Term
What is the primary approach for infratentorial lesions? Why? |
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Definition
The sitting position
-head up position provides venous drainage
-less facial & conjunctival edema
-better ventilation
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Term
What happens if the head is flexed forward in the sitting position? |
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Definition
| -it cold lead to jugular obstruction and thus facial/tongue swelling |
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Term
What distance should you have between the mandible and sternum? |
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Definition
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Term
What position is used for infratentorial lesions? |
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Definition
Lateral, prone or semi-sitting position |
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Term
What is the problem postoperatively with infratentorial lesions? |
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Definition
Pts may have apnea due to brainstem manipulation, ischemia, swelling in surgical area.
-Vitals may be labile |
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Term
Where are the majority of pituitary tumors located? |
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Definition
at the base of the brain (sella turscica) |
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Term
What are nonfunctioning tumors? |
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Definition
Tumors that impinge on adjacent structures and cause symptoms |
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Term
Name five anesthetic implications for pituitary tumors. |
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Definition
-Normal thyroid function
-Normal blood glucose
-Normal electrolytes
-controlled BP
-Airway assessment and plan
-EKG/CXR
-Steroid replacement
-Vasopressin for diabetes insipidus |
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Term
How is pituitary failure treated? |
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Definition
| It is life threatening and treated by removing the gland or the tumor and supplementing with corticosteroids. |
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Term
What is the approach for transphenoidal hypophysectomies? |
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Definition
through the nose/sphenoid bone
-head up position
-Oral rae tube |
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Term
Name the three problems associated with surgery to remove pituitary tumors? |
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Definition
1) You working near the internal caroids, cranial nerves, & optic chiasm
2) work around the dura can cause vagal outflow (bradycardia)
3) A skin patch is used to close dura which can easily be torn if the patient coughs or bucks |
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Term
What percentage of blood supply is provided by one anterior spinal artery which arises from the vertebral arteries? |
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Definition
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Term
What does the anterior spinal artery feed? |
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Definition
The anterior cord (motor) |
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Term
How is the posterior cord supplied? |
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Definition
By two posterior spinal arteries |
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Term
What do intercostal (redicular) arteries contribute to? |
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Definition
Both the anterior and posterior arteries |
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Term
In the lower thoracic/lumbar cord region, the ?????artery is supplied by the artery of ????? |
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Definition
The anterior artery is supplied by the artery of ADAMKIEWICZ |
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Term
Where is the location of the artery of Adamkiewicz? |
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Definition
its variable T-5 to L-1
*usually arises on the LEFT |
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Term
What artery supplies most of the spinal cord? |
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Definition
the anterior spinal artery |
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Term
Spinal cord perfusion and protection is identical to ???? |
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Definition
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Term
| What are the differences in BP, HR, Fluid response, and Vasopressor response for Spinal & Hemorrhagic Shock? |
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Definition
Spinal-BP decreases; HR decreases if T 1-4 or above is involved; it does NOT respond to fluids, but DOES respond to pressors.
Hemorrhagic-BP decreases; HR increases; it DOES respond to fluids and does NOT respond to pressors. |
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Term
T/F
Hemorrhagic shock responds to Vasopressors |
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Definition
FALSE-Hemorrhagic shock does NOT respond to pressors, but Spinal shock DOES (: |
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Term
When should high doses of methylprednisone be initiated? What is the dose? |
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Definition
Initiated within 3-8 hours of injury
Dose: 30 mg/kg load over 1 hour followed by drip of 5.4 mg/kg/hr over the next 23 hrs |
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Term
An increase in sepsis, pneumonia, and prolonged hospital stay is associated with what? |
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Definition
High doses of methylprednisone |
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Term
When does hyperrelexia occur? |
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Definition
spinal injuries ABOVE T-5
(rarely seen if injury below T-10) |
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Term
(Sorry this one sucks) Describe the mechanism of autonomic hyper-reflexia. |
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Definition
| Cutaneous or visceral stimulation below cord injury sends impulses to spinal cord, travel upward until it reach the level of injury. A reflex arc is activated increasing the activity of the smypathetic portion of the ANS. The sympathetic system is not inhibited by the PSNS which would normally come from above. |
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Term
What is the result of autonomic hyper reflexia? |
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Definition
An increased SVR and hypertension
-The baroreceptors detect the elevated pressure and reflexively decrease HR and vasodilate teh vessels ABOVE the injury. |
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Term
In autonomic hyper-reflexia, what occurs above the injury? |
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Definition
Flushing
Sweating
HA/nasal stuffiness |
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Term
In autonomic hyper-reflexia, what occurs below the injury? |
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Definition
Pallor
Pilomotor erection
Muscle contraction/spasm |
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Term
If you are going to treat a patients BP that has autonomic hyper-reflexia or dysreflexia, what should you be thinking? |
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Definition
Direct arterial dilators
(Short acting-Nipride) |
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Term
What is the treatment in hyper reflexia or dysreflexia? What is your anesthetic of choice? |
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Definition
Treatment: removal of stimuli
Anesthetic of choice: Spinal |
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