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29 Cards in this Set
- Front
- Back
What percent of patients exhibit autonomic hyperreflexia after recovery from spinal cord transection?
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85%
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Autonomic hyperreflexia is associated with what sort of spinal cord injury?
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transection at T5 and above
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Describe the syndrome of autonomic hyperreflexia.
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Severe paroxysmal HTN with bradycardia, dysrhythmias, cutaneous vasoconstriction below and vasodilation above the level of the injury
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What triggers an episode of autonomic hyperreflexia?
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typically distension of the bladder or rectum, but any noxious stimulus can cause it.
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Many patients with spinal injuries and autonomic hyperreflexia will complain of headaches in the setting of _____.
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Bladder distention
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In autonomic hyperreflexia, what is it that's lacking that results in the symptoms and signs?
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A lack of supraspinal inhibition to the sympathetic outflow below the lesion.
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How should one treat an episode of autonomic hyperreflexia?
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remove stimulus, deepen anesthesia, administer direct-acting vasodilators.
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What end-organ damage can autonomic hyperreflexia cause?
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seizures, MI, intracranial hemorrhage
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What type of anesthesia are effective in preventing autonomic hyperreflexia?
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Spinal > general with gas or epidural
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How does one treat systemic hypertension in autonomic hyperreflexia?
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Nitroprusside
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How does pregnancy affect MAC?
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it decreases
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What hormone may contribute to the decrease in MAC during pregnancy?
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Progesterone due to its sedating effects.
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What might desiccated soda lime degrade sevoflurane to?
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carbon monoxide and/or compound A
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What might moist soda lime degrade sevoflurane to?
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compound A
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What four conditions increase production of compound A with soda lime?
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1) low gas flows 2)higher concentrations of sevo 3)higher absorbent temp 4) absorbent dessication
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If a carbon dioxide absorbent like Baralyme become desiccated what will happen if used with sevoflurane?
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a chemical reaction that can lead to spontaneous fires or extreme heat without fire.
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What is normal and what is elevated ICP?
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Normal is < 10mmHg and ICP HTN is > 15mm Hg
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How do volatile anesthetics affect ICP?
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They increase ICP in a dose-dependent manner.
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In patients with supratentorial tumors with midline shifts which inhaled anesthetics could be more useful and underwhat circumstance?
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Isoflurane and desflurane did not significantly affect lumbar CSF pressure in the setting of moderate hypocapnia (PaCO2 = 30)
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What induction agents are unlikely to increase ICP?
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thiopental or etomidate (and propofol but this might also result in greater decrease in CBF)
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What paralytic should be used in the setting of increased ICP?
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ND NMB because succinylcholine may increase it
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In a patient with increased ICP, what must be confirmed prior to intubation?
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skeletal muscle paralysis so that coughing is avoided
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What IV drugs may be given 1 - 2 minutes prior to DL in a patient with increased ICP and why?
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To attenuate the increase in SBP that comes with intubation, thiopental, propofol, opioids or lidocaine IV can be given.
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What level of hypocapnia is helpful in an intubated patient with increased ICP?
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PaCO2 30 - 35
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What type of carbon dioxide absorber will not degrade inhaled anesthetics?
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Amsorb Plus
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From most likely to least likely which inhaled anesthetics are likely to produce carbon monoxide in desiccated soda lime?
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desflurane = enflurane > isoflurane >> halothane = sevoflurane
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What is the metabolic oxygen requirement of patient undergoing general anesthesia?
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150 - 250mL/min
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If a sidestream gas analyzer is used in a closed circuit, what must happen to the gas analyzed?
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It must be returned to the system.
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If NO is being used in a closed breathing system, what monitor becomes mandatory?
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an oxygen analyzer on the inspiratory or expiratory or inspiratory limb
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