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NUNA 692 Principles III > Exam II: Anesthesia for Ortho Surgery > Flashcards

Exam II: Anesthesia for Ortho Surgery Flashcards

1
Q

common to ortho pts:
- many have _____ ____/____

A

arthritic joints/deformities

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2
Q

common to ortho pts:
- many have limited _____ in ____

A

ROM
neck

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3
Q

common to ortho pts:
- require careful _____

A

positioning

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4
Q

common to ortho pts:
- may need help moving to ___ ___

A

OR table

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5
Q

common to ortho pts:
- fracture pts may have ____ ____

A

full stomachs

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6
Q

common to ortho pts:
- may have increased ____

A

bleeding

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7
Q

common to ortho pts:
- increased risk for ____ emboli, ____, and ____

A

fat
DVT
PE

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8
Q

common to ortho pts:
- exposure to larges amounts of _____

A

radiation

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9
Q

RA is an immune related, ______ inflammation of _____ joints, not just wear and tear

A

progressive
synovial

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10
Q

RA has multiple joint involvement, ______

A

deformity

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11
Q

RA: _____ lines and _______ challenges

A

invasive
monitoring

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12
Q

RA: ____ and ____ issues - check neck ROM, ____ opening

A

cervical
TMJ
mouth

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13
Q

RA: atlantoaxial subluxation: ____ films to evaluate and determine if ____ ____ ____ is indicated if >5mm instability exists

A

c-spine
awake fiberoptic intubation

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14
Q

RA: _____ _____ - hoarseness, airway obstruction

A

cricoarytenoid arthritis

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15
Q

RA: r/t to chronic ____ use, ____ bleeding, ____ toxicity, ____ dysfxn

A

NSAID
GI
renal
platelet

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16
Q

RA CV: ____ thickening and effusions, _____, coronary arteritis, _____ defects, cardiac ____ _____

A

pericardial
myocarditis
conduction
valve fibrosis (AR)

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17
Q

RA pulm: ____ _____, pulm nodules, interstitial ___ ____

A

pleural effusions
pulm fibrosis

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18
Q

RA hematology: ____, ____ dysfxn, thrombocytopenia

A

anemia
platelet

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19
Q

RA endocrine: ____ insufficiency (steroid rx), impaired ____ system

A

adrenal
immune

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20
Q

RA derm: ____ ____ skin from skin and steroids

A

thin atrophic

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21
Q

Positioning: done mostly after pt is _____

A

anesthetized

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22
Q

Positioning: usually ____, sitting ____ ____ or prone

A

supine
lateral decubitis

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23
Q

Positioning: protect ____ from injury - ____ and ____, may require padding ____

A

face
eyes and nose
face

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24
Q

Positioning: sitting increases risk for ___ ____, ___ and ___ in neutral position, some recommend avoiding ____

A

air embolus
head and neck
N2O

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25
Q

Positioning: ____ over ____ may impede ventilation

A

arms
chest

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26
Q

Positioning: sitting can reduce ____ ____ pressure

A

cerebral perfusion

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27
Q

Positioning: ____ injuries

A

stretch

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28
Q

Regional anesthesia: excellent advantages but can be _____

A

unreliable

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29
Q

Regional anesthesia: supplement with ___ ___

A

IV opioids

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30
Q

Regional anesthesia: may be used for ____ extremity surgery

A

upper

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31
Q

Regional anesthesia: reduced ___ ___ in some surgeries

A

blood loss

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32
Q

Regional anesthesia: ____ block commonly utilized for many wrist and hand surgeries

A

bier

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33
Q

Regional anesthesia: inserted ____ or ____ nerve catheters allow continuous infusions in the post op period

A

neuraxial or peripheral

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34
Q

Shoulder Surgery: ____ or “____ ___” positions

A

lateral or “beach chair”

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35
Q

Shoulder Surgery: positioning challenge, ____, ____, ____ areas

A

ears, eyes, bony areas

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36
Q

Shoulder Surgery: may utilize ____ during procedure
[Airway]

