Anaesthesia for ortho and spinal surgery

Question 1

Why might a patient underrgoing athroscopy become hypothermic?

Answer 1

saline flush is used as irrigation and the patient could get wet

Question 2

What are the considerations for electrive orthopaedic surgery?

Answer 2

• pain
• surgery can take a long time
• imaging may be required
• positioning, patients could have arthritis

Question 3

What are the landmarks for doing a femoral and sciatic nerve block?

Answer 3

sciatic nerve
- wing of ileum, ishiatic tuberosity

Question 4

Does the femoral and sciatic nerve block affect bladder?

Answer 4

no

Question 5

What are the considerations for an RTA cat with a fractured mandible on fluids?

Answer 5

• intibation potentially difficult if fractured mandible
• painful
• feeding tube post GA
• equipment for re-intubation in recovery
• equipment to break wire if jaw wired shut
• imaging
• hydration
• bloods
• bladder function

Question 6

What are the anaesthetic considerations for the RTA cat with a fractured mandible?

Answer 6

• intubation - possible debris in pharyn
• surgical access - pharyngostomy intubation, difficulty monitoring anaesthesia
• extubation - possible debris in pharynx, equipment for re-intubation
• nutrition and fluid therapy post op

Question 7

What is important to do to ensure a pharyngostomy intubation is successful?

Answer 7

radiographs

Question 8

What should you check with your monitoring equipment before going into MRI?

Answer 8

that it doesn’t contain metal, including anaesthetic and monitoring equipment, metal in or on the animal or staff

Question 9

What can contrast (gadolinium) result in?

Answer 9

hypotension and lightening of anaesthesia

Question 10

What happens if the magnet in the MRI becomes quenched in an emergency?

Answer 10

helium released can result in a hypoxic environment

Question 11

What are the considerations for monitoring GA for MRI?

Answer 11

• air-conditioned environemnt - patient could get cold
• no direct monitoring, difficult to check depth of anaesthesia such as reflexes
• cannot go inside with the MRI is on

Question 12

What types of myelography are there?

Answer 12

cisternal and lumbar puncture

Question 13

What are the risks with cisternal myelography?

Answer 13

seizures

Question 14

What is important to do when performing either myelography?

Answer 14

keep the head elevated and care when flexing the neck

Question 15

What was myelography used for?

Answer 15

diagnosing neurlogical disorders before MRI

Question 16

What should you take care doing with a patient in for spinal surgery?

Answer 16

positioning for intubation particularly if there is cervical instability

Question 17

What are the considerations for positioning the patient for spinal surgery?

Answer 17

• ventilation may be compromised if head down position required
• make sure endotracheal tube isn’t kinked
• nasal oedema pssible if nose is lower than the body

Question 18

What species recovery can be affected if they have nasal oedema?

Answer 18

rabbits as they are obligate nasal breathers

Question 19

What are the risks wit hanaesthesia for spinal surgery?

Answer 19

• haemorrhage
• veniltation problems due to head down and innervation to the diaphragm
• reflex twitches during direct nerve stimulation
• vagal stimulation during neck surgery - bradycardia
  -pain
• intensive post op nursing