Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

931: Advanced Principles of Anesthesia I > Anesthetic considerations for plastic surgery > Flashcards

Anesthetic considerations for plastic surgery Flashcards

1
Q

Plastic surgery can be performed under _____ and at the following locations____

A

local, regional, MAC, & GA

ambulatory or same-day surgery & office-based procedures

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

______ is the most popular plastic surgery

A

breast augmentation (although it changed to rhinoplasty during covid)

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

The most frequent complications of plastic surgery include

A

DVT & PE*****

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

For patients undergoing plastic surgery, we are most concerned with

A

DVT/PE prophylaxis
liposuction guidelines on lidocaine/epinephrine doses
adequate hydration

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

The most common procedures for women include

A

breast augmentation>liposuction>blepharoplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

the most common procedures for men include

A

liposuction, rhinoplasty, blepharoplasty

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

For the pre-anesthesia evaluation of the patient presenting for a plastic procedure, it is important to consider

A

most patients are healthy
low tolerance of errors or side effects
explain anesthetic techniques-risks/benefits
gain patient trust
reduce anxiety
complete H&P b/c plastic surgeon doesn’t always do a good job of this
NPO: 8 hours solid food & 2 hours liquid

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

Describe the typical patient undergoing plastic surgery.

A

most patients are 35-50 years of age; facial surgery usually >50 years
most ASA I/II
overweight patients may seek skin removal surgery following bariatric surgery
if patient >50 years, should have clearance by internist
pregnancy testing recommended in women of childbearing age

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

A concern with medications regarding patients undergoing plastic surgery includes

A

54% of patients taking herbals that interfere with anesthetics/surgery & 85% are not told to stop before surgery

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

In regards to the patient history, the patient may have

A

co-morbidities that are missed by the plastic surgeon

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

For PONV prophylaxis, it is necessary to

A

give two or more agents

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

______ preoperatively has been shown to reduce anxiety, decrease postoperative pain intensity and opioid consumption, improve postoperative sleep quality and reduce postoperative/emergence delirium.

A

Melatonin 3-10 mg

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

If the surgery is longer than 4 hours, then

A

foley catheter should be inserted

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

Goals for emergence of the plastic patient include

A

no increase in BP/HR, no bucking and no respiratory complications

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

____ is often used on eyelids

A

ophthalmologic lubricant & sterile tape

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

Regional anesthesia techniques provide for

A

fewer complications, safer recovery, & better postoperative analgesia

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

With BIS monitoring, there is a ____ delay from real time

A

15-30 second

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

BIS is useful in conjunction with ____ -that monitors electrical activity of frontalis muscle between eyebrows- spikes suggest patient arousal

A

electromyogram

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

Risks with general anesthesia include

A

difficult intubation, failed intubation, kinked/occluded ETT, dental damage, AGM errors, MH
“room air general” - risk of airway fire
LMA is frequently used in plastic surgery

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

Local anesthesia by plastic surgeon may be used for

A

blepharoplasty, chin implant, liposuction

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

Spinal anesthesia can be done for

A

safe, early discharge, low cost, & rare complications
liposuction, buttocks implants, calf implants, & possibly for breasts
can add adjuvant (clonidine, fentanyl, sufentanil) for surgeries longer than 2 hours

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

Breast procedures include

A

breast augmentation
breast reduction
breast lift

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

Describe the blood supply to the breast

A

internal mammary artery for the medial aspect
lateral thoracic artery for the lateral aspect
venous drainage- superficial veins under dermis & deep veins that parallel the arteries
lymph drainage via retromammary lymph plexus in the pectoral fascia

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

Describe the nerve supply for the breast

A

peripheral nervous system innervation of the anterior and lateral cutaneous branches of the 4th, 5th, and 6th intercostal nerves
thoracic spinal nerve, T4, innervates nipple-areola complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

A breast augmentation can be performed for _____ patients

A

healthy versus breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Breast augmentation can be performed under

A

regional- less PONV, pain, decreased cost
general (VA/IV), cervicothoracic epidural, intercostal block, fascial plane block, tumescent injection with lidocaine
cervicothoracic epidural (C7-T4) better analgesia than general anesthesia
Adjunct: fascial plane blocks- no sympathetic blockade, hemodynamic stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the incision approaches for breast augmentation.

A

infra-mammary, peri-areolar, trans-axillary

28
Q

Describe the implant types & where it is placed for breast augmentation.

A

implant placed in pocket under mammary gland or pectoralis muscle
silicone or saline implants

29
Q

Describe the location of postop pain for breast augmentation.

A

sternum, lateral thorax, middle back

can give NSAIDs, low-dose opioids, & tramadol

30
Q

The anesthetic changes for breast augmentation include:

A

position changes: head secured to table, eye protection, arms padded and wrapped to arm boards, extensions on PIV, extension on circuit
-bra placed at end of case
pain management

31
Q

Complications of breast augmentation include.

A

capsular contracture, hematoma, infection, wound dehiscence

32
Q

The most common cancer globally is

A

breast cancer
1 in 8 women will develop
Ashkenazi Jewish women have high risk d/t BRCA
most common in black women under 45
85% have no family history of breast cancer

33
Q

Breast surgery can be performed for

A

excisional biopsy, breast biopsy, & lumpectomy

34
Q

Describe considerations for breast biopsy

A

GA, regional, or local with sedation
supine, arms abducted, table turned
outpatient, minimal EBL; 1-1.5 hours

35
Q

Describe considerations for lumpectomy.

