Anesthesia for orthopedic surgery
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| show | Improved post op analgesia, decreased PONV, Less respiratory depression, decreased blood loss, decreased risk thromboembolism,
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| Contraindications to regional anesthesia include? | show 🗑
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| Scolosis consists of what type of deformity? | show 🗑
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| show | Cobb angle: Surgical correction formed for angles greater than 50 degrees.
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| show | Impaired development of pulmonary vasculature, pulmonary HTN
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| show | Decreased compliance, decreased ventilatory response to CO2 can lead to arterial hypoxemia and hypercapnia causing respiratory failure.
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| Scoliosis of spine and rib cage deformity lead to what pulmonary conditions? | show 🗑
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| show | PHTN
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| show | Posterior approach done in prone positing, carefully pad pressure points. Anterior approach done in lateral positioning.
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| show | Cervical ROM, neurological symptoms during flexion, extension, rotation.
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| show | prone
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| show | Supine
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| Thorocolumbar laminectomy positioning? | show 🗑
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| show | Paraplegia feared, wake up test, neurphysiologic monitoring: SSEP MEP electromyography
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| show | Proper positioning, use of intra-op blood salvage, induced hypotension, intra-op hemodilution, antifibrinolytics.
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| Visual loss risk factors from spinal surgery? | show 🗑
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| Diagnosis of visual loss post spinal surgery includes? | show 🗑
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| Shoulder/Upper arm surgery stretch injuries from excessive rotation/flexion include? | show 🗑
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| show | "Beach chair"
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| show | Hypotension, bradycardia. This can be decreased by gradual positioning to beach chair, hydration, and atropine if necessary.
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| show | A tourniquet cannot be used because significant blood loss can occur
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| show | Interscaline supraclavicular block, a combined regional general. Toradol should also be considered to reduce opiod requirements.
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| Most reliable block for elbow surgery? | show 🗑
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| show | Median, ulnar, radial, musculocutaneous
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| show | Pneumothorax
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| show | Carpral tunnel release
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| show | Double tourniquet, more extensive surgery, no postoperative analgesia
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| Pre-existing medical conditions common with a hip surgery include? | show 🗑
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| Hip position for total hip surgery? | show 🗑
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| Advantages of fracture table for femur fractures? | show 🗑
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| Hip fracture complications pre-op? | show 🗑
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| Pre-op hypoxia for pt's undergoing hip surgery may be due to what conditions? | show 🗑
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| show | Central neuraxial blockade
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| Spinal considerations for hip surgery/position? | show 🗑
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| Complications with spinal? | show 🗑
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| What fracture is associated with the most blood loss? | show 🗑
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| What fracture is associated with the least blood loss | show 🗑
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| Deliberate Hypotension with GA can do what to blood loss? | show 🗑
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| What can be used to induce hypotension to decrease surgical blood loss? | show 🗑
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| Complications associated with total hip arthroplasty? | show 🗑
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| Treatment for venous thromboembolism following total hip? | show 🗑
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| Minimally invasive arthroplasty benefits? | show 🗑
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| show | Spinal/epidural/propofol infusion. LMA most often used. Epidural catheter withdrawn at end of case.
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| Knee arthroscopy positioning/anesthesia considerations? | show 🗑
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| Total knee arthroplasty complications? | show 🗑
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| Considerations for using a tourniquet for a total knee arthroplasty? | show 🗑
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| Total knee regional anesthesia considerations? | show 🗑
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| show | Higher block than is needed.
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| What type of regional anesthesia is considered for a total knee? | show 🗑
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| show | Lumbar plexus block combined with sciatic block reduces opiod requirements/side effects. Pt can be DC home with indwelling femoral catheter to provide analgesia for up to 48 hours.
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| show | Regional anesthesia advantageous over GA.
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| show | Femoral nerver and sciatic nerve
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| More advantages of regional anesthesia for ankle block? | show 🗑
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| Disadvantages of ankle block? | show 🗑
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| show | Lower pain scores, better knee flexion/improved joint mobility, faster ambulation, shorter hospital stays.
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| show | Reattachment of a completely severed body part, revascularization to reestablish blood flow through a severed body part.
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| Anesthesia management for microvascular surgery? | show 🗑
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| show | Long cases pt must lie completely still
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| Replacement of blood/fluid loss for microvascular surgery? | show 🗑
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| How to improve blood flow through anastomoses during microvascular surgery? | show 🗑
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| Determinants of microvascular perfusion pressure? | show 🗑
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| show | Phenylephrine
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| Drugs used in microvascular surgery to preserve blood flow anastomoses? | show 🗑
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| Things to avoid during microvascular surgery? | show 🗑
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| Prior to inflation of tourniquet what needs to be done? | show 🗑
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| show | Tournequet ischemia, this can be prevented by proper cuff size/inflation pressure
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| Adequate tourniquet pressures? | show 🗑
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| show | time range 30 min to 4 hours
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| Inflation greater than 2 hours needs? What are the dangers of greater than 2 hours? | show 🗑
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| The tourniquet can cause damage to? | show 🗑
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| Deflation of a tourniquet can cause what complications? | show 🗑
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| show | Aching pain, dull, restless
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| show | A delta/C fibers (AC for air conditioning) HA HA HA! 45 minutes it take for pain to appear
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| Tx for tourniquet pain? | show 🗑
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| show | Multiple traumatic injuries/surgery involving long bones.
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| Risk factors of fat embolus? | show 🗑
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| show | Occurs 12-72 hours after injury, classic triad is dyspnea, confusion, peteciae. Decreased arterial o2 is most consistent abnormal lab value.
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| Other triggering factors to fet embolism include? | show 🗑
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| show | Early recognition, reversal of aggravating factors-hypovolemia, early surgical stabilization of fracture sites, aggressive respiratory support, corticosteroid therapy may be beneficial for cerebral edema.
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| Diagnosis of fat embolus syndrome includes 1 of the following major symptoms. | show 🗑
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| show | Tachycardia
Hyperthermia
Retinal fat emboli
urinary fat gobbles
Decreased PLT/HCT
Increased ESR
Fat globules in sputum
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| What is methyl methacrylate? | show 🗑
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| Side effects of methyl methacrylate? | show 🗑
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| What causes the side effects of methyl methacrylate? | show 🗑
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| Clinical manifestations of methyl methacrylate? | show 🗑
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| show | Adequate hydration, maximizing inspired o2 concentration minimizes hypotension/hypoxemia that can accompany cement prosthesis. Discontinue N20 several minutes before cementing occurs bc air can be trapped during this procedure.
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| show | Cementless prostheses generally last longer and may be advantageous for younger active patients. Cementless implants are for healthy active bone formations.
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| Cement recommended for older pt's? | show 🗑
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| Risk factors for DVT and Thromboembolism? | show 🗑
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| show | Hip surgery and knee construction pt's
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| Multiple factors for DVT and thromboembolism? | show 🗑
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| show | Low dose heparin
IPC
Warfarin
LMWH
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| show | Several hours after surgery to decrease intraop bleeding
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| How can you reduce thromboembolic complications? | show 🗑
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| What are the benefits of lidocaine for Antithrombotic prophylaxis? | show 🗑
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| When is it not safe to provide neuraxial anesthesia? | show 🗑
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| show | Risk of neurologic compromise from expanding spinal hematoma
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