Exam 1: Spinal Surgery Anesthesia Flashcards
What is scoliosis?
Lateral rotation of the spine > 10° with vertebral rotation.
- congenital
- idiopathic
- neuromuscular
What are the effects of thoracic spine scoliosis?
- ↓ Chest wall compliance
- Restrictive lung disease
- ↓ exercise tolerance
Get PFTs!
With spinal cord injury, what muscles can be flaccid if we have a C5 injury?
- deltoid
- biceps
- brachialis
- brachio-radialis
- partial paralysis of diaphragm
What would we expect with a T5 and higher spinal cord injury?
- Sympathectomy
- hypotension
- bradycardia with T1-T4 injuries
What would we expect to see with a T5/T6 spinal cord injury
- Autonomic hyperreflexia
- below the injury: cutaneous vaoconstriction, severe HTN, and bradycardia/dysrhythmias
- above the injruy: cutaneous vasodialation
Autonomic disreflexia steps (7)
Level of cord injury at T6 or above
1. stimulus from below the injuiry (ex. appendectomy or full bladder)
2. afferent stimulus to cord
3. massive sympathetic response
4. widespread vasoconstriction (below injury)
5. hypertension
6. baroreceptors in blood vessels detect hypertensive crisis and signal the brain
7.
a. HR slows
b. descending inhibitory tract signals blocked at the cord injury level
What would we expect with a cord injury to C3-C5?
- respiratory failure
What EKG/cardiac findings might one suspect to find on a scoliosis patient? (Select all that apply)
a. RVH
b. RAE
c. LVH
d. Bi-atrial enlargement
a & b
The increased pulmonary vascular resistance of chronic, significant scoliosis can lead to ___ _______.
cor pulmonale
Enlarged RV due to lung disease.
In autonomic hyperreflexia, cutaneous vasodilation is seen ____ the site of injury, whilst cutaneous vasoconstriction is seen ____ the site of injury.
above ; below
What are the most common causes of Autonomic Dysreflexia?
- Distended bladder/bowel
- Noxious stimuli (think surgical pain)
What is the treatment for Autonomic Dysreflexia?
- Removal of stimulus
- Deepen anesthetic
- Direct-acting Vasodilators
Is respiratory function affected by injury to C5-C7?
Yes; impairment of abdominal and intercostal respiratory support
Why is there an increased risk of pulmonary infection with cervical spine injuries?
- Inability to cough/ clear secretions
- Atelectasis
What is poikilothermia?
Inability to maintain constant core temp
What is the pathophysiology of poikilothermia?
- SNS disruption
- Temperature sensation disruption
- Inability to vasoconstrict below spinal cord injury
Spinal deformities are associated with ____ respiratory patterns, often necessitating PFT’s and an ABG.
Restrictive
Flaccidity in which two muscles would indicated possible cervical spine fracture?
- Deltoids
- Biceps
How do you intubate with a cervical spine injury?
- as soon as you see the C-collar, they are determined to be a difficult airway
so go directly to video laringoscopy or fiberoptic
What is the greatest risk with a total sitting position?
VAE (Venous Air Embolism)
An anterior approach for a thoracic spine procedure requires what position and equipment?
- Lateral position with bag
- Double Lumen ETT or bronchial blocker
May have to drop lung for access.
A posterior approach for a thoracic spine procedure requires what position and equipment?
- Prone with arms tucked or 90° abduction
- Single lumen ETT.
What time of frame pictured below?
Wilson Frame
Jackson spine table is much preferred
Give the Chest support, abd, pelvis, and leg positioning of each of the following bed frames:
Siemens
Andrews
Wilson
Jackson
Longitudinal bolster
Which of the following positioning devices is the most stable?
Mayfield Tongs
