

Myasthenia Gravis

A

Chronic autoimmune disease involving the NMJ
Decrease in Ach receptors
Weakness and rapid exhaustion of skeletal muscles with repetitive use

8
Q

What are the s/s of myasthenia gravis?

A

Ptosis and diplopia
Weakness of pharyngeal and laryngeal muscles
Asymmetric extremity skeletal muscle weakness and atrophy
Cardiomyopathy
Hypothyroidism

9
Q

What are the most common initial symptoms of myasthenia gravis?

A

Ptosis and diplopia

10
Q

What is the treatment for myasthenia gravis?

A
Anticholinesterase drugs - pyridostigmine 
Steroids
Cyclosporine 
Plasmapheresis 
Thymectomy 

*These patients may come in with cholinergic crisis

11
Q

Anesthesia Management: Myasthenia Gravis

A

Expect altered response to MR - resistant to Sux, sensitive to NDMR
Tracheal intubation w/o MR - aspiration risk

12
Q

Parkinson’s Disease

A

Degenerative disease of the CNS
Loss of dopaminergic fibers in the basal ganglia
*Dopamine is an inhibitory NT acting on the extrapyramidal motor system
These patients have more Ach and less dopamine

13
Q

What are the s/s of Parkinson’s Disease?

A

Skeletal muscle rigidity
Resting tremor
Diaphragmatic spasms
Mental depression

14
Q

Treatment for Parkinson’s Disease

A
Increase concentration of dopamine! 
Levodopa - combines with decarboxylase inhibitor 
Anticholinergic drugs
Antihistamine drugs 
Continue meds perioperatively
15
Q

What drugs should you avoid in the patient with Parkinson’s?

A

Avoid drugs with antidopaminergic effects

Droperidol, possibly opioids, Reglan

16
Q

What is the most common type of scoliosis?

A

Idiopathic scoliosis

17
Q

Describe the respiratory changes with thoracic scoliosis.

A

Restrictive pattern
Decreased - VC (60-80% of predicted), TLC, IRV, FRC, IC, ERV
*RV may be normal, FEV1/FVC is normal

18
Q

What would the ABG of patient with thoracic scoliosis look like.

A

Arterial hypoxemia and desaturation

PaCO2 and pH normal

19
Q

What is the most common cardiovascular system change in the patient with severe scoliosis?

A

MVP

*May develop pulmonary HTN…leading to RHF

20
Q

Considerations for scoliosis correction surgery.

A

Prepare for blood loss
Deliberate hypotension w/o compromising spinal cord BF
Strict parameters for extubation - VC > 10 mL/kg, TV > 3 mL/kg, RR < 30, Neg insp. force > -30
Complications - pneumo, atelectasis, pleural effusion, hemothorax, neurologic injury

21
Q

Eaton-Lambert Syndrome

A

Antibodies to presynaptic Ca channels

Sensitive to Sux and NDMRs

22
Q

What is the opposite of Parkinson’s disease?

A

Huntington’s disease - plenty of dopamine, not enough Ach

Autosomal dominant degenerative disease of the CNS

23
Q

Alzheimer’s Disease

A

Cerebral atrophy especially in hippocampus and temporal lobes
Ach makes memories, GABA throws memories out

Tx- anticholinesterases (Tacrine, Donepezil)

Avoid scopolamine, benadryl, and versed