Anaesthesia for orthopaedic and spinal cases Flashcards
What are the two types of patients that may undergo spinal/ortho anaesthesia?
Healthy elective procedure
Unstable poly-traumatised undergoing emergency surgery
Young congenital defects
What conditions must we consider in a trauma patient?
Bladder rupture Ruptured diaphragm Blood loss Cardiac contusions Pneumothorax Cerebral, spinal and peripheral nerve damage Always stabilise patient before surgery
What must we consider in young patients undergoing anaesthesia?
High metabolism, high oxygen consumption Small (hypothermia) Limited glycogen store Incomplete blood brain barrier Immature renal and hepatic clearance of drugs Incomplete cardiovascular reflexes
What type of procedures are involved in orthopaedic and spinal surgery?
Minimal to maximal invasive Fracture repair Arthroscopy CCL repair Spinal chord decompression
What analgesia apporach should be considered for an orthopaedic and spinal patient?
Very painful procedures
Multiomodal approach
NSAIDS opioids alpha 2 agonists ketamine local regional techniques
What loco-regional techniques can be preformed for a orthopaedic and spinal patient?
Brachial plexus Femoral and sciatic nerve block Radial Ulnar Median Musculocutaneous block Epidural/spinal injections Intra-articulate injections
How is a Brachial plexus block preformed?
Provides analgesia to the front limb
C6 C7 C8 T1 are blocked via paravertebral approach, nerves are blocked where they leave the spinal column
Cranial to and under the scapula
Axillary approach
Nerves are blocked from the medial humerus and scapula at the level of the shoulder joint (block from mid humerus down)
What are the complications associated with a brachial plexus block?
Phrenic nerve and subsequent diaphragm paralysis
Puncture of the large vessels
Pneumothorax
Permanent nerve damage
How is a RUMM block preformed?
Radius ulna median musculocutaneous block
Just proximal to the elbow joint
Analgesia to the front limb distal to the elbow
Avoids risks in brachial block
Surgery on toes, radial, ulnar, nerve can also be blocked at the dorsal and palmer carpus
How is the femoral and sciatic nerve block preformed?
Femoral nerve (L4-L5 Sciatic nerve (L6-S1) Blocks hindlimb including the stifle joint and down
How is an epidural block preformed?
Above the stifle requires blocking
Spinal nerves and spinal chord itself are blocked at the central axis
Strong analgesic or local anaesthetic
Either in the epidural or subarachnoid space
What are the complications with the and epidural spinal block?
Spinal chord damage
Unrinary retention
Temporary hind limb paralysis
Hypotensive shock
How are intra-articular injections preformed?
Local anaesthetic or opiod is injected directly into the joint
Blocks tissue within and surrounding the joint
Useful in pain prevention and relief
What are the risks associated with intra-articulate injections?
Septic arthritis
What are the common complications with loco-blocks?
Large vessel puncture
Nerve damage
What are the two techniques used to locate nerves?
Ultrasound
Electro-location using nerve stimulator
What techniques are used in large animals?
Non that use local anaesthetics as they paralyse the limb only strong analgesia is used
What is a sufficient fluid rate during surgery?
5ml/kg/hr
Why is intravenous access necessary and what should be considered when placing an IV?
Haemorrhage can happen during these surgeries
Iv must be placed in the limb not undergoing surgery
Jugular for horses
Why is it important to consider joint positioning?
If a patient has degenerative joint disease it could be aggregated post-op adding to a patients. Appropriate bedding!
Horses very important to reduce myopathy and neuropathy
Cope better when in lateral recumbency
Why may thermoregulation be compromised in an orthopaedic or spinal patient?
Fluids are used to flush wounds and joints
Require post-operative imaging on a cold table!
What other drugs may be required for the orthopaedic surgery?
NMB agents
Must be ventilated
Adequate monitoring
What are the specific risks of orthopaedic and spinal surgery?
Haemorrhage
Pneumothorax
Impaired ventilation (high cervical spinal chord)
What is important to monitor in recovery?
Breathing if been blocked
Non exciting recovery soft bedding may require further sedation