A

wire guided (radiology- wire inserted under fluoroscopy)–> don’t touch the cup

  • GA, regional, local with sedation
  • supine
  • avoid muscle relaxants b/c of axillary node removal possibility
  • <1.5 hours, outpatient procedure
36
Q

With a sentinel lymph node biopsy,

A

the axillary node may be dissected- NO relaxation*
used for small, invasive breast cancer
dye injected around breast
wait for pathology (if positive nodes–> axillary dissection)
Gamma probe used to identify tracer in lymph nodes
Transient drop in pulse oximetry, allergic reaction*

37
Q

Damage to the long thoracic nerve results in

A

(motor)
winged scapula*** from the paralysis of the serratus anterior muscle
radical mastectomies or with any removal of axillary lymph nodes

38
Q

Damage to the thoracodorsal nerve

A

(motor)

results in palsy of the latissimus dorsi muscle*****

39
Q

Damage to intercostobrachial nerve (sensory)

A

results in numbness or pain in the lateral aspect of the axilla & medial aspect of upper arm

40
Q

Intercostobrachial neuralgia causes

A

post mastectomy pain syndrome

pain in axilla, medial upper arm & anterior chest wall

41
Q

Lymphedema is a complication of mastectomy and is most common with

A

axillary dissection + axillary radiation

42
Q

Nerve damage and complications of mastectomy include

A 
damage to long thoracic nerve
damage to thoracodorsal nerve
damage to intercostobrachial nerve
intercostobrachial neuralgia
lymphedema
43
Q

Anesthetic considerations for mastectomy include

A

supine, IV/NIBP/pulse ox on opposite arm
EBL 150-500 cc
usually admitted overnight
1.5 hours up to 7 hours if reconstruction

44
Q

A total or simple mastectomy involves

A

removes breast only

45
Q

A modified or partial mastectomy necessitates

A

postop radiation/chemotherapy

46
Q

A radical mastectomy involves

A

removal of breast, pectoral muscle, and axillary lymph nodes

47
Q

Describe preoperative considerations for mastectomy

A

respiratory/airway compromise possible if radiation
chemotherapy (cardiomyopathy)
metastasis
anemia with chemotherapy

48
Q

Describe intraoperative considerations for mastectomy

A 
GA (ETT/LMA) or regional
avoid muscle relaxants during axillary dissection**
position changes
pressure dressings during emergence
high incidence of PONV
49
Q

When performing an immediate breast reconstruction there is

A

use of either temporary tissue expander or autologous myocutaneous flaps

50
Q

A relative contraindication to breast reconstruction is

A

postoperative chest radiation

51
Q

FLAPS can include

A

deep inferior epigastric perforator (DIEP)
superficial inferior epigastric artery (SIEA)
Transverse upper gracilis (TUG)
Gluteal (buttocks)
transverse rectus abdominis myocutaneous (TRAM

52
Q

With a DIEP flap, important considerations include

A 
nO VASOPRESSORS (microvascular case)****
doppler used to check vessels
avoid hypertension/fluid overload
indocyanine green may be used to check tissue perfusion
53
Q

Describe risks associated with a DIEP flap,

A

ICU disposition, risk of graft failure, venous congestion, fat necrosis, bleeding

54
Q

A DIEP flap is performed

A

deep inferior epigastric perforator flap
abdominal skin, fat, & deep inferior epigastric vessels are removed and replanted to create new breasts
internal mammary artery and vein are transected suprasternal and anastomosed to epigastric vessels

55
Q

The latissimus dorsi flap involves

A

transfer of back tissues (latissimus muscle, fat, blood vessels, and skin) to the mastectomy site
the thoracodorsal artery supplies the flap- left attached to its original supply

56
Q

Following the mastectomy when performing the latissimus dorsi flap,

A

the patient is turned lateral or prone
usually requires implant as well
overnight stay in hospital

57
Q

The TRAM flap involves

A

Transverse rectus abdominis myocutaneous flap- pedicle or free flap type
“tummy tuck breast reconstruction”
skin, fat, and muscle tunneled from abdomen to chest

58
Q

With the TRAM flap it is important to

A

avoid hypotension
use doppler to check perfusion
flap based on superior epigastric vessels

59
Q

Anesthetic considerations for breast reconstruction involve (type of anesthesia & access)

A

General anesthesia
keep warm & hydrated (long cases)
vascular access: long procedure time, blood/fluid loss- multiple peripheral IVs

60
Q

Complications related to chemotherapy and breast reconstruction include

A

myelosuppresion
cardiomyopathy with adriamycin
pulmonary fibrosis, interstitial infiltrates, pleural effusions with methotrexate, cylcophosphamide, & bleomycin

61
Q

With breast reconstruction ____ should not be used because it can interfere with healing.

A

N2O

62
Q

Anesthetic considerations for breast reconstruction include

A

ephedrine> phenylephrine for hypotension (vasoconstriction)
-heparin intraoperative
foley catheter
postoperative pain management (regional block)
-Dextran for flap procedures- reduces clot formation in microvasculature, 25-30 mL/h (low molecular weight), monitor for allergic reactions (ARDS)

63
Q

Preoperative evaluation for breast reduction includes

A

back pain, skin irritation/infection, skeletal deformities, respiratory disorders
liposuction may be added

64
Q

Describe the two techniques for breast reduction.

A

inferior pedicle with long curved horizontal incision across crease beneath breast
inferior pedicle with vertical incision and short horizontal at crease (less scaring and shorter time)

65
Q

Describe the anesthetic considerations for breast reduction surgery.

A 
general anesthesia
frequent position changes
longer procedure (3-5+ hours)
fluid warmer, bair hugger, foley catheter
fluid/volume blood deficits
PONV
23 hour stay
66
Q

Describe the complications of breast reduction surgery

A

wound dehiscence, infection, seroma, hematoma, skin flap necrosis, loss of sensation, hypertrophic scarring

931: Advanced Principles of Anesthesia I (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions