ANESTHESIA STUDENT

  Signs and symptoms: Headache  Vomiting  Papilloedema Unilateral or bilateral pupillary dilatation  Cranial nerve II or VI palsy  Drowsiness or loss of consciousness Absent brain stem reflex Pupillary light reflex Corneal reflex Gag reflex Cough reflex Oculocephalic reflex Oculovestibular reflex  Abnormal respiration  Arterial hypertension  Bradycardia  Radiological signs: Mass Hydrocephalus  Cerebral edema  Midline shift  Obliteration of CSF cisterns Effacement of ventricles and cortical sulci 

  Characteristics of acute flaccid paralysis: Ascending paralysis  Bilateral symmetrical  Usually starts from lower limb  Cranial nerves (brain stem) Glossopharyngeal and vagus nerve - difficulty in swallowing CN III, IV, VI - eye muscle  CN VII - bilateral facial  Respiratory muscle, Phrenic nerve (diaphragm) may also be affected  Areflexia Atonia

Acute flaccid paralysis in a lower motor neuron lesion which occurs over a period of 15 days. Aetiologies of acute flaccid paralysis are divided according to anatomical site:  Spinal cord:  Acute transverse myelitis  Ascending myelitis  Anterior horn cell:  Poliomyelitis  GBS Nerve: Acute porphyria  Arsenic poisoning  Neuromuscular junction: Myasthenia gravis  Hypermagnesemia  Snake venom  Organophosphate  Botulism  Muscle: Hypokalaemia Periodic paralysis  Viral myositis   Polymyositis Clinical features of acute flaccid paralysis

  Absolute contraindications:  Patient refusal  Infection at the site of injection  Drug allergy  Coagulopathy and thrombocytopenia  Severe hypovolemia  Increased intracranial pressure (ICP) Relative contraindications:  Sepsis  Stenotic valvular heart disease  Left ventricular outflow tract obstruction (hypertrophic obstructive cardiomyopathy or fixed cardiac output state) Uncooperative patient  Preexisting neurological deficit  Indeterminate neurological disease  Demyelinating lesions (multiple sclerosis)  Severe spinal deformity  Controversial: Previous back surgery at the site of injection  Complicated surgery  Prolong surgery  Major blood loss  Maneuver that compromise respiration  Source:  Morgan & Mikhail's Clinical Anesthesiology, 6e Nysora