Anesthesia students

02/07/2022

Anaesthesiologist .

Regarding anesthesia for neurosurgery, the following statements are true EXCEPT
A. Volatiles, ie Halothane, sevoflurane etc, cause a dose dependent increase in cerebral blood flow.
B. Isoflurane at 1 MAC is safe as far as maintaining a stable intracranial pressure is concerned.
C. Sodium Thiopentone, with its good anticonvulsant properties, reduction in cerebral metabolic requirements and blood flow, make it an good induction agent.
D. Patients in the prone position require a reinforced armoured endotracheal tube s
E. An end tidal carbon dioxide level of 50 mmHg (6.6kPa) is considered safe as far as intracranial pressure is concerned

13/09/2021

23/07/2021

3rd or 4th semester

16/07/2021

19/05/2021

03/12/2020

ANESTHESIA FOR MUSCULAR DYSTROPHY

AVOID
i. Succinylcholine
ii. Volatile anesthetic - risk of hyperkalemic cardiac arrest and rhabdomyolysis.
iii. In case of present cardiomyopathy avoid nitrous oxide because of cardio-depressant effects.

SAFE
i. Opiates,
ii. Propofol - Patients may require a higher dose of propofol or opiates.
iii local anaesthetics have been used without any complication.

SPECIAL CONSIDERATION

A. NEUROMUSCULAR BLOCKERS
- Non-depolarizing neuromuscular blocking agents can be used safely in these patients, but show markedly differences in onset and duration of action.
- onset of neuromuscular block is delayed and duration is markedly prolonged.
- Antagonisation of neuromuscular blockade with pyridostigmine or neostigmine seems to be possible.

In doubt prefer ventilation until spontaneous recovery.
There is no need for prophylactic postoperative ventilation if neuromuscular blockade was monitored consequently.

B. BODY TEMPERATURE
Monitor body temperature to avoid shivering and increased oxygen demand.

C. FLUIDS
High risk surgery, major fluids shifts or advanced disease -> arterial cannulation for invasive blood pressure Measurement and central venous line placement is recommended.
- In case of cardiomyopathy, transesophageal echocardiography is very useful.

COMPLICATIONS
i. Patients with DMD are at risk for hyperkalaemic cardiac arrest (succinylcholine) and rhabdomyolysis (volatile anaesthetics).
ii. Sedative drugs (benzodiazepines) can cause respiratory insufficiency.
iii. Muscle relaxants show up to a 4 times prolongation of neuromuscular block. This effect is dependent on the stage of the disease.
iv. DMD patients are at risk for respiratory and cardiac insufficiency.

POST-OPERATIVE CARE
i. Degree of postoperative monitoring is depending on surgical procedure and preoperative condition of the patient. ii. Intensive care is not mandatory.
iii. Avoid prolonged immobilization.
Muscular atrophy may worsen disease.
iv. In case of necessary postoperative ventilation
-> aggressive weaning (e.g., non invasive ventilation), avoid prolonged ventilation.

OUT PATIENT - ANESTHESIA
Should only be done in DMD patients with early disease (no cardiopulmonary symptoms) and low risk surgery.

Dr Roc
Anesthesia Page

14/10/2020

24Hour

01/09/2020

Under supervision doctor

06/07/2020

Professor Doctor Tariq Abas

19/06/2020

24/05/2020

‎*بِسْــــــــــــــــــمِﷲِالرَّحْمَنِ اارَّحِيم*
‎*السَّلاَمُ عَلَيْكُمْ وَرَحْمَةُ اللهِ وَبَرَكَاتُهُ*
On the occasion of the end of this glorious month of Ramadan, may the auspicious occasion of Eid, bless you with peace and bring joy to you and ur family. EID MUBARAK.
Best regards۔۔
Anesthesia students
‎,آَمِيـٍـِـنْ يَآرَبْ آلٌعَآلَمِِيِن