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Priniclpes Of Anesthesia > Exam 3 - positioning > Flashcards

Exam 3 - positioning Flashcards

Positioning lecture and nerve injury including lab

1
Q

Ischemic optic neuropathy consequence

A

Increase risk of post op vision loss

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2
Q

Obturator nerve injury consequence

A

Inability to ADDuct leg

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3
Q

Direct pressure on globe consequence

A

Cerebral Retinal artery occlusion

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4
Q

Saphenous nerve injury consequence

A

Parasthesia along medial & anteromedial CALF

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5
Q

Femoral nerve injury consequence

A

Absent knee-jerk reflex

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6
Q

Most common peri operative eye injury is

A

Corneal eye abrasion

*this is why we tape eyes

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7
Q

Median nerve injury consequence

A

Inability to oppose 1st and 5th digit

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8
Q

Radial nerve injury consequence (2)

A

Wrist drop
Ape hand

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9
Q

Ulnar nerve injury consequence

A

Claw hand

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10
Q

Anterior Tibial nerve injury

A

Foot drop

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11
Q

Sciatic Nerve injury consequence

A

Foot drop

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12
Q

Common Peroneal nerve injury consequence

A

Foot Drop

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13
Q

Shunt

A

More blood flow than O2 exchange

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14
Q

Dead space

A

Less blood flow than alveolar gas exchange

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15
Q

Factors that increase shunt

A

COPD
Pulm edema
Pneumonia

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16
Q

Factors that increase dead space

A

anything that decreases perfusion to well ventilated alveoli
Hemorrhage
Hypovolemia/hypotension
Pulmonary embolism
anticholinergic drugs

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17
Q

IRV

A

Inspiratory reserve volume

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18
Q

ERV

A

Expiratory reserve volum

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19
Q

RV

A

Residual volume

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20
Q

Inspiratory Capacity (IC) =

A

IRV + TV

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21
Q

FRC =

A

ERV + RV

Whatis left risidually after exhale of quiet breathing (TV)

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22
Q

VC (vital capacity) =

A

IRV+Vt+ERV

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23
Q

Expiratory reserve volume (ERV)

A

the amount of volume that can be expired with effort past quiet expiration

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24
Q

Functional Residual Capacity

A

the amount of air in the lungs after normal respiration

ERV + RV

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25
Q

Function of gases remaining the in the lungs at the end of expiration (FRC) (3)

A
  1. prevent alveolar collapse
  2. continue to oxygenate pulmonary blood flow through the cappilaries
  3. allows non hypoxic apnea and is the reserve of O2
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26
Q

Inspiratory reserve volume (IRV)

A

extra volume of air that can be inspired with maximal effort after reaching the end of normal, quiet respiration

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27
Q

Tidal Volume

A

Amount of air that moves in and out of the lungs during quiet respiration

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28
Q

Vital capacity

A

the greatest volume of breath that can be expelled from lungs after taking the deepest possible breath

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29
Q

Inspiratory capacity

A

maximum volume of air that can be inspired
TV+IRV

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30
Q

Total lung capacity

A

volume in the lungs after maximal effort inspiration

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31
Q

Arterial Baroreceptor reflex is a ____ loop

A

negative feedback

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32
Q

Arterial baroreceptor location (3)

A
  1. Carotid sinuses
  2. Aortic Arch
  3. Pulmonary arteries
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33
Q

baroreceptors responsible for position changes are mostly in

A

Carotid Sinus

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34
Q

_____ blocks the Bezold-Jarisch Reflex

A

Ondansetron

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35
Q

How does gravity effect going from standing to supine

A

Blood no longer goes as much to legs and feet = increased blood volume in thoracic compartment

increased preload and stroke volume

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36
Q

Reverse trendelenburg is

A

head up

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37
Q

Reverse trendelenburg BP head vs heart

A

BP head < BP heart

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38
Q

Trendelenburg is

A

head down

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39
Q

Trendelenburg BP head vs heart

A

BP head > BP heart

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40
Q

dead space is:

A

the volume of breath that does not participate in gas exchange

41
Q

Physiologic or total deadspace is the sum of

A

anatomic dead space +alveolar dead space

42
Q

Anatomic deadspace definition and examples

A

volume of gas within conducting zone

ex) trachea, bronchus, bronchioles, terminal bronchioles

43
Q

Anatomic deadspace volume in upright position (amount)

A

2mL/kg

44
Q

cardia reflexes are

A

fast acting loops between heart and CNS

regulate cardiac function and maintain homeostasis

45
Q

Components of cardiac relfexes (5)

A
  1. Sensor and stimulus
    2.afferent nerves
    3.Processor
    4.Efferent nerves
    5.Effector
46
Q

Bainbridge relfex

A

IV infusion increases R. atrial pressure –> stimulate R. atrial receptors–>increase HR and increase CO

47
Q

Baroreceptor relfex

A

Increased CO –> increased arterial pressure —>decrease HR

48
Q

Bezold - Jarisch relfex complex

A

Orthostasis –> decrease CO and BP–>decrased LV end diastolic volume –>LV mechanoreceptors—>increase in vagal efference and decrease in sympathetic tone –>syncope

49
Q

Bezold - Jerisch reflex basic MOA and result

A

Decreases HR by inhibiting sympathetic drive

causes hypotension and peripheral dilation

50
Q

Alveolar dead space

A

volume of gas within unperfused alveoli

51
Q

Ratio of physiologic dead space to tidal volume is usually

A

1:3

52
Q

Factors that increase dead space are

and examples

A

anything that decreases perfusion to well-ventilated alveoli

PA thrombis, hemorrhage, hypotension, surgical manipulation of pulmonary tree

53
Q

Anticholinergic drugs increase ______ by _____

A

increase dead space by impairing ventilation rather than perfusion

54
Q

Alveolar ventilation is

A

the portion of oxygen that reaches the alveoli and takes part in gas exchage

55
Q

Normal alveolar ventilation

A

4L/min

56
Q

Normal perfusion (CO) is

A

5 L/min

57
Q

What causes reduction in FRC?

