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

Blood Supply of Brain and Infarcts

Aphasia

Spinal Cord Lesions

Here are some mnemonics to remember spinal cord lesions. Hope they help!

Central Cord Lesion (syringomyelia)
First Lady Chiari went to Central Park with a cape and syringe.
First Lady Chiari-Chiari I
Central Park-Central Cord Syndrome
cape-cape-like distribution of loss of pain and temperature
syringe-syrinx

Anterior Horn Lesion (ALS)
Gehrig climbed a pyramid, blew on the ant hero's horn, and then looked up and down.
Gehrig-Lou Gehrig's (ALS)
ant hero's horn-anterior horn
pyramid-pyramidal tract
up and down-upper and lower motor neuron lesions

Posterior Column Syndrome
Lhermitte walked into the posterior column and lost his joint and reflex hammer. He got mad and started stomping.
Lhermitte-Lhermitte's sign
posterior column-posterior column syndrome
lost joint-loss of joint sensation
lost reflex hammer-areflexia
stomping-"stomping gait" because of loss of proprioception
(One type is Tabes Doralis which is seen after a syphilis infection, has a positive Romberg test, and Argyll Robertson pupil.)

Posterolateral Column Lesion (SCD)
If you don't have B12 and copper, or use too much NO, the posterolateral column will be too weak to balance. If you hold it in place all the time, your fingers will get tingly and pale.
don't have B12 or copper-B12 and copper
too much NO-exposure to nitric oxide
posterolateral column-posterolateral column lesion
too weak to balance-weakness and loss of balance
tingly-abnormal sensation like tingliness
pale-pernicious anemia

Causes of Hemicord Lesion
Ms. Varicella pressed down on half the cord and then pierced it halfway.
Ms.-MS or multiple sclerosis
Varicella-varicella zoster
pressed down on half the cord-asymmetric compression
pierced it halfway-penetrating trauma
mentioned half alot-hemicord lesion

Special thanks to Aditi!