A

LMA

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37
Q

Shoulder Surgery: controlled _____

A

hypotension

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38
Q

Shoulder Surgery: ____ pressure during arthoscopic surgery

A

irrigation

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39
Q

Shoulder Surgery: associated with ____ injury

A

nerve

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40
Q

Shoulder Surgery: ____ possible in “beach chair” position

A

VAE

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41
Q

Cerebral Perfusion Pressure: level of the ____ ____ ____ and tragus = circle of ____ that estimates CPP

A

external auditory meatus
willis

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42
Q

Cerebral Perfusion Pressure: ____ pressure than level of the heart due to the vertical column and _____ pressure difference

A

lower
hydrostatic

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43
Q

Cerebral Perfusion Pressure: formula: __ mmHg for each ____ cm

A

7.5
10

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44
Q

Arthroscopic Surgery: used for k___, s____, e____, w___, h___, a____

A

knee
shoulder
elbow
wrist
hip
ankle

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45
Q

Arthroscopic Surgery: ___ invasive with ____ blood loss

A

less
reduced

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46
Q

Arthroscopic Surgery: ___ surgical field

A

bloodless

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47
Q

Arthroscopic Surgery: ____ incision with ____ postop pain

A

minor
less

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48
Q

Arthroscopic Surgery: reduced ___ ___ on _____ joints optimizes surgical field

A

blood pressure
nontourniquet

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49
Q

Arthroscopic Surgery: irrigation fluid ___-___ ____ distends joint. ____ pressure with ____ duration associated with subq emphysema and tension pneumo

A

60-80 mmHg
High
long

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50
Q

Spinal Surgery: most often to _____ cord or nerve root

A

decompress

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51
Q

Spinal Surgery: ____ and ____ surgeons perform

A

neuro and ortho

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52
Q

Spinal Surgery: multilevel ______ with plates, ____, ____ for spinal instability

A

instrumentation
rods
screws

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53
Q

Spinal Surgery: GA with or w/o _____

A

paralysis

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54
Q

Spinal Surgery: _____ may need to deflate lung

A

transthoracic

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55
Q

Spinal Surgery: airway challenges - ____ position, ____ immobility

A

prone
cervical

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56
Q

Spinal Surgery: can be done ____ or ____ approach

A

posterior
anterior

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57
Q

Spinal Surgery: may develop a ____ leak requiring a ____

A

CSF
VCM

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58
Q

Cervical Spinal Surgery: ___, ___ or ____ position

A

prone
sitting
supine

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59
Q

Cervical Spinal Surgery: arthritic conditions may cause ____ issues

A

ROM

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60
Q

Cervical Spinal Surgery: ROM issues include -
_____ dysfxn, limited ____ opening

A

TMJ
jaw

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61
Q

Cervical Spinal Surgery: ROM issues include -
____ instability, limited neck ROM

A

atlantoaxial

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62
Q

Cervical Spinal Surgery: ROM issues include -
potential ____ mngmnt challenge

A

airway

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63
Q

Cervical Spinal Surgery: ROM issues include -
may require ____ ____ intubation

A

awake fiberoptic

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64
Q

Cervical Spinal Surgery: major ____ and ____ are nearby (check distal ____) can utilize ear probe ____

A

arteries and veins
pulse
oximeter

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65
Q

Cervical Spinal Surgery: potential _____ injury, some surgeons dont want MRs used

A

RLN

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66
Q

Cervical Spinal Surgery: airway swelling could be issue _____

A

post-op

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67
Q

Cervical Spinal Surgery: identify an document preexisting ____ deficits

A

neuro

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68
Q

Cervical Spinal Surgery: prevent too much ____ and ____ traction (pad)

A

head and neck

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69
Q

Cervical Spinal Surgery: ____ or ____ must be prevented, LTA kit indicated

A

coughing or bucking

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70
Q

Lumbar Spinal Surgery: can be minimally ____ or more extensive

A

invasive

71
Q

Lumbar Spinal Surgery: prone position using prone chest rolls, ____ ____ at risk, ___/___ less than 90 degrees

A

brachial plexus
arms/shoulders

72
Q

Lumbar Spinal Surgery: abdominal compression impedes ___ ___, diaphragm is ____ decreasing FRC and VT

