Week 1 presentations

Question 1

Most common manifestation of CP?

Answer 1

muscle spasticity
results in contractures and fixed deformities of joints in upper and lower extremities

Question 2

Extrapyramidal CP is associated with _______ and ________.

Answer 2

choreoathetosis (involuntary movements) and dystonia

Question 3

MAC and Emergence for CP patients

Answer 3

LOWER MAC and delayed emergence from GA

-likely from increased sensitivity d/t anti-convulsant meds and preoperative hypothermia

Question 4

CP patients extremely susceptible to _______ perioperatively d/t thin body habits

Answer 4

hypothermia

Question 5

CP and NMBs/ NDNMBs

Answer 5

Slightly increased sensitivity to depolarizing NMBs (succinylcholine), but relative resistance to non-depolarizing NMBs (rocuronium) if taking anticonvulsant medications

Question 6

Most common anesthesia complications for CP

Answer 6

Respiratory

-recurrent respiratory infections common
-scoliosis of spine cause restrictive lung physiology
-decreased C-spine mobility –> difficult airway
-overproduction of saliva and dysphasia
-increased aspiration risk
-mostly intubate these patients

Question 7

CP CV complications

Answer 7

-Hypotension one of the most common

Question 8

CP GI complications

Answer 8

Often malnourished and dehydrated to due poor feeding

Decreased lower esophageal tone leads to high risk of GERD and aspiration

Question 9

Vagus nerve stimulator stimulates the _____ vagus nerve and is used to avoid _______ complications.

Answer 9

-left
-cardiac

(left innervates AV node & right innervates SA node)

Question 10

2 incisions for vagus nerve stimulator:

Answer 10

left anterior cervical (C6-C7) and left infraclavicular (placement of pulse generator)

Question 11

2 type of Epileptic seizures:

Answer 11

1. Focal: starts in one area on one side of brain
2. Generalized: affects a widespread network of cells on both sides of brain simultaneously

Question 12

VNS: should patients take seizures meds through the day of surgery?

Answer 12

YES

Question 13

Antiepileptic drugs cause ____ _____induction —-> accelerated drug metabolism with resistance to NMBs

Answer 13

hepatic enzyme

Question 14

VNS:________ may promote seizure activity

Answer 14

Hyperventilation

Question 15

VNS can affect the _____ SLN and RLN, leading to ______, ______, and ______.

Answer 15

LEFT
hoarseness, coughing and voice changes

Question 16

True or False: VNS is considered a first-line treatment for epilepsy

Answer 16

False

Question 17

Does VNS target the right or the left vagus nerve?

Answer 17

LEFT

Question 18

How many incisions are made during VNS implantation?

Answer 18

2

Question 19

1. All of the following are primary concerns for the cerebral palsy patient during anesthesia except:
   a. Hypotension
   b. Hypothermia
   c. Hyperthermia
   d. Aspiration

Answer 19

b. hyperthermia

Question 20

2. Cerebral palsy is classified according to
   a. Extremity involvement
   b. Neurologic dysfunction
   c. Both of the above
   d. None of the above

Answer 20

c. both of the above

Question 21

3. True/False: patients with cerebral palsy typically have lower mean alveolar concentrations (MAC) and delayed emergence from general anesthesia

Answer 21

True

Question 22

GB: Weakness typically….

Answer 22

ascends from the legs and is symmetrical

Question 23

GB: (respiratory) anesthesia consideration

Answer 23

Respiratory muscle weakness = difficult extubation.

Question 24

GB: autonomic dysfunction

Answer 24

high risk for hemodynamic instability from anesthesia, position change, PPV, and blood loss.

Question 25

GB: most involved organ systems

Answer 25

cardiovascular, respiratory, and gastrointestinal. 

Question 26

GB: common cardiac manifestations

Answer 26

hypertension, hypotension, and brady/tachyarrytmias. Some patients may require pacemaker placement.

