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Summer 2020 - APA Foundations 2 - Other > Anesthesia for Orthopedic Procedures - Final Wrap Up > Flashcards

Anesthesia for Orthopedic Procedures - Final Wrap Up Flashcards

1
Q

What are the special considerations for Orthopedic Surgery?

A

Bone Cement

Pneumatic Tourniquet

Fat Embolism

DVT

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2
Q

How does Bone Cement work?

A

Powder Methylmethacrylate + Liquid Methylmethracrylate = Exothermic Hardening

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3
Q

What are complications of Bone Cementing?

A

Intermedullary HTN > 500 mmHg

Fat, Bone Marrow, Cement, & Air Embolism

Residual MMA = Vasodilation

Tissue Thromboplastin Release = Microthrombus

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4
Q

What are symptoms of Bone Cement Implantation Syndrome?

A

Hypoxia

Hypotension

Dysrhythmias

Pulm. HTN

↓CO

Embolization

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5
Q

What are ways to minimize the negative effects of Bone Cementing?

A

↑FiO2

Euvolemia

Vasopressors

Venting Distal Femur

High Pressure Lavage of Femoral Shaft

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6
Q

What are problems r/t Pneumatic Tourniquets?

A

Hemodynamic & Metabolic Change

Pain

Embolus

Muscle/Nerve Injury

Limb Cooling

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7
Q

What are the CV effects of having a prolonged tourniquet of 45 - 60 mins?

A

HTN

Tachycardia

Sympathetic Stimulation

Sweating

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8
Q

What happens when a prolonged cuff/tourniquet is deflated?

A

↓CVP

↓MAP

↓Pain

↓Core Temp

↑HR

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9
Q

How much pressure is applied by the Cuff/Tourniquet

A

100 mmHg above Systolic

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10
Q

Which nerve fibers are affected by Tourniquets that cause pain?

A

Unmyelinated Slow C-Fibers

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11
Q

What is Increased w/ Cuff /Tourniquet Deflation?

A

PaCO2

EtCO2

Lactate &Potassium

Metabolic Waste & Free Radicals

Minute Volume

Dysrhythmias

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12
Q

When are Tourniquets Contraindicated?

A

Calcified Arteries

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13
Q

Tourniquet Ischemia in the lower extremities lead to ______ & potentially Pulmonary Embolisms

A

Tourniquet Ischemia in the lower extremities lead to DVT & potentially Pulmonary Embolisms

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14
Q

What can result if a Tourniquet stays inflated > 2 hours?

A

Transient Muscle Injury

Permanent Nerve Injury

Rhabdomyolysis

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15
Q

What are the characteristics of Fat Embolism Syndrome?

A

Less Frequent, but more Fatal

Dyspnea

Confusion

Petechiae

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16
Q

What is Fat Embolism Syndrome associated w/?

A

Long Bone Fractures

CPR

Liposuction

IV Lipds

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17
Q

What is the Pathophysiology of Fat Embolism Syndrome?

A
  1. Fat Globules enter circulation via medullary vessel tears
  2. ↑Fatty Acid Release Vasoactive Amines & Prostaglandins
  3. ARDS
  4. Cerebral Capillary Damage/Edema
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18
Q

How is Fat Embolism Syndrome diagnosed?

A

Petechiae

Fat in Retina, Urine, Sputum

Coagulopathy

Progressive Pulm. Decline

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19
Q

What would Fat Embolism Syndrome look like under General Anesthesia?

A

↓EtCO2

↓SpO2

↑PAP

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20
Q

What is the best way to Prevent & Treat Fat Embolism Syndrome?

A

Early Stabilization & Supportive Treatment

21
Q

Which type of procedures have the greatest risk for DVT/PE?

A

Knee & Hip Replacement

22
Q

What are Risk factors that contribute to DVT/PE?

A

> 60 y.o

> 30 min Procedure

> 4 Days Immobility

Obesity

Tourniquets

Lower Extremity Fx

23
Q

What causes a DVT/PE?

