Anesthesia Student Survival Guide.pdf - Index of

PhysioloGy And AnesthesiA for neuroloGic, ent, And oPhthAlmoloGic surGery ● 293
Table 18.2 (continued)
Preoperative consider-
ations
Patients may require ventilatory support
increased aspiration risk
Anesthetic management consider rsi, avoid succinylcholine, minimize muscle relaxants &
opioids
Neuroleptic Malignant Syndrome (NMS)
etiology derangement of dopaminergic receptors in hypothalamus
Associated with psychotropic drug use (phenothiazines, butyrophenones)
symptoms hyperthermia, muscle rigidity,
treatment discontinue neuroleptic meds, control temperature, hydrate
Administer dantrolene, bromocriptine, amantadine
Anesthetic considerations nms has a slower onset than malignant hyperthermia (see Appendix B)
and muscle rigidity is a central, not peripheral, effect in nms
Parkinson’s Disease
etiology loss of dopaminergic fibers leads to unopposed acetylcholine activity
symptoms uncontrollable tremors, slow movements, muscle rigidity
treatment levodopa, anticholinergics, antihistamines, mAo inhibitors
Anesthetic management Patients at high risk of aspiration, consider rsi
Avoid dopamine and acetylcholine antagonists
(droperidol, promethazine, prochlorperazine, metoclopramide,
scopolamine, high dose glycopyrrolate)
Patients may exhibit dysrhythmias and intravascular volume depletion
airway between the surgeon and the anesthesiologist. Detailed communication
with the surgical team in the preoperative and intraoperative periods is
imperative along with an appreciation for both the lack of access to the airway
and the possibility of surgical disruption of the airway.
Specialized equipment
ENT surgery provides exposure to a variety of specialized airway and surgical
equipment. This includes a variety of endotracheal tubes (nasal and oral RAE,
reinforced, anode, red-rubber) that generally afford the operative team
improved access, a more secure airway, or special monitoring capability. Procedures
on the larynx or trachea may utilize high-frequency jet ventilation and
laser technology for lesion ablation, whereas sinus surgery increasingly utilizes
real time CT-image guidance. Early familiarity with the available anesthesia
equipment will facilitate anesthetic planning.