Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

________ reaction ultimately resulting in hardening.

A

Exothermic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

-intermedullary hypertension
->500 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Residual mma monomer produces ______ and ______ SVR

A

vasodilation, decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

Tissue thromboplastin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Embolization most frequent during _______ ________.

A

prosthetic insertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Surgical methods to minimize effects of MMA

A

-venting distal femur
-high pressure lavage of femoral shaft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Strategies to minimize effects of MMA

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

_______ ________ is associated with the highest risk of BCIS.

A

Hip arthroplasty

-others include knee, vertebra, and kyphoplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

dyspnea and altered mental state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

Decrease EtCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

100% FiO2
IV fluids
phenylephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Problems associated with Pneumatic Tourniquets

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

A

-distal
-anaerobic
-metabolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Inflation pressure for upper extremity surgery:

A

70-90 mmHg above SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Inflation pressure for lower extremity surgery:

A

2x over SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Releasing the tourniquet produces transient changes that include:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tourniquet pain usually begins at _____ after inflation.

A

45-60 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

_______ ________ is the most likely cause of tourniquet pain.

A

Tissue ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Tourniquet pain is transmitted by _____ ______.

A

C fibers (slow pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pain is _______ to analgesics.

A

Unresponsive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

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

A

-hypertension and tachycardia
-esmolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Cuff deflation drops _____ , _____, and _____.
CVP, MAP, and Pain
26
Cuff deflation: _____ increases and core temp ______
HR, decreases
27
Tourniquet pain is less common is _______ anesthesia vs _______.
Regional vs General
28
Metabolic waste products accumulate in tissue. Cuff deflation is rapid wash out of same: Increase _____,_______, _______ and _______.
Increased PaCO2, ETCO2, serum lactate and potassium
29
Tourniquet is contraindicated in ______ ______.
calcified arteries
30
Prolonged inflation = > ___ hours. Causes:
2 hours transient muscle injury permanent nerve injury rhabdo
31
Triad of Fat Emboli Syndrome:
dyspnea, confusion, petechiae (usually w/ in 72 hours of long bone Fx)
32
FES can happen from ____,____ and _____ as well
CPR, liposuction, IV lipids
33
FES diagnosis
-petechiae of chest, upper extremities, axillae and conjuctivae CXR = ARDS
34
FES: fat globules in _____,_____and _____.
retina, urine, sputum
35
FES: Under GA see decline in ______ and _____ and a rise in ______
decline - ETCO2 and SPO2 rise- PAP
36
DVT and PE major source:
M&M post pelvic and lower extremity surgery
37
Risk factors of DVT and PE:
age > 60yr, obesity, tourniquet, procedures >30 min, lower extremity fx, and immobilzation > 4 days Highest risk are in knee and hip replacements
38
What decreases risk of both DVT and PE?
Neuraxial Anesthesia
39
DVT and PE pathogenesis:
venous stasis and hypercoaguability from inflammation
40
Neuraxial Anesthesia reduces DVT and PE in what ways:
-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
Hallmarks of hematoma are _____ _____ and_______ _______ weakness.
back pain, lower extremity
42
Joint manipulation type of drugs:
IV agents with short duration (Propofol)
43
JM: General preferred to regional because:
-LMA/ mask/ett -Profound relaxation allows surgeon to distinguish anatomical limitations from patient guarding -Muscle relaxant, succ or roc may be needed
44
Hip fracture mortality ___% during initial hospitalization and ___% for first year
10% 25%
45
Reasons to delay Hip fx surgery
-coagulopathy -uncompensated HF
46
Hip fx: Blood?
Blood in the room because you cant put a tourniquet on a hip
47
Hip Fx: Predictors of peri-op mortality
Age >85 yrs H/o cancer Baseline/pre-op alteration in neuro status Post-op chest infection Post-op wound infection
48
Hidden blood loss:
Large amounts of blood can be sequestered around fracture
49
Blood loss from greatest to least from hip fracture
subtrochanteric,intertrochanteric > base of femoral neck > transcervical, subcapital
50
Hip Fx: Bigger fracture?
Consider arterial line and large bore iv for transfusion, hemodynamic monitoring Use short acting drugs Use lower solubility agents Minimize postop cognitive impairmen
51
Benefits of arthroscopy
Less ebl Less post-op pain Less rehab time
52
Nerve injury from Traction table
Pudendal Nerve
53
LMA for which arthroscopic surgeries?
knees, wrists
54
Which arthroscopic surgery requires an ETT?
shoulder
55
Position for THA
lateral decubitus
56
Embolic event most frequent at insertion of ________ _________.
femoral component
57
Highest rate of DVT for all ortho procedures
Total Knee Arthroplasty
58
Nerve block for upper extremity surgery
Interscalene block of brachial plexus helpful. Done preop, very good 80% of time.
59
Anesthesia considerations for Re-implantations:
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
Most common cause of toxic plasma concentration of local is....
inadvertent intravascular injection during regional anesthesia
61
Most frequent symptom of LAST is..... What is the exception?
Seizure Bupi is the exception -cardiac arrest occurs before seizure
62
LAST is more common with __________ than with ________ anesthesia
peripheral nerve blocks, epidural
63
Highest risk for LAST?
Bier Block
64
How long to leave tourniquet inflated for bier block.
20 minutes
65
_______ and _____ will worsen the symptoms of LAST.
Hypoxia and Acidosis
66
Difficulty of cardiac resuscitation (Locals)
Bupivacaine > Levobupivacaine > Ropivacaine > Lidocaine
67
The risk of bupivacaine toxicity is increased with _____, _____, ______, and ______
-pregnancy -beta-blockers -calcium channel blockers -digitalis
68
If Epi used for LAST, keep dose below ___ mcg/kg
1 mcg/kg
69
Ultimate treatment for LAST Is _______
lipids!
70
Lipid emulsion dose for patient over 70kg:
Bolus= 100ml over 2-3 minutes Infusion= 250 ml over 15-20 minutes if remains unstable repeat bolus and/or double infusion rate
71
Lipid emulsion dose for patient under 70kg:
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions