AKT-6 keywords Flashcards

Intracranial pressure
Terms Definitions
What percent of patients exhibit autonomic hyperreflexia after recovery from spinal cord transection?
Autonomic hyperreflexia is associated with what sort of spinal cord injury?
transection at T5 and above
Describe the syndrome of autonomic hyperreflexia.
Severe paroxysmal HTN with bradycardia, dysrhythmias, cutaneous vasoconstriction below and vasodilation above the level of the injury
What triggers an episode of autonomic hyperreflexia?
typically distension of the bladder or rectum, but any noxious stimulus can cause it.
Many patients with spinal injuries and autonomic hyperreflexia will complain of headaches in the setting of _____.
Bladder distention
In autonomic hyperreflexia, what is it that's lacking that results in the symptoms and signs?
A lack of supraspinal inhibition to the sympathetic outflow below the lesion.
How should one treat an episode of autonomic hyperreflexia?
remove stimulus, deepen anesthesia, administer direct-acting vasodilators.
What end-organ damage can autonomic hyperreflexia cause?
seizures, MI, intracranial hemorrhage
What type of anesthesia are effective in preventing autonomic hyperreflexia?
Spinal > general with gas or epidural
How does one treat systemic hypertension in autonomic hyperreflexia?
How does pregnancy affect MAC?
it decreases
What hormone may contribute to the decrease in MAC during pregnancy?
Progesterone due to its sedating effects.
What might desiccated soda lime degrade sevoflurane to?
carbon monoxide and/or compound A
What might moist soda lime degrade sevoflurane to?
compound A
What four conditions increase production of compound A with soda lime?
1) low gas flows 2)higher concentrations of sevo 3)higher absorbent temp 4) absorbent dessication
If a carbon dioxide absorbent like Baralyme become desiccated what will happen if used with sevoflurane?
a chemical reaction that can lead to spontaneous fires or extreme heat without fire.
What is normal and what is elevated ICP?
Normal is < 10mmHg and ICP HTN is > 15mm Hg
How do volatile anesthetics affect ICP?
They increase ICP in a dose-dependent manner.
In patients with supratentorial tumors with midline shifts which inhaled anesthetics could be more useful and underwhat circumstance?
Isoflurane and desflurane did not significantly affect lumbar CSF pressure in the setting of moderate hypocapnia (PaCO2 = 30)
What induction agents are unlikely to increase ICP?
thiopental or etomidate (and propofol but this might also result in greater decrease in CBF)
What paralytic should be used in the setting of increased ICP?
ND NMB because succinylcholine may increase it
In a patient with increased ICP, what must be confirmed prior to intubation?
skeletal muscle paralysis so that coughing is avoided
What IV drugs may be given 1 - 2 minutes prior to DL in a patient with increased ICP and why?
To attenuate the increase in SBP that comes with intubation, thiopental, propofol, opioids or lidocaine IV can be given.
What level of hypocapnia is helpful in an intubated patient with increased ICP?
PaCO2 30 - 35
What type of carbon dioxide absorber will not degrade inhaled anesthetics?
Amsorb Plus
From most likely to least likely which inhaled anesthetics are likely to produce carbon monoxide in desiccated soda lime?
desflurane = enflurane > isoflurane >> halothane = sevoflurane
What is the metabolic oxygen requirement of patient undergoing general anesthesia?
150 - 250mL/min
If a sidestream gas analyzer is used in a closed circuit, what must happen to the gas analyzed?
It must be returned to the system.
If NO is being used in a closed breathing system, what monitor becomes mandatory?
an oxygen analyzer on the inspiratory or expiratory or inspiratory limb
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