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13 Cards in this Set
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- Back
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What is the risk of stroke for all patients undergoing general anesthesia?
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0.4 to 0.8%
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Does carotid bruit increase the risk of stroke in patients after surgery?
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It does not but it increases the risk of coexisting coronary artery disease
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What is the risk of stroke in patients undergoing valvular surgery
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it is about 4%, with a mortality of about 26%
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Describe the pathophysiology of stroke in patients who undergo non-thoracic or non-cardiac surgery?
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It is likely from severe prolonged hypotension or prolonged hypertension that disrupts blood brain barrier
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Define TIA
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A transient < 24 hours impairment without residual symptoms of impairment
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Describe the risk for patients who had a TIA in developing a stroke
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TIAs have a 30 to 40% chance of developing stroke with 5 years, 50% occur within first year
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When can a patient start anti-coagulant therapy after surgery?
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Most patients can restart within 12 to 48 hours depending on the type of surgery
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What is the usual anesthetic goal for patients with konwn CVA
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Generally maintain a BP at or slightly above baseline, use vasodilators or adrenergic blockade to decrease blood pressure during emergence & stimulation
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What is wrong with using the paralyzed extremity of a patient with stroke?
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TOF monitoring may results from paralyzed extremity may cause overdose of NMB, since they are resistant to NMB
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What medication is not ideal for NMB with stroke patients
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Succinocholine since it can elevate the potassium or cause hyperkalemia
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What are some seizures mechanisms
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Loss of inhibitory GABA activity, enhanced release of excitatory amino acids (glutamate), enhanced neuronal firing due to abnormal voltage-mediated calcium currents
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What are the initial steps in managing a patient that develops a seizure?
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Maintain adequate airway, and oxygenation, provide IV thiopental (50-100mg), dilantin (500-1000mg) slowyly, benzodiazepines: valium or verced
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What medications should be avoided with patients with known seizure disorder?
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Ketamine and methohexital, atracurium or cistatracurium, demerol
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