Anesthesia for Orthopedic Procedures - Final Wrap Up Flashcards
What are the special considerations for Orthopedic Surgery?
Bone Cement
Pneumatic Tourniquet
Fat Embolism
DVT
How does Bone Cement work?
Powder Methylmethacrylate + Liquid Methylmethracrylate = Exothermic Hardening
What are complications of Bone Cementing?
Intermedullary HTN > 500 mmHg
Fat, Bone Marrow, Cement, & Air Embolism
Residual MMA = Vasodilation
Tissue Thromboplastin Release = Microthrombus
What are symptoms of Bone Cement Implantation Syndrome?
Hypoxia
Hypotension
Dysrhythmias
Pulm. HTN
↓CO
Embolization
What are ways to minimize the negative effects of Bone Cementing?
↑FiO2
Euvolemia
Vasopressors
Venting Distal Femur
High Pressure Lavage of Femoral Shaft
What are problems r/t Pneumatic Tourniquets?
Hemodynamic & Metabolic Change
Pain
Embolus
Muscle/Nerve Injury
Limb Cooling
What are the CV effects of having a prolonged tourniquet of 45 - 60 mins?
HTN
Tachycardia
Sympathetic Stimulation
Sweating
What happens when a prolonged cuff/tourniquet is deflated?
↓CVP
↓MAP
↓Pain
↓Core Temp
↑HR
How much pressure is applied by the Cuff/Tourniquet
100 mmHg above Systolic
Which nerve fibers are affected by Tourniquets that cause pain?
Unmyelinated Slow C-Fibers
What is Increased w/ Cuff /Tourniquet Deflation?
PaCO2
EtCO2
Lactate &Potassium
Metabolic Waste & Free Radicals
Minute Volume
Dysrhythmias
When are Tourniquets Contraindicated?
Calcified Arteries
Tourniquet Ischemia in the lower extremities lead to ______ & potentially Pulmonary Embolisms
Tourniquet Ischemia in the lower extremities lead to DVT & potentially Pulmonary Embolisms
What can result if a Tourniquet stays inflated > 2 hours?
Transient Muscle Injury
Permanent Nerve Injury
Rhabdomyolysis
What are the characteristics of Fat Embolism Syndrome?
Less Frequent, but more Fatal
Dyspnea
Confusion
Petechiae
What is Fat Embolism Syndrome associated w/?
Long Bone Fractures
CPR
Liposuction
IV Lipds
What is the Pathophysiology of Fat Embolism Syndrome?
- Fat Globules enter circulation via medullary vessel tears
- ↑Fatty Acid Release Vasoactive Amines & Prostaglandins
- ARDS
- Cerebral Capillary Damage/Edema
How is Fat Embolism Syndrome diagnosed?
Petechiae
Fat in Retina, Urine, Sputum
Coagulopathy
Progressive Pulm. Decline
What would Fat Embolism Syndrome look like under General Anesthesia?
↓EtCO2
↓SpO2
↑PAP
What is the best way to Prevent & Treat Fat Embolism Syndrome?
Early Stabilization & Supportive Treatment
Which type of procedures have the greatest risk for DVT/PE?
Knee & Hip Replacement
What are Risk factors that contribute to DVT/PE?
> 60 y.o
> 30 min Procedure
> 4 Days Immobility
Obesity
Tourniquets
Lower Extremity Fx
What causes a DVT/PE?
Venous Stasis & Hypercoagulability d/t Inflammation
How does Neuraxial Anesthesia (Spinals/Epidurals) decrease the risk for DVT/PE?
↑Venous Blood Flow
Anti-Inflammatory
↓Platelet Activity
↓Factor VIII & VWF
↓Stress Hormone
Stable Antithrombin III
Which type of Anesthesia is preferred for Joint Manipulation?
General w/ short acting meds along w/ Sux or Roc
What would be appropriate reasons to Delay surgery for a Hip Fracture?
Coagulopathy
&
Uncompensated Heart Failure
What are predictors of Peri-Op Mortality r/t Hip Repairs?
> 85 y.o
Cancer Hx
Pre-Op Neuro Changes
Post-Op Chest & Wound Infection
What are the advantages of Regional Anesthesia for Hip Repairs?
Low Blood Loss
↓DVT/PE Risk
Faster return to Neuro Baseline
What technique can be used to keep a patient off the fracture pre-operatively?
Hypobaric Technique
When does a Regional lose its benefit during a Hip Repair?
Oversedation & Hypoxia
List the Hip Fracture location Blood Loss from Greatest to Least
Trochanteric > Femoral Neck > Transcervical & Subcapital
How are Undisplaced Intracapsular Fractures repaired?
Cannulated Screw
How are Displaced Intracapsular Fractures repaired?
Internal Fixation
Hemiarthroplasty
Total Hip Replacement
How are Extracapsular Fractures treated?
Extramedulllary Sliding Plate/Screw
Intramedullary Gamma Nail
When is a Total Hip Repair indicated?
Osteoarthritis
RA
Vascular Necrosis
What is the EBL for Total Hip Repairs?
400-2000 mL
Have PRBCs, 2nd IV, Cell Saver
What are the potential complications of Upper Extremity Arthroplasty?
Blood Loss
PTX
Subclavian Vein Injury
Accidental Extubation
C-Spine Injury
Embolism
Bone Cement Problems
What procedures are used for Severed Parts?
Re-Implantation - Long, Staged procedures w/ Grafting & Re-Anastamosis
Interscalene blocks target the _______ and should be avoided in patients w/ compromised ________ status
Interscalene blocks target the Brachial Plexus Trunks and should be avoided in patients w/ compromised Respiratory status
What are risks associated w/ Interscalene Blocks?
Horner’s Syndrome
PTX
Epidural, Spinal, Arterial Injection
Complete Phrenic Block
What does a Supraclavicular Block target?
Brachial Plexus Divisions
What are the risks associated w/ Supraclavicular Blocks?
PTX
Vocal Cord Palsy
50% Phrenic Block
What kind of block targets the Brachial Plexus Cords?
Infraclavicular Block for Elbows & Hands has a small PTX risk
Which nerves are blocked w/ an Axillary Block?
Medial, Ulnar, & Radial Nerves
What are the risks associated w/ an Axillary Block?
Hematoma & Vascular Injection
What is a concern when using a Femoral Nerve Block?
Falls d/t Loss of Quad Function
Where can a Sciatic Nerve Block have its effect?
From Hip to Foot
A Popliteal block can be useful for Foot & Ankle surgery, but spares the ______ & ______ for easier ambulation
A Popliteal block can be useful for Foot & Ankle surgery, but spares the HAMSTRING & KNEE FLEXION for easier ambulation
