Anesthesia and Orthopedic surgery

Question 1

Which anesthesia technique is particularly suited for orthopedic surgery

Answer 1

Regional techniques

Question 2

What are ortho patients most at risk for

Answer 2

DVT

Pulmonary emboli

Question 3

Name the benefits of reginal anesthesia for ortho cases

Answer 3

Post op analgesia

Decreased postop N/V

Reduced blood loss/ risk of thromboembolism

Less respiratory and cardiac depression

Question 4

Contraindications to regional anesthesia

Answer 4

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

Question 5

Things to consider when providing regional anesthetic in the outpatient setting

Answer 5

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

Question 6

Tourniquet pressure setting

Answer 6

100-150 mmHg above SBP for thigh cuffs

50-75 mmHg above SBP for arms

Question 7

Tourniquet- safe duration of cuff inflation

Answer 7

No more than 2 consecutive hours

*Notify after 2 hours of inflation and every 15 minutes thereafter. Document!

Question 8

List the complications with tourniquet

Answer 8

injury to vessels/nerves

tissue ischemia

Transient systemic metabolic acidosis/incr. CO2 upon deflation

Question 9

what to expect when tourniquet released

Answer 9

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

Question 10

Fat embolus Syndrome is associated with what injuries

Answer 10

multiple traumatic injuries

surgery of the long bones

Question 11

Risks of Fat embolus Syndrome increase with

Answer 11

being male
age
Hypovolemic shock
intramedullary instrumentation
bilateral total knee replacements
RA

Question 12

When do S/S of fat embolus syndrome occur

Answer 12

12-40 hours post-injury

Question 13

What are the major diagnostic criteria of fat embolus syndrome

Answer 13

axillary/subconjunctival petechiae

Hypoxemia- Pa02 <60

CNS depression

pulmonary edema

Question 14

Postop mortality r/t DVT is from what major cause

Answer 14

PE

Question 15

the incidence of DVT is highest in which extremity group

Answer 15

lower

Question 16

Insertion of methymethacrylate is associated with

Answer 16

sudden onset of hypotension lasting 5-7 minutes

Question 17

hypotension r/t methylmethacrylate is attributed to

Answer 17

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

Question 18

Do the following when you smell methylmethacrylate

Answer 18

Discontinue NO use
hydrate
maximize FI02
decrease depth of anesthesia

Question 19

main considerations for an shoulder arthroscopy

Answer 19

Beach chair positioning
* venous air embolism-any arm or shoulder case
eye protection
secure head to table
ETT taped to contralateral side

Question 20

Total hip arthroplasty condierations

Answer 20

anticipate large blood loss
lateral decubitus position-axillary roll
methylmethacrylate use
severe postop pain

Question 21

Intramedullary nailing considerations

Answer 21

healthy adult due to trauma
fluid management
pain control
consider regional technique
blood replacement- artline montioring

Question 22

orthopedic spinal case

Answer 22

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