Anaesthesia for Orthopaedic and Spinal Surgery

Question 1

what are the main anaesthesia considerations for elective orthopaedic surgery?

Answer 1

often otherwise healthy but still need thorough clinical exam
procedures are painful
long surgical time and pre/intra/post op imaging needed
positioning crucial to protect joints if OA
arthroscopy runs risk of animal becoming drenched

Question 2

where should IV placement be considered if patients are reactive/fear aggressive?

Answer 2

saphenous

Question 3

when may an epidural not be best even if indicated for the procedure?

Answer 3

requires bladder checks and intervention
risk of urine retention
if patient is fear aggressive this can be very difficult

Question 4

what are the landmarks for femoral sciatic nerve blocks?

Answer 4

injection performed between cranial and middle third of a line connecting the greater trochanter and the ischiatic tuberosity

Question 5

what are the main anaesthetic considerations for anaesthesia following traumatic fracture?

Answer 5

pain
blood loss and does it need to be corrected with IVFT or blood products
hydration status
other injuries due to trauma
pre-exisiting conditions
ease of intubation if jaw trauma
surgical access
extubation risks
post op needs (e.g. feeding tube?)

Question 6

when assessing trauma patients what are you looking for?

Answer 6

external injuries
bladder damage
pneumothorax
internal bleeding
shock / decompensation

Question 7

if intubation is likely to be complex what should be considered?

Answer 7

difficult airway box
pharyngeal intubation
adequate depth
suction
laryngeal exam prior to intubation

Question 8

why may using methadone after buprenorphine not be as effective?

Answer 8

buprenorphine is mixed agonist / antagonist and so can block mu receptors to methadone as buprenorphine duration of action is longer

Question 9

what is involved in pharyngostomy intubation?

Answer 9

need at least 3 people
one to manipulate head
one to manage tube
surgeon to ID location for incision

Question 10

what indicates pneumothorax on xray?

Answer 10

heart elevated off sternum
small lung area
air in chest

Question 11

what are the main anaesthesia considerations for MRI?

Answer 11

no metal objects to be taken into the scanner (on/in animal or staff, equipment)
distance monitoring
need specialist monitoring equipment
delayed sampling due to longer sample lines
noisy environment
cold

Question 12

what affect can contrast administration have during MRI?

Answer 12

hypotension
lightening of anaesthesia

Question 13

what should be done before contrast is administered?

Answer 13

check anaesthetic depth

Question 14

what can happen if MRI magnet is quenched in an emergency?

Answer 14

helium may be released resulting in hypoxic environment

Question 15

where will contrast be administered during myelography?

Answer 15

cisternal or lumbar punture

Question 16

what must you be cautious about when flexing the neck for cisternal CSF puncture?

Answer 16

ET tube may kink
monitor capnography

Question 17

what is a big risk associated with myelography?

Answer 17

seizures following contrast administration due to irritation

Question 18

when are seizures following contrast administration for myelography seen?

Answer 18

following cisternal samples in recovery

Question 19

how can seizures following contrast administration for myelography be avoided?

Answer 19

keep head elevated

Question 20

how may spinal patients need to be positioned for intubation?

Answer 20

may not be sternal especially if cervical instability
lateral may be an option

Question 21

what are the considerations regarding positioning for spinal surgery?

Answer 21

ventilation may be compromised if head down position needed or animal taped to the table
risk of ET tube kinking
nasal oedema

Question 22

why is ventilation compromised if the patient is in a head down position?

Answer 22

abdominal contents pressing on diaphragm

Question 23

what is the risk with nasal oedema?

Answer 23

if patients are obligate nasal breathers they may obstruct

Question 24

how can nasal oedema be avoided?

Answer 24

ensure nose not lower than body

Question 25

how can anaesthetic monitoring be made more difficult during spinal surgery?

Answer 25

access to head may be restricted

Question 26

why is haemorrhage risk high in spinal surgery?

Answer 26

vessels not easy to ligate and can bleed quite severely

Question 27

how may the surgery itself affect ventilation?

Answer 27

if it involves innervation to diaphragm e.g. C6-C7

Question 28

why may twitching be seen during spinal surgery when patient is at adequate anaesthetic depth?

Answer 28

reflex twitching due to nerve stimulation by surgeon

Question 29

how can reflex nerve twitches during spinal surgery be avoided?

Answer 29

NMBA

Question 30

what can be the result of vagal stimulation during neck surgery?

Answer 30

bradycardia

Question 31

what can cause bradycardia during neck surgery?

Answer 31

vagal stimulation

Question 32

why is good analgesia for spinal surgery required?

Answer 32

risk of chronic pain
painful procedure

Question 33

what should be checked before administering NSAIDs to spinal patients?

Answer 33

whether steroids have been given as contraindicated

Question 34

what post op nursing of spinal patients is required?

Answer 34

pain
bladder management