Question 27

GB: Exaggerated response to ______ ______ ______due to upregulation of postjunctional adrenergic receptors

Answer 27

indirect-acting sympathomimetics

Question 28

GB: Treatment

Answer 28

includes IVIG & plasma exchange

Question 29

1. Which of the following medications should be avoided with Guillain-Barre Syndrome? a. Fentanyl b. Succinylcholine c. Rocuronium d. Cisatracurium

Answer 29

b. Succinylcholine

Question 30

2. T/F: The primary pathophysiology of Guillain-Barre Syndrome is an immune-mediated response to a prior infection a. True b. False

Answer 30

True

Question 31

3. Patients with Guillain-Barre Syndrome are at risk for which of the following? a. Hypertension b. Hypotension c. Genetic mutation d. Both A and B

Answer 31

d. Both A and B

Question 32

What is Myasthenia Gravis?

Answer 32

A neurological autoimmune disorder Is an example of an antigen-mediated autoimmune disorder Antibodies affect the transmission of nerve signals to muscles resulting in decreased muscle contraction

Question 33

MG: Autoantibodies are produced that attack the.......

Answer 33

POSTSYNAPTIC nicotinic acetylcholine receptors.

Question 34

MG: The primary immunogenic target of MG is the ______ subunits of the ____receptor channel

Answer 34

alpha Ach

Question 35

MG: early symptoms

Answer 35

Eyelid drooping and/or double vision Also, Fatigue & muscle weakness including difficulty getting out of a chair, climbing stairs, and lifting arms Slurred or nasal speech Difficult chewing/choking when swallowing

Question 36

MG: Common medication treatment

Answer 36

Cholinesterase inhibitors Helps inhibit the hydrolysis of ACh= raises the neurotransmitter’s concentration at the NMJ. Most common drug is oral pyridostigmine

Question 37

1. Where do myasthenia gravis antibodies affect?

Answer 37

Nicotinic acetylcholine receptors

Question 38

2. What is one anesthetic consideration for taking care of someone with MG?

Answer 38

Respiratory status, cardiac assessment

Question 39

3. What main gland is associated with being affected by myasthenia gravis?

Answer 39

Thymus gland

Question 40

Awake craniotomy: used for?

Answer 40

Historically used for the treatment of seizures and epilepsy

Question 41

Most important benefit from awake craniotomy?

Answer 41

allows the neurosurgeon to maximize tumor resection while preserving neurological function.  Patients undergoing awake craniotomy have fewer neurological deficits and hospital stays vs. those who are under general anesthesia

Question 42

Relative contraindications of awake craniotomy?

Answer 42

obese, obstructive sleep apnea, difficult airways, chronic cough, anxiety disorder, substance abuse, low pain tolerance, apparent dysphasia

Question 43

Awake Crani: 3 Types of Mapping:

Answer 43

Motor, Visual & Language

Question 44

Two Main Approaches for Regional with Awake Craniotomy

Answer 44

1. Scalp block with incision line infiltration 2. Scalp nerve block for 6 nerves

Question 45

Awake Craniotomy: 6 nerves that are blocked bilaterally

Answer 45

Supraorbital Supratrochlear Auriculotemporal Temporozygomatic Greater Occipital Lesser Occipital

Question 46

Awake craniotomy: 2 methods

Answer 46

MAC or AAA (GA -> Awake -> GA)

Question 47

Awake Craniotomy: AAA (awake - asleep - awake) explain it

Answer 47

AAA: Propofol given following insertion of LMA/ETT for positioning and craniotomy portion Once brain is exposed, airway is removed per surgeon The brain lacks pain receptors Surgeon waits for the patient to be awake for mapping and resection The airway is reinserted for closure

Question 48

Awake Craniotomy: 3 Most Common Simultaneous Infusions

Answer 48

Propofol: stop 15 min before EEG recording Precedex: (0.3-0.7 mcg/kg/hr) Remifentanil: (0.1-0.2 mcg/kg/min)

Question 49

Awake Craniotomy: AVOID/LIMIT -->> may lead to confusion/delirium/ affect intraop mapping

Answer 49

Versed Atropine Scoplamine Large doses of fentanyl

Question 50

1. What is an absolute contraindication of an awake craniotomy?

Answer 50

Patient refusal, inability to cooperate or obey commands

Question 51

2. Which stage of surgery should patients be awake with the MAC or asleep-awake-asleep anesthetic techniques?

Answer 51

Patient should be awake for mapping and resection

Question 52

3. Which anesthetic technique is associated with a lower risk of surgical failure and shorter procedure time?

Answer 52

MAC