Demyelination
An acquired immune- mediated demyelinating disease affecting peripheral NS
Hyponatremia, volume contraction, high urine Na
MG is caused by IgG antibodies to ____
Acetylcholinesterase receptors (Nicotinic)
A 25 year old with Downs syndrome, asthma, 1 ppd smoker, GERD presents for a biopsy of a mediastinal mass. She has difficulty swallowing and SOB on exertion. Meds include pyridostigmine, 3-4 diaminopyridine and TUMS. What do you think about her SOB?
Discuss her asthma, smoking, possible aspiration, airway or cardiac compression of mass, lambert eaton syndrome
Who did Trump fire (or he resigned) the day after the midterm elections
Jeff Sessions
Ascending motor weakness, autonomic dysfunction (hypo/hypertension, brady/tachy arrhythmias) GI – ileus, diarrhea, Respiratory failure
General vasoconstriction, lack of central nervous modulation, HTN, upper body flushing, bradycardia
Patients with MG not receiving treatment are more ______ to Sux and _____ to NDMB. What about if they are on anticholinesterase therapy ?
resistant to sux because less Ach receptors, more sensitive to NDMB. Reversed if on Tx
During an aneurysm clipping, the aneurysm ruptures. What do you do?
Lower MAP, (consider adenosine), support hemodynamics.
What is the name of the town that is most affected by the California Camp Fire
Paradise
What is one thing you can help avoid in the OR to prevent MS exacerbation?
Hyponatremia, elevated urine osmolality/concentrated urine, often hypervolemic
Name 3 predictors of post op mechanical ventilation in patients with MG
MG >6 years duration , daily pyridostigmine dose >750mg, COPD, Vital capacity of less than 40ml/kg (2.9L)
A patient is brought to the ICU after C spine injury from MVC causing quadriplegia. What is he at risk for in the first 24 hours?
Spinal shock!
Hypothermia (unable to vasoconstrict below the level)
Hypotension (Get sympathectomy below the level of injury
Pulmonary edema
What is the name of the journalist that was killed in Turkey
Jamal Khashoggi
Hyponatremia is an independent predictor, age > 50, ventilator support, bulbar weakness
Occurs when Hyponatremia is corrected too rapidly
Central Pontine Myelinosis
Select the true statement regarding neonatal Myasthenia Gravis -
A: The newborn is usually affected
B: The newborn is affected by maternal IgM antibodies
C: The newborn may require anticholinesterase therapy for up to 4 weeks
D: The newborn will need lifelong treatment
E: Only female newborns are affected
Answer C: The newborn may require anticholinesterase therapy for up to 4 weeks -
10-20% of newborns are affected because the IgG Ab is transferred via placenta. Therapy may be required for 2 to 4 weeks until the IgG Abs are metabolized
A patient with MG presents for resection of mediastinal mass? What are your concerns?
Risk of post op mechanical ventilation, compression of airway/heart by mass, aspiration risk if pt has bulbar symptoms
Trump suggested we prevent forest fires by raking, like they do in what country?
Finland
A patient with MS presents for surgery and asks about the risk of Anesthesia worsening her MS. What do you tell her?
It has been speculated that general anesthesia and surgery may increase the risk for aggravation of MS. At present, there is no general consensus on this matter, and patients should therefore be informed of the potential for aggravated symptoms in the postoperative period and there has been no documented association with the type of anesthetic or particular anesthetic agents and exacerbation of disease
This occurs with relative hypocarbia, normal vessels vasoconstrict but ischemic vessels stay dilated (they are max dilated) and therefore get more flow
Robin Hood Steal or Inverse steal
A patient with MG and high risk for post operative mechanical ventilation presents for hysterectomy, what are some options for anesthesia?
Spinal, GA, can consider using TIVA /Remi in patients that you want to avoid NMB.
A patient with Acromegaly presents for pituitary tumour resection. What are some of your specific concerns in regards to Acromegaly
Hypertrophy of facial bones, tongue, airway soft tissues, difficult airway, difficult mask ventilation, sleep apnea, restrictive pulmonary physiology due to costal cartilage hypertrophy, HTN, LVH, diastolic dysfunction
Name 4 of the people Cesar Sayoc targeted
George Soros
Hillary Clinton
Barack Obama
John Brennan
Debbie Wasserman Schultz
Maxine Waters
Joe Biden
Robert DeNiro
Cory Booker
James Clapper
Kamala Harris
Tom Steyer
CNN