A

venous return
cephalad

73
Q

Lumbar Spinal Surgery: long procedures lead to ___ ___ loss

A

large blood

74
Q

Spinal Fusion: fusion of ___ or more vertebra are indicaed

A

2

75
Q

Spinal Fusion: ___ grafting autologous or cadaveric

A

bone

76
Q

Spinal Fusion: artificial ____ is inserted into space

A

disk

77
Q

Spinal Fusion: plates, rods, screws stabilize the ___ ___

A

2 vertebra

78
Q

Spinal Fusion: restores the correct distance between vertebra as a “cage” is constructed to ___ the vertebra in ____ and prevent ____

A

hold
place
collapse

79
Q

Spinal Fusion Implications: identify and document _____ _____ deficits

A

preexisting neuro

80
Q

Spinal Fusion Implications: pressure off ___, ___, ____, ____. blindness can occur, ischemic nose or chin

A

eyes, ears, nose, breast, genitalia

81
Q

Spinal Fusion Implications: limited access to ____, ____ leads

A

airway, monitoring leads

82
Q

Spinal Fusion Implications: ____ procedures, warm patient, ___ monitors

A

longer
temp

83
Q

Spinal Fusion Implications: greater ___ loss, ___ saver, T&CM

A

blood
cell

84
Q

Spinal Fusion Implications: ____ pt may have restrictive lung dz

A

scoliosis

85
Q

Spinal Fusion Implications: major vessels are in close proximity to the ____

A

spine

86
Q

Both Anterior and Posterior Approach: ____ approaches during surgery

A

2

87
Q

Both Anterior and Posterior Approach: supine, open ____ cavity, dissect down to ____ ____

A

abdominal
anterior vertebrae

88
Q

Both Anterior and Posterior Approach: turn patient ___ and continue surgery posteriorly

A

prone

89
Q

Both Anterior and Posterior Approach: ____ vs ____

A

ALIF vs PLIF

90
Q

Both Anterior and Posterior Approach: can be done for ___, ____, and ___ spinal issues

A

cervical, thoracic, and lumbar

91
Q

Both Anterior and Posterior Approach: _____ monitoring indicated d/t artery of Adamkiewicz

A

neuromuscular

92
Q

Both Anterior and Posterior Approach: supine spinal sx may be done with O2 ____ ____ on ____ to monitor vessel occlusion by _____

A

saturation monitor
toe
retractors

93
Q

Wilson frame:

A

spinal operation bed device that uses a convex saddle frame

94
Q

Mirrored ___ ___ for prone positioning

A

face cradle

95
Q

__-___ for spinal sx

A

O-arm

96
Q

Hip Fracture: typically e____, f____, d____, d____ patients with pre-existing comorbid conditions

A

elderly, frail, debilitated, dehydrated

97
Q

Hip Fracture: ____ postition

A

supine

98
Q

Hip Fracture: ____ table

A

fracture

99
Q

Hip Fracture: ____ is applied to the fracture

A

traction

100
Q

Hip Fracture: ____ post

A

perineal

101
Q

Hip Fracture: ____ arm is placed on chest

A

ipsilateral

102
Q

Hip Fracture: hypo____ and hyper____ ____ can be used

A

hypobaric
hyperbaric
SAB

103
Q

Hip Fracture: ___ embolism common

A

fat

104
Q

Fracture table: the patient must be moved ____ with continuous ____ on the fractured limb. The ____ arm is positioned on an arm board or sling without stretching the ___ ____

A

carefully
traction
ipsilateral
brachial plexus

105
Q

Hip Replacement: typical patient is ____, likely ___ hx

A

elderly
arthritic

106
Q

Hip Replacement: blood ____ can be large

A

loss

107
Q

Hip Replacement: ____ ___ position allowing greater ROM

A

lateral decubitis

108
Q

Hip Replacement: ____ incision

A

large

109
Q

Hip Replacement: prosthetic can be _____ or _____

A

cemented or uncemented

110
Q

Hip Replacement: bilateral hip surgery contraindicated if declining ____ ____ occurs after first hip sx

