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Anesthesia Principles 2 (Broadbent) > Anesthesia for Ortho > Flashcards

Anesthesia for Ortho Flashcards

1
Q

Mixing polymerized mma powder with liquid mma monomer causes

A

polymerization and cross linking of polymer chains

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2
Q

________ reaction ultimately resulting in hardening.

A

Exothermic

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3
Q

Heat, expansion and hardening lead to ________ (> ______ mmHg).

A

-intermedullary hypertension
->500 mmHg

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4
Q

Residual mma monomer produces ______ and ______ SVR

A

vasodilation, decreases

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5
Q

_____________release may cause platelet aggregation, microthrombus (lungs) and CV instability

A

Tissue thromboplastin

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6
Q

Bone Cement Implantation Syndrome

A

-Hypoxia (increased pulmonary shunt)
-Hypotension
-Dysrhythmias (heart block and sinus arrest)
-Pulmonary htn (increased PVR)
-Decreased Cardiac Output
-Embolization most frequent during prosthetic insertion

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7
Q

Embolization most frequent during _______ ________.

A

prosthetic insertion

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8
Q

Surgical methods to minimize effects of MMA

A

-venting distal femur
-high pressure lavage of femoral shaft

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9
Q

Strategies to minimize effects of MMA

A

-Increase inspired O2 prior to mma
-Maintain euvolemia
-Vasopressor as needed

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10
Q

_______ ________ is associated with the highest risk of BCIS.

A

Hip arthroplasty

-others include knee, vertebra, and kyphoplasty

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11
Q

In the awake patient undergoing regional anesthesia, the first signs of BCIS are usually _______ and _______.

A

dyspnea and altered mental state

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12
Q

Under GA, the first sign of BCIS is a _______ _________.

A

Decrease EtCO2

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13
Q

First line treatment of BCIS includes…….(3)

A

100% FiO2
IV fluids
phenylephrine

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14
Q

Problems associated with Pneumatic Tourniquets

A

-Hemodynamic changes
-Pain
-Metabolic changes
-Arterial thromboembolism & -Pulmonary embolism
-Muscle and nerve injury
-Limb cooling

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15
Q

Cells _____ to pneumatic tourniquet shift to _______ metabolism, and ________ by products accumulate as long as tourniquet is inflated.

A

-distal
-anaerobic
-metabolic

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16
Q

Inflation pressure for upper extremity surgery:

A

70-90 mmHg above SBP

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17
Q

Inflation pressure for lower extremity surgery:

A

2x over SBP

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18
Q

2 ways that Tourniquet release stresses the body:

A
  1. restoring blood flow to extremity produces a relative decrease in circulating blood volume.
  2. The products of cellular hypoxia enter the systemic circulation.
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19
Q

Releasing the tourniquet produces transient changes that include:

A

-increased EtCO2
-Decreased core body temperature
-Decreased blood pressure
-Decreased SvO2
-Metabolic acidosis

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20
Q

Tourniquet pain usually begins at _____ after inflation.

A

45-60 minutes

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21
Q

_______ ________ is the most likely cause of tourniquet pain.

A

Tissue ischemia

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22
Q

Tourniquet pain is transmitted by _____ ______.

A

C fibers (slow pain)

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23
Q

Pain is _______ to analgesics.

A

Unresponsive

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24
Q

Under GA tourniquet pain manifests as ______ and _____. Consider _______ for the patient with CAD.

A

-hypertension and tachycardia
-esmolol

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25
Q

Cuff deflation drops _____ , _____, and _____.

A

CVP, MAP, and Pain

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26
Q

Cuff deflation: _____ increases and core temp ______

A

HR, decreases

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27
Q

Tourniquet pain is less common is _______ anesthesia vs _______.

A

Regional vs General

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28
Q

Metabolic waste products accumulate in tissue. Cuff deflation is rapid wash out of same: Increase _____,_______, _______ and _______.

A

Increased PaCO2, ETCO2, serum lactate and potassium

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29
Q

Tourniquet is contraindicated in ______ ______.

A

calcified arteries

30
Q

Prolonged inflation = > ___ hours.
Causes:

A

2 hours
transient muscle injury
permanent nerve injury
rhabdo

31
Q

Triad of Fat Emboli Syndrome:

A

dyspnea, confusion, petechiae

(usually w/ in 72 hours of long bone Fx)

32
Q

FES can happen from ____,____ and _____ as well

A

CPR, liposuction, IV lipids

33
Q

FES diagnosis

A

-petechiae of chest, upper extremities, axillae and conjuctivae

CXR = ARDS

34
Q

FES: fat globules in _____,_____and _____.

