Anesthesia for Orthopedics (Part 1) Flashcards
Normal preoperative tests before a total joint replacement
-Check current meds (especially anticoagulants)
-CBC, BMP, Type and Screen, UA
For surgical site infection prevention we will give what? When do we give it?
Cefazolin (Ancef) 1-2g IVPB
Should be given within 1 hour of incision
-If over 100kg give 2g
If they need to get another antibiotic due to allergy, it will be ____.
Vancomycin OR clindamycin Thanks Dana!!
-Give within 2 hours of cut time
Osteoarthritis is what?
Degeneration of articular cartilage with inflammation and pain with joint motion
T/F: Rheumatoid arthritis is the most common form of arthritis and effects 21% of US adults.
WRONGO.
-Osteoarthritis is actually the most common and it effects 21% of US adults.
-Prevalence is also going up due to aging population and obesity.
Osteoarthritis is classified as being the leading cause of ____ ____ ____.
Lower extremity disability
-Knee highest risk at 46%
-Hip at 25%
OA can be diagnosed ____, ____, and ____.
Radiographically, pathologically, or clinically.
-Radiographically most common (Kellgren-Lawrence grading system)
OA defined by what symptoms?
Pain, stiffness, decreased ROM, NO SYSTEMIC involvement
-Knees, hips, first metacarpal, distal interphangeal joints most commonly affected
____ is the main manifestation of OA that eventually causes the pt to seek care.
Pain
OA management includes
Non-pharm and pharm interventions
-Weight loss, exercise, physiotherapy, bracing
-NSAIDs, opioids, local injections
-Surgery
Huge part of OA history/physical for anesthesia
-C-spine involvement
-Chart existing deficits (CYA!!!)
-Look over current med regimen
Rheumatoid Arthritis is what?
Autoimmune mediated SYSTEMIC inflammatory disease
-Pain and disability from destruction of synovial joints
RA characterized by what big symptom?
Morning stiffness that improves over the course of the day
___ and ____ play a role in RA pathogenesis.
Cytokines and B lymphocytes
-B cells –> rheumatoid factor
-Cytokines –> infllammation cascade
RA Med Concerns
NSAIDs
D/c 2 days prior to surgery
Renal function, coags
RA Med Concerns
DMARDs
Check CBC and LFT
-Due to pancytopenia and liver harm
DMARD are the only drugs that have the capability to do what in RA patients?
Only drugs that can slow down progression and prevent deformities
RA Med Concerns
Corticosteroids
Impair wound healing and maybe enhance surgical infection risk
RA Med Concerns
Leflunomide (never heard of her)
Check CBC and LFT
-Due to hepatotoxicity and pancytopenia
RA Med Concerns
TNF inhibitors (Etanercept)
Infection risk
RA Med Concerns
IL-1 Antagonist (Anakinra)
Infection risk
RA physical exam concerns
C SPINE INSTABILITY (can be asymptomatic in up to 80% of pts)
-Atlanto-axial instability
-Atlanto-occipital subluxation
-Cranial settling onto c1
-Ankylosis in late stages
TMJ disease
Arytenoid disease / VC dysfunction
Srojen’s
T/F: As cord compression worsens in RA, so do the patient’s symptoms.
FALSE.
-A high percentage of these patients are asymptomatic and symptoms do not necessarily align with severity of compression.
You knew it was coming - biggest difference between OA and RA?
OA has no systemic effects
-RA with fever, weight loss, fatigue, myalgias, decreased appetite, Srojen’s
Ankylosing Spondylitis is what?
Chronic progressive inflammation of spine and thorax
Ankylosing Spondylitis is characterized by what?
- Lower back pain with morning stiffness (referred pain to butt)
- Bamboo Spine radiograph
-Affects sarcoiliac joints and progresses cephalad
AS most commonly effects __-__ vertebrae
C5-C7 –> have multiple airway plans!
Biggest AS symptom CV related:
Aortic valve insufficiency
-Seen in 40% of patients
What are big anesthesia concerns for these joint conditions - AS, OA, RA:
-Airway management –> we need thorough preoperative exams and preparation for tough airway
-Positioning –> we should plan to position these patients comfortably AND THEN induce
-Tough neuraxial –> limited spinal flexion and increased ossification of ligaments
-If using regional anesthesia, first check for neuropathy and chart (CYA!!)
Involvement of the cricoarytenoid joint, cricothyroid joint, temporomandibular joint, and associated structures in the larynx is found in ___% of RA patients.
90%
-This can lead to postoperative airway obstructions and also can make their initial airway placement more difficult.
T/F: Early implementation of conservative measures have proven to be useful in preventing kyphoscoliosis patients from needing corrective surgery.
FALSE.
-Over 80% of these patients have an idiopathic form.
-Surgery is indicated to prevent long-term ventilatory compromise when curvature exceeds 40 degrees.
Kyphoscoliosis causes severe ____ pulmonary disease.
Restrictive
The most important preoperative anesthesia implication for kyphoscoliosis pts is what?
Optimization of cardiopulmonary status.
-Remove airway irritants, treat infections, steroids for inflammation, treat GERD
-Pulmonary prehabilitation is great but often not covered by insurance and can be expensive –> incentive spirometer is free!
Some important intraoperative anesthesia implication for kyphoscoliosis pts is what?
-Good access and proper positioning
-Invasive monitoring
-SSEP and MEP use (no NMB with MEP)
-EDUCATE if possible wake up test
-Optimization of blood plan
-Prepare for ICU postop
