Anaesthesia for Orthopaedic/Spinal Surgery

Question 1

What considerations should we have for elective orthopaedic procedures?

Answer 1

Otherwise healthy patient - but careful exam needed to ensure good ASA grade
Painful procedures
Long procedures, imaging before/after
Careful positioning as may have OA of other joints
Arthroscopy leads to wet/cold

Question 2

What analgesia can we use for orthopaedic surgeries?

Answer 2

Opioid premed, top up before recovery
Epidural (morphine)
Nerve blocks e.g. femoral and sciatic nerve block
Ring blocks/splash blocks
NSAIDs to continue at home

Question 3

How many people are needed for pharyngostomy intubation?

Answer 3

At least 3
1 for positioning tube
1 (surgeon) to identify cut placement
1 for manipulating head into correct position

Question 4

What anaesthetic considerations should we have during MRIs?

Answer 4

No metal objects!
Standard monitoring equipment not suitable e.g. very long capnography tube delaying readings
Noisy environment
Cold, air-conditioned
Contrast (gadolinium) admin can result in hypotension and lightening of depth of anaesthesia

Question 5

What considerations should we have for anaesthesia for myelography?

Answer 5

Cisternal/lumbar puncture
Care re flexing neck
Risk of seizures - most common after cisternal myelography, usually during recovery, keep head elevated

Question 6

What considerations should we have for anaesthesia for spinal surgery?

Answer 6

Positioning for intubation esp. with cervical instability
Positioning for surgery - compromised ventilation, kinking of ET tube, nasal oedema
Access to head for monitoring may be restricted
Potential for haemorrhage
Reflex twitches during direct nerve stimulation
Vagal stimulation during neck surgery - bradycardia
Good analgesia required - may have received steroids so consider with NSAIDs