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Adv Principles A > Exam 1 part 3 > Flashcards

Exam 1 part 3 Flashcards

1
Q

scoliosis surgeries take approx _______ hours

A

6-10

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2
Q

scoliosis is defined as lateral rotation >_____ degrees

A

10

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3
Q

the pain from adult scoliosis is typiacally worse when:

A

standing or walking

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4
Q

which type of scoliosis typically has decreased chest wall compliance?

A

thoracic

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5
Q

which type of scoliosis typically has increased pulmonary vascular resistance?

A

thoracic

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6
Q

which type of scoliosis typically has RV hypertrophy and RA enlargement?

A

thoracic

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7
Q

anticipate ____ blood loss in patients having spine surgery

A

large

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8
Q

after about 2 L of crystalloid, think about administering blood or colloids to prevent:

A

dilutional coagulopathy

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9
Q

what are 4 muscles that are innervated by C5?

A

deltoid
biceps
brachialis
brachio-radialis

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10
Q

if muscles innervated by c5 show signs of weakness, what other important muscle may be weak?

A

diaphragm

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11
Q

why could injuries about T1-T4 cause bradycardia?

A

these are the cardiac accelerator nerves

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12
Q

spinal injuries above T5 are at risk for physiologic ________. what does this cause and what is the treatment?

A

sympathectomy
hypotension, midodrine

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13
Q

what can result if there is complete cord transection above T5 or T6?

A

autonomic hyperreflexia

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14
Q

what are 5 signs/symptoms of autonomic hyperreflexia?

A

severe+transient HTN and bradycardia
dysrhythmias
cutaneous vasoconstriction BELOW injury
cutaneous vasodilation ABOVE injury

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15
Q

what typically sets off autonomic hyperreflexia?

A

some afferent noxious stimulus (full bowel or bladder, surgery) produces a massive sympathetic response

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16
Q

what are 3 treatment options intra op for autonomic hyperreflexia?

A

deepen anesthetic
remove stimulus
direct-acting vasodilators

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17
Q

injury to which cord levels can lead to impairment of abdominal and intercostal muscles that support breathing?

A

C5-T7

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18
Q

define poikilothermic

A

inability to maintain constant core body temp due to disruption of sympathetic pathways

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19
Q

spinal cord injury pts typically have issues with vasoconstriction ______ the level of injury

A

below

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20
Q

airway management issues are ____ common in thoracic and thoracic cases

A

more

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21
Q

spinal deformities typically lead to _____ respiratory patterns

A

restrictive

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22
Q

cardiac issues can be seen in pts with severe:

A

kyphoscoliosis

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23
Q

pts with RA can have this type of cervical instability:

A

alanto-axial instability

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24
Q

what is the most common anesthetic plan for spinal surgeries?

A

GETA

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25
Q

if SSEP/MEP/EMG is being used, what is the preferred muscle relaxant fpr intubation?

A

succs

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26
Q

what is the positioning of pts head and arms in prone for surgery?

A

arms tucked, head in mayfield pins
***head should still be neutral

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27
Q

what is a major concern for the sitting position for cervical spine procedures?

A

risk of VAE
**uncommon positioning

28
Q

what kind of tube needs to be used for anterior approach of thoracic? pt position?

A

DLT or bronchial blocker
lateral

29
Q

what kind of tube needs to be used for posterior approach of thoracic? pt position?

A

single lumen ETT
prone, arms tucked

30
Q

what can you give to decrease drooling in prone pts?

A

0.2 glyco in preop

31
Q

what are 3 causes of post op vision loss

A

ischemic optic neuropathy
retinal artery/vein occlusion
cortical brain ischemia

32
Q

ION occurs ___ pressure to the eyes

A

without
**caused by decreased blood flow/O2 delivery

33
Q

6 risk factors for ION?

A

male
obesity
wilson frame use
surgery > 6 hours
decreased colloid use (using crystalloid)
blood lodd > 1 L

34
Q

when does ION onset? 4 signs/symptoms?

A

24-48 hours postop
bilateral, painless vision loss, nonreactive pupils, no light perception

35
Q

treatment for ION?

A

diuretics , Azetazolamide, hyperbaric O2, increased BP or Hgb

36
Q

3 ways to prevent ION?

A

head neutral
use of blood or colloids for fluid
minimize intentional hypotension

37
Q

if the head is flexed too much, ETT moves towards:

A

carina

38
Q

which surgical positioning increased abdominal and thoracic pressures?

A

prone

39
Q

what are 2 pulmonary changes in prone?

A

decreased FRC and pulmonary compliance

40
Q

what patient position sees and increase in bleeding from epidural veins?

A

prone

41
Q

what is the most stable head positioning device for prone?

A

mayfield tongs

42
Q

extreme head rotation can _____cerebral venous drainage and CBF

A

decrease

43
Q

6 risk factors for increased blood loss

A

increased # of levels
>50 y/o
obesity
tumors
increased abdominal pressure transpedicular osteotomy

44
Q

1 indication and 1 contraindication to pre-op autologous blood donation

A

EBL> 500-1000 mL expected
significant cardiac disease or infection

45
Q

TXA dose for spine surgery dose and infusion rate

A

10 mg/kg
2 mg/kg/hr

46
Q

Amicar dose for spine surgery dose and infusion rate

A

100 mg/kg
10-15 mg/kg/hr

47
Q

deliberate hypotension is ____ recommended in spine surgery

A

NOT

48
Q

what does SSEP detect?

A

dorsal column pathways pf proprioception and vibration
***afferent

49
Q

what does MEP detect?

A

anterior/motor portion of spinal cord
**efferent

50
Q

what does EMG detect?

A

nerve root injury during pedicle screw placement and nerve decompression

51
Q

what are 5 adverse events to MEPs?

A

cognitive defects
seizures
intraop awareness
scalp burns
cardiac arrhythmias

52
Q

what airway device should be placed when MEPs are being used?

A

bite block

53
Q

what are 3 contraindications to MEPs?

A

cochlear implants
active seizures
vascular clips in brain

54
Q

what 4 clinical conditions alter SSEP/MEP?

A

hypotension
hypothermia
hypocarbia
anemia

55
Q

amplitude=
latency=

A

-signal strength
-time for signal to travel through spinal cord

56
Q

what effects do volatiles have on SSEP/MEP?

A

dose dependent decrease in amplitude + decrease in latency
**usually not an issue with less than 1 MAC

57
Q

which volatile should not be used during MEP?

A

N2O

58
Q

what does N2O do to MEP?

A

decreased amplitude

59
Q

what does propofol do to MEP?

A

depresses

60
Q

MEPS are least affected by what 3 drugs?

A

midazolam
opioids
ketamine

61
Q

what is a good dose of intrathecal morphine for postop spine pts?

A

0.1-0.2 mg

62
Q

what is a good dose of epidural dilaudid for postop spine pts?

A

0.5-1 mg

63
Q

what peripheral nerve block is good for postop spine pts?

A

erector spinae

64
Q

which type of spine surgery has the highest risk of VAE?

A

laminectomy
**lots of exposed bone, surgical site above heart

65
Q
A

Adv Principles A (5 decks)

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