Myelopathy to Myopathy

Anesthesia

General IV

Lipophilic

GABA receptor

Local Anesthesia 

Bind to Na+ channels during refractory period

High firing nerves more susceptible 

Weak bases

Ionized once inside cell so it can bind to receptor

Pain-->temperature-->touch-->pressure

Adverse effects: cardiotoxicity and seizures 

Epinephrine can be used as "adjunctive" to prolong the effects of other local anesthesia 

Myelin Diseases

Multiple Sclerosis
-chronic, autoimmune demyelinating disease
-immune response activates macrophages and their proteins
-neuro deficits separated in time
-white matter lesions
-MRI
-Uhthoff's sign
-Lhermitte's sign
-acute: mononuclear inflammatory cells, myelin breakdown, little astrogliosis, decrease in oligodendroglia, larger paler astrocytic nuclei
-chronic: decrease in inflammatory cells, complete demyelination and axonal loss, severe astrogliosis
-CSF: increased IgG, increased mononuclear cells, oligoclonal bands

Guillain-Barre Syndrome
-autoimmune demyelinating neuropathy
-ascending paralysis
-preceded by acute infection
-inflammation and demyelination
-loss of DTR
-decreased conduction velocity
-increased CSF protein

Leukodystrophies
-abnormal formation of stability of myelin
-progressive loss of cerebral function
-lysosomal or peroxisomal enzyme defects
1. Metachromatic Leukodystrophy
-defect in arylsulfatase-A --> accumulation of sulfatides
-lossof myelin and gliosis
-metachromasia
2. Krabbe's Disease (Globoid Cell Leukodystrophy)
-deficiency of galactocerebroside b-galactosidase --> galactosphingosine
-loss of myelin and oligodendrocytes
-globoid cells around blood vessels
3. Adrenoleukodystrophy
-mutation in ALD gene
-lack of catabolism of very long chain fatty acids
-elevated VLCFA in serum
-loss of myelin
-gliosis
-lymphocytic inflammation
4. Progressive Multifocal Leukoencephalopathy
-JC polyomavirus infects oligodendrocytes --> demyelination
-viral inclusions in nuclei
-foamy macrophages
-astrogliosis

Neuromuscular Nicotinic Receptor Blockers

Succinylcholine

• Metabolized by plasma cholinesterase
• Apnea
• Hyperthermia
• Bradycardia
• Histamine

Benzylisoquinoline

• Non-hepatic metabolism 

1. Atracurium

• Laudanosine accumulates and causes seizures

2. Cisatracurium

• Cis isomer
• Does not accumulate

Aminosteriods

• Hepatic and renal metabolism 

1. Pancuronium/Doxacurium/Pipecuronium

• Difficult to achieve reversal

2. Rocuronium

• Less potent so anesthesia for intubation
• Hypersensitivity

OMM Techniques

Muscle Energy

• active direct
• golgi tendon organ
• position patient into the barriers
• patient moves to freedom for 3 seconds (isometric)
• 3 sets
• reposition and move further into barrier
• passive stretch at end

Counterstrain

• passive
• spindle fibers
• decrease pain at tenderpoints
• hold for 90 seconds

Facilitated Myofascial Release

• decrease myofascial restriction

Facilitated Positional Release

• passive indirect
• muscle spindle
• decrease muscle spasm
• neutralize, compress, move to freedom for 3 to 5 seconds
• 1 set