A

pulm fxn

111
Q

Hip Replacement: ____/____ roll

A

axillary/chest

112
Q

Hip Replacement: ___ arm supported and stabilized

A

upper

113
Q

Hip Replacement: down ____ should be flat or no pressure

A

ear

114
Q

Knee Replacement: usually elderly, ____

A

arthritic

115
Q

Knee Replacement: ____ position

A

supine

116
Q

Knee Replacement: _____ utilized

A

tourniquet

117
Q

Knee Replacement: more ____ than hip replacement

A

painful

118
Q

Knee Replacement: high incidence of ____

A

DVT

119
Q

Knee Replacement: many regional anesthetic options - ____ 3 in 1 block (____, ____, ___) combined with spinal. _____ catheter utilized for post op pain control

A

femoral
LFC, Obt, FN
Femoral

120
Q

Knee Replacement: many times an older, at risk, out of shape population vs young, active, inshape ______ knee surgery

A

arthoscopic

121
Q

Knee Replacement: prosthetics cemented to ____ and ____

A

femur and tibia

122
Q

Closed Reduction: usually very ____ procedures

A

short

123
Q

Closed Reduction: h____, s_____, w____, e_____, f____

A

hips, shoulders, wrists, elbows, fingers

124
Q

Closed Reduction: shorting acting _____ usually required

A

paralysis

125
Q

Closed Reduction: may be done with ____ ventilation

A

mask

126
Q

Closed Reduction: done many times with _____ bolus since short time (usually mins) are required for reduction success

A

propofol

127
Q

Methylmethacrylate Cement: used to bind _____ to bone

A

prosthetic

128
Q

Methylmethacrylate Cement: ____ reaction occurs, hardens cement and expands, lysis of _____ _____ and marrow

A

exothermic
blood cells

129
Q

Methylmethacrylate Cement: _____ HTN - embolization of air, fat, marrow, cement

A

intermedullary

130
Q

Methylmethacrylate Cement: systemic absorption - decreased ____ leads to vasodilatory effects, release of tissue _____, plt aggregation, microemboli formation

A

SVR
thromboplastin

131
Q

Bone Cement Implantation Syndrome: ___ migrate to pulmonary system

A

emboli

132
Q

Bone Cement Implantation Syndrome: hypo____, hypo____, reduced ____, dysrhythmias, s____, PHTN, increase ____, adequate h_____.

A

hypotension
hypoxia
CO
shunt
FiO2
hydration

133
Q

Pneumatic Tourniquet: utilized to minimize ___ ___ and optimize surgical field

A

blood loss

134
Q

Pneumatic Tourniquet: exsanguination - ____ bandage, distal to proximal

A

esmarch

135
Q

Pneumatic Tourniquet: cuff overlap should be i80 degrees from ___ ____

A

nerve bundle

136
Q

Pneumatic Tourniquet: inflation pressure determined by ____, some tourniquets will have ____ sensor. Typically, ____ torr lower extremity and ____ torr upper extremity over SBP. Venous tourniquet can occur.

A

BP
pulse
100
50

137
Q

Pneumatic Tourniquet: neuro damage may occur if _____ or if overlap is over ____ bundle

A

> 2 hrs
nerve

138
Q

Physiologic effects of tourniquets: during inflation, initial rise in ____, ____, ____ d/t displaced blood volume (300-500 mL) exsanguination

A

SVR
CVP
PVR

139
Q

Physiologic effects of tourniquets: during deflation you see metabolic ____ d/t increased K+ and increased CO2, ____ increase, ____ decrease, hypo____ (most common) d/t sudden reduction of SVR and PVR and wash out of ischemic metabolites (thromboxane)

A

acidosis
HR
Temperature
hypotension

140
Q

physiologic changes caused by limb tourniquets

A
141
Q

Tourniquet Pain: usually an ____ after tourn. inflation

A

hour

142
Q

Tourniquet Pain: increase in ___ & ___

A

HR & BP

143
Q

Tourniquet Pain: ischemia, ___ ___ compression

A

nerve fiber

144
Q

Tourniquet Pain: burning, ____ aching, ____ pain

A

dull
throbbing

145
Q

Tourniquet Pain: __-____ - unmyelinated, slow conducting

A

C-fibers

146
Q

Tourniquet Pain: ___ analgesics minimally effective

A

IV

147
Q

Tourniquet Pain: ____ added to the LA have been shown to help

A

opioids

148
Q

Tourniquet Pain: deflation for __-__ ___ can help

A

10-15 mins

149
Q

Tourniquet Pain: quality/intensity of block vs ____ of block

A

level

150
Q

Tourniquet Pain: __-____ - pinprick, tingling after deflation

A

A-fibers

151
Q

Long Bone Fractures: fracture of ____ and ____, fat is released into the circulation