A

Venous Stasis & Hypercoagulability d/t Inflammation

24
Q

How does Neuraxial Anesthesia (Spinals/Epidurals) decrease the risk for DVT/PE?

A

↑Venous Blood Flow

Anti-Inflammatory

↓Platelet Activity

↓Factor VIII & VWF

↓Stress Hormone

Stable Antithrombin III

25
Q

Which type of Anesthesia is preferred for Joint Manipulation?

A

General w/ short acting meds along w/ Sux or Roc

26
Q

What would be appropriate reasons to Delay surgery for a Hip Fracture?

A

Coagulopathy

&

Uncompensated Heart Failure

27
Q

What are predictors of Peri-Op Mortality r/t Hip Repairs?

A

> 85 y.o

Cancer Hx

Pre-Op Neuro Changes

Post-Op Chest & Wound Infection

28
Q

What are the advantages of Regional Anesthesia for Hip Repairs?

A

Low Blood Loss

↓DVT/PE Risk

Faster return to Neuro Baseline

29
Q

What technique can be used to keep a patient off the fracture pre-operatively?

A

Hypobaric Technique

30
Q

When does a Regional lose its benefit during a Hip Repair?

A

Oversedation & Hypoxia

31
Q

List the Hip Fracture location Blood Loss from Greatest to Least

A

Trochanteric > Femoral Neck > Transcervical & Subcapital

32
Q

How are Undisplaced Intracapsular Fractures repaired?

A

Cannulated Screw

33
Q

How are Displaced Intracapsular Fractures repaired?

A

Internal Fixation

Hemiarthroplasty

Total Hip Replacement

34
Q

How are Extracapsular Fractures treated?

A

Extramedulllary Sliding Plate/Screw

Intramedullary Gamma Nail

35
Q

When is a Total Hip Repair indicated?

A

Osteoarthritis

RA

Vascular Necrosis

36
Q

What is the EBL for Total Hip Repairs?

A

400-2000 mL

Have PRBCs, 2nd IV, Cell Saver

37
Q

What are the potential complications of Upper Extremity Arthroplasty?

A

Blood Loss

PTX

Subclavian Vein Injury

Accidental Extubation

C-Spine Injury

Embolism

Bone Cement Problems

38
Q

What procedures are used for Severed Parts?

A

Re-Implantation - Long, Staged procedures w/ Grafting & Re-Anastamosis

39
Q

Interscalene blocks target the _______ and should be avoided in patients w/ compromised ________ status

A

Interscalene blocks target the Brachial Plexus Trunks and should be avoided in patients w/ compromised Respiratory status

40
Q

What are risks associated w/ Interscalene Blocks?

A

Horner’s Syndrome

PTX

Epidural, Spinal, Arterial Injection

Complete Phrenic Block

41
Q

What does a Supraclavicular Block target?

A

Brachial Plexus Divisions

42
Q

What are the risks associated w/ Supraclavicular Blocks?

A

PTX

Vocal Cord Palsy

50% Phrenic Block

43
Q

What kind of block targets the Brachial Plexus Cords?

A

Infraclavicular Block for Elbows & Hands has a small PTX risk

44
Q

Which nerves are blocked w/ an Axillary Block?

A

Medial, Ulnar, & Radial Nerves

45
Q

What are the risks associated w/ an Axillary Block?

A

Hematoma & Vascular Injection

46
Q

What is a concern when using a Femoral Nerve Block?

A

Falls d/t Loss of Quad Function

47
Q

Where can a Sciatic Nerve Block have its effect?

A

From Hip to Foot

48
Q

A Popliteal block can be useful for Foot & Ankle surgery, but spares the ______ & ______ for easier ambulation

A

A Popliteal block can be useful for Foot & Ankle surgery, but spares the HAMSTRING & KNEE FLEXION for easier ambulation

Summer 2020 - APA Foundations 2 - Other (10 decks)

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