Neuroanesthesia pt3.2

Question 1

What patients are candidates for interferon for treatment of MS? Why?

Answer 1

• Rapidly progressing disease
• Cardiac toxicity

Question 2

What type of drug is azathioprine?

Answer 2

Purine analogue immunosuppressant

off-label use

Question 3

How does methotrexate treat MS?

Answer 3

Slows progression through typically immunosuppression/anti-inflammatory effects.

off-label use

Question 4

Should MS medications be continued on the day of surgery?

Answer 4

yes; typically

steroid coverage should be given

Question 5

What is the anesthetic relevance of baclofen pumps for MS patients?

Answer 5

Baclofen will increase sensitivity to non-depolarizing paralytics.

lowest NDMR dose possible should be given

Question 6

What paralytic should be avoided in MS patients? Why?

Answer 6

Succinylcholine

Due to upregulation of extrajunctional ACh receptors = severe hyperkalemia

Question 7

What are risk factors for MS relapse? (that anesthesia can help regulate)

Answer 7

• Fever / Hyperthermia
• Infection
• Emotional stress (consider versed pre-op)

Question 8

What is another name for Acute Inflammatory Demyelinating Polyradiculoneuropathy?

Answer 8

Guillain Barre Syndrome (GBS)

Question 9

Guillan Barre Syndrome (GBS) is rare and sometimes preceded by an _______.

Answer 9

infection

Question 10

What is often the 1st sign of GBS?

Answer 10

“Pins & needles” and numbness

Question 11

In GBS, weakness begins in the _____, and then spreads to the ______.

Answer 11

begins in the legs and then spreads to the upper body

Question 12

What are the most serious signs associated with GBS?

Answer 12

• Difficulty swallowing
• Impaired ventilation

Question 13

What drug should absolutely be avoided in GBS? Why?

Answer 13

Succinylcholine due to upregulation of ACh receptors

Question 14

Autonomic dysfunction is possible in GBS but not MS. T/F?

Answer 14

False. Autonomic dysfunction can occur in both

Question 15

When is hypertension seen with a GBS patient during an anesthetic case?

Answer 15

Laryngoscopy

Question 16

What tends to cause hypotension seen with a GBS patient during an anesthetic case?

Answer 16

Positive airway pressure and position

Question 17

What kind of anesthetic technique is likely inappropriate for GBS patients? Why?

Answer 17

MAC

• Likely to have airway reflex dysfunction & respiratory compromise

Question 18

What paralytic should be avoided with GBS?

Answer 18

Succinylcholine

use NDMR’s judiciously

Question 19

What are the three components of Parkinson’s Disease process?

Answer 19

• Loss of dopaminergic fibers of the basal ganglia
• ↓ NE production (ANS dysfunction)
• Lewy Body development

Question 20

What causes the movement disorder aspect of Parkinson’s?

Answer 20

Loss of dopaminergic neurons of the basal ganglia

Question 21

What is the name for the α-synuclein clumps of proteins developed in Parkinson’s disease?

Answer 21

Lewy Bodies

Question 22

What is the most important risk factor for development of Parkinson’s Disease?

Answer 22

Age

Question 23

What acronym showcases the sign/symptoms associated with Parkinson’s?

Answer 23

TRAP

Tremors
Rigidity (stiffness)
Akinesia (impaired voluntary movement)
Posture

Question 24

Where does muscle rigidity in Parkinson’s patients first appear?

Answer 24

Proximal muscles of the neck resulting in “loose arm swinging”.

Question 25

How are the tremors of Parkinson's disease usually characterized?

Answer 25

- Pill-Rolling = Rhythmic w/ alternating flexion/extension of digits. - Shaking that usually starts on one side

Question 26

Tremors in Parkinson's disease are usually more prominent when moving. T/F?

Answer 26

False. Tremors more prominent at **rest**.

Question 27

Is there an autonomic dysfunction component to Parkinson's? What is the result?

Answer 27

Yes; results in the following being more common: - Respiratory obstruction - Aspiration pneumonia

Question 28

What are the two treatment goals with Parkinsons?

Answer 28

- Increase Dopamine in basal ganglia - Decrease effects of excess ACh

Question 29

How do Levodopa/Carbidopa work?

Answer 29

- Levodopa - crosses BBB and forms into dopamine - Carbidopa (decarboxylase inhibitor) prevents levodopa breakdown prior to crossing of BBB.

Question 30

What are the side effects of Levodopa/Carbidopa?

Answer 30

- Dyskinesias - Altered heart contractility - Orthostatic Hypotension - N/V

Question 31

What is the success rate for surgical treatment (DBS) of Parkinson's disease? What patients are candidates for surgical treatment?

Answer 31

- 70% - Reserved for patients w/ disabling & medically refractory symptoms

Question 32

What type of anesthesia should be considered with patients w/ dementia?

Answer 32

TIVA *TIVA is easier to clear and tolerated better than gas*

Question 33

Review these autonomic nervous system bodily function.

Answer 33