A

retina, urine, sputum

35
Q

FES: Under GA see decline in ______ and _____ and a rise in ______

A

decline - ETCO2 and SPO2

rise- PAP

36
Q

DVT and PE major source:

A

M&M post pelvic and lower extremity surgery

37
Q

Risk factors of DVT and PE:

A

age > 60yr, obesity, tourniquet, procedures >30 min, lower extremity fx, and immobilzation > 4 days

Highest risk are in knee and hip replacements

38
Q

What decreases risk of both DVT and PE?

A

Neuraxial Anesthesia

39
Q

DVT and PE pathogenesis:

A

venous stasis and hypercoaguability from inflammation

40
Q

Neuraxial Anesthesia reduces DVT and PE in what ways:

A

-Sympathectomy induced increases in venous blood flow
-Antiinflammatory effects of local anesthesia
-Decreased platelet activity
-Decreased rise in factor VIII and Von -Willebrand factor
Less fall in antithrombin III
-Less stress hormone release

41
Q

Hallmarks of hematoma are _____ _____ and_______ _______ weakness.

A

back pain, lower extremity

42
Q

Joint manipulation type of drugs:

A

IV agents with short duration (Propofol)

43
Q

JM: General preferred to regional because:

A

-LMA/ mask/ett
-Profound relaxation allows surgeon to distinguish anatomical limitations from patient guarding
-Muscle relaxant, succ or roc may be needed

44
Q

Hip fracture mortality ___% during initial hospitalization and ___% for first year

A

10%
25%

45
Q

Reasons to delay Hip fx surgery

A

-coagulopathy
-uncompensated HF

46
Q

Hip fx: Blood?

A

Blood in the room because you cant put a tourniquet on a hip

47
Q

Hip Fx: Predictors of peri-op mortality

A

Age >85 yrs
H/o cancer
Baseline/pre-op alteration in neuro status
Post-op chest infection
Post-op wound infection

48
Q

Hidden blood loss:

A

Large amounts of blood can be sequestered around fracture

49
Q

Blood loss from greatest to least from hip fracture

A

subtrochanteric,intertrochanteric > base of femoral neck > transcervical, subcapital

50
Q

Hip Fx: Bigger fracture?

A

Consider arterial line and large bore iv for transfusion, hemodynamic monitoring

Use short acting drugs
Use lower solubility agents
Minimize postop cognitive impairmen

51
Q

Benefits of arthroscopy

A

Less ebl
Less post-op pain
Less rehab time

52
Q

Nerve injury from Traction table

A

Pudendal Nerve

53
Q

LMA for which arthroscopic surgeries?

A

knees, wrists

54
Q

Which arthroscopic surgery requires an ETT?

A

shoulder

55
Q

Position for THA

A

lateral decubitus

56
Q

Embolic event most frequent at insertion of ________ _________.

A

femoral component

57
Q

Highest rate of DVT for all ortho procedures

A

Total Knee Arthroplasty

58
Q

Nerve block for upper extremity surgery

A

Interscalene block of brachial plexus helpful.
Done preop, very good 80% of time.

59
Q

Anesthesia considerations for Re-implantations:

A

Careful attention to positioning
Maintain body temp!!!
Regulation of fluids
Maintenance of blood flow
Optimal HCT 28-30%
Keep warm
Avoid vasoconstrictors
Dextran or heparin infusion intraop

60
Q

Most common cause of toxic plasma concentration of local is….

A

inadvertent intravascular injection during regional anesthesia

61
Q

Most frequent symptom of LAST is…..
What is the exception?

A

Seizure

Bupi is the exception
-cardiac arrest occurs before seizure

62
Q

LAST is more common with __________ than with ________ anesthesia

A

peripheral nerve blocks, epidural

63
Q

Highest risk for LAST?

A

Bier Block

64
Q

How long to leave tourniquet inflated for bier block.

A

20 minutes

65
Q

_______ and _____ will worsen the symptoms of LAST.

A

Hypoxia and Acidosis

66
Q

Difficulty of cardiac resuscitation (Locals)

A

Bupivacaine > Levobupivacaine > Ropivacaine > Lidocaine

67
Q

The risk of bupivacaine toxicity is increased with _____, _____, ______, and ______

A

-pregnancy
-beta-blockers
-calcium channel blockers
-digitalis

68
Q

If Epi used for LAST, keep dose below ___ mcg/kg

A

1 mcg/kg

69
Q

Ultimate treatment for LAST Is _______

A

lipids!

70
Q

Lipid emulsion dose for patient over 70kg:

A

Bolus= 100ml over 2-3 minutes

Infusion= 250 ml over 15-20 minutes

if remains unstable repeat bolus and/or double infusion rate

71
Q

Lipid emulsion dose for patient under 70kg:

A

Bolus= 1.5 mk/kg of lean body weight over 2-3 mins

Infusion= 0.25 ml/kg/min

if remains unstable repeat bolus and/or double infusion rate

max dose is 12ml/kg

Anesthesia Principles 2 (Broadbent) (4 decks)

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