Anesthesia and Orthopedic surgery Flashcards
Which anesthesia technique is particularly suited for orthopedic surgery
Regional techniques
What are ortho patients most at risk for
DVT
Pulmonary emboli
Name the benefits of reginal anesthesia for ortho cases
Post op analgesia
Decreased postop N/V
Reduced blood loss/ risk of thromboembolism
Less respiratory and cardiac depression
Contraindications to regional anesthesia
P.I.C.I.S.S.S
Patient refusal Infection at site of needle insertion Coagulopathy Increased ICP Severe hypotension Stenosis-mitral valve Stenosis-aortic valve
*Document pre-existing veurologic deficits & neurologic examination
Things to consider when providing regional anesthetic in the outpatient setting
Choose LA with shortest DOA Patient must have full recovery of sensory/motor fx -stand upright and ambulate -urinate -no orthostatic hypotenstion *inform patient of risk of PDPH
Tourniquet pressure setting
100-150 mmHg above SBP for thigh cuffs
50-75 mmHg above SBP for arms
Tourniquet- safe duration of cuff inflation
No more than 2 consecutive hours
*Notify after 2 hours of inflation and every 15 minutes thereafter. Document!
List the complications with tourniquet
injury to vessels/nerves
tissue ischemia
Transient systemic metabolic acidosis/incr. CO2 upon deflation
what to expect when tourniquet released
10-15% increase in HR
5-10% increase in serum Potassium
Rise of PaCO2 1-8 mmHG
Decrease in MAP r/t vasodilaiton from incr. CO2
Fat embolus Syndrome is associated with what injuries
multiple traumatic injuries
surgery of the long bones
Risks of Fat embolus Syndrome increase with
being male age Hypovolemic shock intramedullary instrumentation bilateral total knee replacements RA
When do S/S of fat embolus syndrome occur
12-40 hours post-injury
What are the major diagnostic criteria of fat embolus syndrome
axillary/subconjunctival petechiae
Hypoxemia- Pa02 <60
CNS depression
pulmonary edema
Postop mortality r/t DVT is from what major cause
PE
the incidence of DVT is highest in which extremity group
lower
Insertion of methymethacrylate is associated with
sudden onset of hypotension lasting 5-7 minutes
hypotension r/t methylmethacrylate is attributed to
absorption of cement
embolization of air/bone marrow during femoral reaming
lysis of RBC/marrow induced by exothermic rxn
conversion of cement to metharcrylate acid
Do the following when you smell methylmethacrylate
Discontinue NO use
hydrate
maximize FI02
decrease depth of anesthesia
main considerations for an shoulder arthroscopy
Beach chair positioning * venous air embolism-any arm or shoulder case eye protection secure head to table ETT taped to contralateral side
Total hip arthroplasty condierations
anticipate large blood loss
lateral decubitus position-axillary roll
methylmethacrylate use
severe postop pain
Intramedullary nailing considerations
healthy adult due to trauma fluid management pain control consider regional technique blood replacement- artline montioring
orthopedic spinal case
positioning and padding with appropriate documentation
Neurological assessment before/after case
thorocotomy approach for thoracic spine-one lung ventilation
wake-up test may be done-need 40-60 min notification from surgeon
dural lacerations greatly increased
