516 Dr. Broulliard Problem Based

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516 Dr. Broulliard Problem Based

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516 Dr. Broulliard Problem Based

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What is the case?

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Cerebral angiography and possible coiling of a superior hypophyseal artery aneurysm.

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Where does the cerebral aneurysm usually occur?

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At or near the bifurcation of vessels.

Anterior comm. artery aneurysm

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What is the bottom line in antibiotic administration perioperatively?

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The surgeon makes the decision.

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Components of propofol?

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1. contraindicated in patients with egg allergies.
2. formulated with egg lecithin and soybean oil.
3. often attributed to a diisopropyl side chain or phenol group.

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Most egg allergic people react to what?

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Egg albumin

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What is Diovan (Valsartan) used for?

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Bloop Pressure control

Renin-angiotensin system inhibitor

Same class as ACE inhibitor

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Use for Naproxen (Aleve)?

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Pain/inflammation

NSAID class

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Use for Novolin?

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Tx Diabetes

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Metformin (glucophage)

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Hypoglycemic drug

Dec. hepatic glucose production.

Inc. insulin action in muscle and fat.

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What doe the Sulfonylureas do?

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Stimulate insulin release from Beta cell of pancreas.

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Nimodipine class

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Calcium channel blocker

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What are the effects of Nimodipine?

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1. dec. BP
2. inc. coronary blood flow
3. delaying AV conduction
4. dec. HR

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What are the uses of Nimodipine?

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1. angina
2. cardiac dysrhythmias
3. heart disease and HTN

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Calcium channel blockers

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Decrease blood pressure

Control heart rate

Prevent cerebral vasospasm,

Reduce chest pain due to angina pectoris.

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Zocor

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Treat dyslipidemia (abnormal amount of lipids in blood)

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Indications for Nimodipine

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For improvement of neurological outcome.

For prevention of vasospasm after cerebral aneurysm coiling.

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Warnings for Vicodin

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Respiratory depression

Inc. ICP

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Colace

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Allows easier defecation

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Pepcid (famotidine)

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Histamine H2 receptor blocker

Inhibits gastric acid production

Treatment of acid reflux (GERD)

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Fasting blood glucose at what level is diagnostic of Type II DM?

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Greater 125 mg/dL

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What are some surgical concerns of DM?

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1. wound healing: granulocytic function and collagen synthesis are suppressed with glucose levels above 200 mg/dL

2. wound infection: prevalence of vascular and renal dz contributes to higher rate of infection.

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Perioperative goal for DM?

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1. prevention of ketoacidosis (hypoglycemia)

2. prevention of hyperglycemia

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Cases for diabetic pts should be done when?

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First case of the day if possible.

NOTE: glucose should be checked in pre-op if later in the AM or PM.

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If glucose level is < 50 mg/dL, then what must be done?

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Treat with 50% Dextrose, starting with 15ml bolus.

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How is DM monitored periop?

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1. Accu chek

2. Arterial or venous blood sample.

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Pathology of asthma

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Bronchoconstriction or spasm

Airway inflammation

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Tx for asthma?

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1. bronchodilator: beta 2 agonist (1-5 min onset and 2-6 hrs duration).

2. aerosol therapy

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Anti-inflammatory agents that can be used to treat asthma?

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Glucocorticoids (treats severe chronic asthma)

NOTE: steroids have a bronchial dilating effect.