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Chapter 25 Rare and Coexisting Diseases
Stephen F. Dierdorf J. Scott Walton
Key Points
The cytoskeleton of the muscle membrane in patients with muscular dystrophy is abnormal and is susceptible to damage from succinylcholine. Massive release of intracellular contents, including potassium, may occur.
Myotonic dystrophy produces cardiac conduction delay that can manifest as high-grade atrioventricular block.
Patients with myasthenia gravis are exquisitely sensitive to nondepolarizing muscle relaxants. Short-acting muscle relaxants and objective monitoring of neuromuscular function are indicated.
Many types of cancer, in addition to small cell lung carcinoma, can produce myasthenic syndrome.
Patients with multiple sclerosis should be advised that an exacerbation of their neurologic symptoms may occur during the perioperative period.
Repeated episodes of sickling in patients with sickle cell disease cause pulmonary hypertension. Pulmonary hypertension in sickle cell patients is associated with increased mortality.
Rheumatoid arthritis is a multisystem disease that causes subclinical cardiac and pulmonary dysfunction.
Many patients with rheumatoid arthritis have significant degeneration of the cervical spine with few neurologic symptoms. Cervical manipulation during laryngoscopy and intubation requires special precautions.
Esophageal dysfunction in patients with scleroderma or dermatomyositis increases the risk of aspiration pneumonitis.
Patients with epidermolysis bullosa can have undiagnosed dilated cardiomyopathy.
第25章 罕见疾病及合并疾病患者的麻醉
要点
肌营养不良患者肌膜细胞骨架异常,易受琥珀胆碱的破坏,琥珀胆碱可导致细胞内容物(包括钾)大量释放出来。
肌强直性营养不良可导致心脏传导延迟,表现为高度房室传导阻滞。
重症肌无力患者对非去极化肌松药相当敏感,应使用短效肌松药,并客观监测神经肌肉功能。
除小细胞肺癌外,很多癌症都可引起肌无力综合征。
应告知多发性硬化患者,围手术期神经症状会加重。
镰状细胞病患者反复镰状化会导致肺动脉高压,如果合并肺动脉高压,死亡率会增加。
类风湿关节炎是一个多系统疾病,可造成亚临床心功能不全和肺功能不全。
很多类风湿关节炎患者颈椎有明显变性,但几乎没有神经症状。在颈部进行喉镜操作和气管插管时要特别小心。
硬皮病或皮肌炎患者的食道功能不全会增加吸入性肺炎的风险。
大疱性表皮松解症患者可能有未诊断的扩张性心肌病。
出处:Clinical Anesthesia (6th edition) |
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