A

Changes from upright to supine OR
lateral to prone

58
Q

Reduction in FRC causes

A

Airway closer in dependent lung regions

59
Q

Early airway closure leads to

A

decreased ventilation in dependent regions

60
Q

Factors that cause early airway closure are _____ (3) and cause ____

A
  1. position
  2. obesity
  3. elderly

cause closing capacity

61
Q

closing capacity

A

volume of air that is not utilized d/t early airway closure

62
Q

compliance is best at the _____ of the lung due to ______

A

best at the base of the lung due to gravity

63
Q

Perfusion is best at the _____ of the lung due to _____

A

best at the base of the lung due to gravity

64
Q

V/Q ratio is highest at the _____ and lowest at the ____

A

highest at the top of the lung, lowest at the base of the lung

65
Q

Surgical factors that affect V/Q relationship (3)

A
  1. GA
  2. Mechanical ventilation
  3. Position
66
Q

Gradient between V/Q occur in _____ of the lung fields reguardless of ____

A

occur in vertical axis regardless of position

67
Q

Worst V/Q mismatch occurs in the (position)

A

lateral decubitus positioning

68
Q

area of atelectasis causes

A

shunt (no gas exchange occurs in spite of perfusion)

69
Q

Avg. Lung blood flow in lateral position

A

60% to dependent lung, 40% to non dependent

70
Q

Aortocaval syndrome and causes

A

supine hypotensive syndrome

Great vessels compressed by large abdominal mass or gravida uterus

71
Q

What position?

A

Lithotmy

72
Q

most Lithotomy nerve injury is ____ and can cause _____

A

Common peroneal injury can cause foot drop

73
Q

Complication of reverse trendelburg and sitting position (3)

A
  1. systemic hypotension
  2. Higher risk for cerebral ischemia
  3. air embolism
74
Q

Compression of the chest/abdomen in prone position causes (3)

A
  1. CVP increased but LV volume is reduced
  2. Decreased venous return
  3. Increased intrathoracic pressure
75
Q

Prone position complications (5)

A
  1. post op vision loss
  2. Neck torison from turning head
  3. Extreme rotation (occlusion of arteries)
  4. Brachial plexus injury
  5. Increased intrathoracic pressure
76
Q
A

Lateral decubitus

77
Q

Lateral decubitus can cause

A
  1. V/Q mismatch
  2. decreased circulation to elevated kidney
  3. Brachial plexus injury (axillary roll)
78
Q

Compression of dependent tissues can cause _____ (most common in _____).

A

Rhabdomylosis with acute renal failure (most common in in lateral position)

79
Q

Factors that contribute to nerve injuries (5)

A
  1. Ancillary positioning devices
  2. Prolonged surgical procedures (>4hrs)
  3. Anesthetic technique
  4. Body habitus
  5. Pre-existing conditions
80
Q

Dependent tissues in position can lead to _____

A

Edema and ischemic injury with peripheral nerve injury

81
Q

Most commonly injured nerve

A

Ulnar nerve injury

82
Q

Ulnar nerve injury manifestation

A

claw hand

83
Q

Brachial plexus injury occurs during (3)

A
  1. Arm used as lever during prone position
  2. spreading of sternum (OHS)
  3. Axillary block
84
Q

C5-7 spinal nerves innervate

A

serratus anterior muscle

85
Q

Radial nerve injury manifestation

A

wrist drop

86
Q

Median nerve injury manifestation

A

ape hand

87
Q

Common peroneal nerve is a branch of the

A

sciatic nerve

88
Q

Most frequently damaged nerve in lower extremities is

A

Common peroneal nerve

89
Q

Common peroneal nerve injury results in

A

foot drop

90
Q

Anterior tibial nerve injury results in

A

foot drop

91
Q

Foot drop nerves:

A
  1. Sciatic nerve
  2. Common peroneal nerve
  3. Anterior tibial nerve
92
Q

Femoral nerve injury occurs from ____ position

A

lithotomy

93
Q

Femoral nerve injury manifestation

A

absent knee jerk reflex

94
Q

Saphenous nerve injury occurs when

A

foot is suspended lateral to a vertical brace

-compresses against medial tibial condyle

95
Q

Obturator nerve injury occurs from ___ position

A

Lithotomy

96
Q

Obturator nerve injury manifestation

A

inability to adduct leg

97
Q

Lithotomy position nerve injures ():

A
  1. Femoral nerve
  2. Obturator nerve
  3. Common peroneal (most common)
98
Q
A

Priniclpes Of Anesthesia (19 decks)

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