Anaesthesia for Orthopaedic and Spinal Surgery Flashcards
what are the main anaesthesia considerations for elective orthopaedic surgery?
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
where should IV placement be considered if patients are reactive/fear aggressive?
saphenous
when may an epidural not be best even if indicated for the procedure?
requires bladder checks and intervention
risk of urine retention
if patient is fear aggressive this can be very difficult
what are the landmarks for femoral sciatic nerve blocks?
injection performed between cranial and middle third of a line connecting the greater trochanter and the ischiatic tuberosity
what are the main anaesthetic considerations for anaesthesia following traumatic fracture?
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?)
when assessing trauma patients what are you looking for?
external injuries
bladder damage
pneumothorax
internal bleeding
shock / decompensation
if intubation is likely to be complex what should be considered?
difficult airway box
pharyngeal intubation
adequate depth
suction
laryngeal exam prior to intubation
why may using methadone after buprenorphine not be as effective?
buprenorphine is mixed agonist / antagonist and so can block mu receptors to methadone as buprenorphine duration of action is longer
what is involved in pharyngostomy intubation?
need at least 3 people
one to manipulate head
one to manage tube
surgeon to ID location for incision
what indicates pneumothorax on xray?
heart elevated off sternum
small lung area
air in chest
what are the main anaesthesia considerations for MRI?
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
what affect can contrast administration have during MRI?
hypotension
lightening of anaesthesia
what should be done before contrast is administered?
check anaesthetic depth
what can happen if MRI magnet is quenched in an emergency?
helium may be released resulting in hypoxic environment
where will contrast be administered during myelography?
cisternal or lumbar punture
what must you be cautious about when flexing the neck for cisternal CSF puncture?
ET tube may kink
monitor capnography
what is a big risk associated with myelography?
seizures following contrast administration due to irritation
when are seizures following contrast administration for myelography seen?
following cisternal samples in recovery
how can seizures following contrast administration for myelography be avoided?
keep head elevated
how may spinal patients need to be positioned for intubation?
may not be sternal especially if cervical instability
lateral may be an option
what are the considerations regarding positioning for spinal surgery?
ventilation may be compromised if head down position needed or animal taped to the table
risk of ET tube kinking
nasal oedema
why is ventilation compromised if the patient is in a head down position?
abdominal contents pressing on diaphragm
what is the risk with nasal oedema?
if patients are obligate nasal breathers they may obstruct
how can nasal oedema be avoided?
ensure nose not lower than body
how can anaesthetic monitoring be made more difficult during spinal surgery?
access to head may be restricted
why is haemorrhage risk high in spinal surgery?
vessels not easy to ligate and can bleed quite severely
how may the surgery itself affect ventilation?
if it involves innervation to diaphragm e.g. C6-C7
why may twitching be seen during spinal surgery when patient is at adequate anaesthetic depth?
reflex twitching due to nerve stimulation by surgeon
how can reflex nerve twitches during spinal surgery be avoided?
NMBA
what can be the result of vagal stimulation during neck surgery?
bradycardia
what can cause bradycardia during neck surgery?
vagal stimulation
why is good analgesia for spinal surgery required?
risk of chronic pain
painful procedure
what should be checked before administering NSAIDs to spinal patients?
whether steroids have been given as contraindicated
what post op nursing of spinal patients is required?
pain
bladder management