A

femur and tibia

152
Q

Long Bone Fractures: fat embolism syndrome (triad)

A

petechiae (axillary, subconjunctival), dyspnea, confusion (mental changes)

153
Q

Long Bone Fractures: ____, ____, and ____ can occur

A

DVT
PE
VAE

154
Q

Fat embolus: common in fractures of ____ and ____

A

femur and tibia

155
Q

Fat embolus: fat globules are released into the blood and impair _____ perfusion, endothelial damage to ____ capillaries, ____ wall damage, ____ congestion

A

pulm
pulm
alveolar
pulm

156
Q

Fat embolus: fat embolus syndrome triad occurs ___-___ hours later

A

12-24
(petechiae, dyspnea, confusion)

157
Q

Fat embolus: tachycardia and/or ____ segment changes may also occur.

A

ST

158
Q

Fat embolus: fat in the ____ and sputum, _____ may be present

A

urine
conjuctiva

159
Q

Fat embolus: coexisting ____ disease at greater risk

A

lung

160
Q

Fat embolus: treatment is (3)

A
  • O2
  • fluids
  • steroids
161
Q

Fat embolus: aggressive ____

A

ventilation

162
Q

DVT and PE: more common after ____ and ____

A

THA and TKA

163
Q

DVT and PE: mechanisms (3)

A
  • venous stasis
  • hypercoagulable state
  • plt aggregation
164
Q

DVT and PE: ____ greatly contributes to problem

A

tourniquet

165
Q

DVT and PE: epidural or spinal anesthesia ____ DVT. Higher levels of ______ and _____ activators, hyperkinetic blood flow

A

reduces
plasminogen and plasminogen activators

166
Q

DVT and PE: may be attributed to allowing early _____

A

ambulation

167
Q

DVT and PE: utilization of _____

A

anticoagulants

168
Q

Orthopedic PE Case Study

A

58 y.o. male health hip replacement

During prosthetic rod placement sudden and profound drop in BP
ETCO2 = 5 mmHg, BP = 43/16, ETO2 = 95, SpO2 = 79%
10 minutes later ABG’s
pCO2 = 53, pH = 7.29, pO2 = 56, Sat = 81%
CO2 A-a gradient = 51, O2 A-a gradient 60

What has happened?

What are we intrapulmonary shunt or dead space ventilation?

169
Q

Orthopedic PE Case Study cont’d

A

Why the odd pulmonary gas numbers?

Large amount of embolic material wedged in pulmonary artery blocking perfusion to lungs
Ventilation without perfusion = dead space ventilation

Blood CO2 unable to diffuse to lungs b/c of a reduced perfusion to gas-exchanging alveoli units
Mathematically, more CO2 being produced than can be eliminated

Lung O2 unable to diffuse to blood b/c of reduction in perfused gas exchanging alveoli units
Mathematically, more O2 in blood consumed than replenished by the lungs

170
Q

Orthopedic PE Case Study cont’d

A

Why the hemodynamic numbers?

Venous return cut in half
Decreased preload = decreased stroke volume = decreased cardiac output = decreased BP

Decreased BP results in inadequate perfusion combined with a decreased PO2(hypoxemia) results in tissue hypoxia results in anaerobic cellular respiration and lactic acid buildup = decreased pH.

Hyperkalemia or hypokalemia?
PVCs and dysrhythmias occurring.

171
Q

Post Op Pain Mgmt - ____ and IV ____

A

NSAIDs and IV opioids

172
Q

Post Op Pain Mgmt: systemic opioids via PCA device leads to (3)

A
  • improved anesthesia
  • decreased total opioid consumption
  • increased pt/nurse satisfaction
173
Q

Post Op Pain Mgmt: intra-articular injection is a combo of ____ and ____s.

A

opioids and LAs

174
Q

Post Op Pain Mgmt: continous post-op neuraxial and peripheral analgesia allows for (3)

A
  • better pain relief/lower pain scores
  • faster ambulation/rehab
  • better post-op joint mobility

NUNA 692 Principles III (20 decks)

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