Exam II: Anesthesia for Ortho Surgery Flashcards by Linsley Lloyd

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

arthritic joints/deformities

How well did you know this?

Not at all

Perfectly

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

ROM
neck

How well did you know this?

Not at all

Perfectly

common to ortho pts:
- require careful _____

positioning

How well did you know this?

Not at all

Perfectly

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

OR table

How well did you know this?

Not at all

Perfectly

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

full stomachs

How well did you know this?

Not at all

Perfectly

common to ortho pts:
- may have increased ____

bleeding

How well did you know this?

Not at all

Perfectly

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

fat
DVT
PE

How well did you know this?

Not at all

Perfectly

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

radiation

How well did you know this?

Not at all

Perfectly

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

progressive
synovial

How well did you know this?

Not at all

Perfectly

RA has multiple joint involvement, ______

deformity

How well did you know this?

Not at all

Perfectly

RA: _____ lines and _______ challenges

invasive
monitoring

How well did you know this?

Not at all

Perfectly

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

cervical
TMJ
mouth

How well did you know this?

Not at all

Perfectly

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

c-spine
awake fiberoptic intubation

How well did you know this?

Not at all

Perfectly

RA: _____ _____ - hoarseness, airway obstruction

cricoarytenoid arthritis

How well did you know this?

Not at all

Perfectly

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

NSAID
GI
renal
platelet

How well did you know this?

Not at all

Perfectly

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

pericardial
myocarditis
conduction
valve fibrosis (AR)

How well did you know this?

Not at all

Perfectly

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

pleural effusions
pulm fibrosis

How well did you know this?

Not at all

Perfectly

RA hematology: ____, ____ dysfxn, thrombocytopenia

anemia
platelet

How well did you know this?

Not at all

Perfectly

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

adrenal
immune

How well did you know this?

Not at all

Perfectly

RA derm: ____ ____ skin from skin and steroids

thin atrophic

How well did you know this?

Not at all

Perfectly

Positioning: done mostly after pt is _____

anesthetized

How well did you know this?

Not at all

Perfectly

Positioning: usually ____, sitting ____ ____ or prone

supine
lateral decubitis

How well did you know this?

Not at all

Perfectly

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

face
eyes and nose
face

How well did you know this?

Not at all

Perfectly

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

air embolus
head and neck
N2O

How well did you know this?

Not at all

Perfectly

Positioning: ____ over ____ may impede ventilation

arms chest

Positioning: sitting can reduce ____ ____ pressure

cerebral perfusion

Positioning: ____ injuries

stretch

Regional anesthesia: excellent advantages but can be _____

unreliable

Regional anesthesia: supplement with ___ ___

IV opioids

Regional anesthesia: may be used for ____ extremity surgery

upper

Regional anesthesia: reduced ___ ___ in some surgeries

blood loss

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

bier

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

neuraxial or peripheral

Shoulder Surgery: ____ or "____ ___" positions

lateral or "beach chair"

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

ears, eyes, bony areas

Shoulder Surgery: may utilize ____ during procedure [Airway]

LMA

Shoulder Surgery: controlled _____

hypotension

Shoulder Surgery: ____ pressure during arthoscopic surgery

irrigation

Shoulder Surgery: associated with ____ injury

nerve

Shoulder Surgery: ____ possible in "beach chair" position

VAE

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

external auditory meatus willis

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

lower hydrostatic

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

7.5 10

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

knee shoulder elbow wrist hip ankle

Arthroscopic Surgery: ___ invasive with ____ blood loss

less reduced

Arthroscopic Surgery: ___ surgical field

bloodless

Arthroscopic Surgery: ____ incision with ____ postop pain

minor less

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

blood pressure nontourniquet

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

60-80 mmHg High long

Spinal Surgery: most often to _____ cord or nerve root

decompress

Spinal Surgery: ____ and ____ surgeons perform

neuro and ortho

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

instrumentation rods screws

Spinal Surgery: GA with or w/o _____

paralysis

Spinal Surgery: _____ may need to deflate lung

transthoracic

Spinal Surgery: airway challenges - ____ position, ____ immobility

prone cervical

Spinal Surgery: can be done ____ or ____ approach

posterior anterior

Spinal Surgery: may develop a ____ leak requiring a ____

CSF VCM

Cervical Spinal Surgery: ___, ___ or ____ position

prone sitting supine

Cervical Spinal Surgery: arthritic conditions may cause ____ issues

ROM

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

TMJ jaw

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

atlantoaxial

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

airway

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

awake fiberoptic

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

arteries and veins pulse oximeter

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

RLN

Cervical Spinal Surgery: airway swelling could be issue _____

post-op

Cervical Spinal Surgery: identify an document preexisting ____ deficits

neuro

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

head and neck

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

coughing or bucking

Lumbar Spinal Surgery: can be minimally ____ or more extensive

invasive

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

brachial plexus arms/shoulders

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

venous return cephalad

Lumbar Spinal Surgery: long procedures lead to ___ ___ loss

large blood

Spinal Fusion: fusion of ___ or more vertebra are indicaed

Spinal Fusion: ___ grafting autologous or cadaveric

bone

Spinal Fusion: artificial ____ is inserted into space

disk

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

2 vertebra

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

hold place collapse

Spinal Fusion Implications: identify and document _____ _____ deficits

preexisting neuro

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

eyes, ears, nose, breast, genitalia

Spinal Fusion Implications: limited access to ____, ____ leads

airway, monitoring leads

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

longer temp

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

blood cell

Spinal Fusion Implications: ____ pt may have restrictive lung dz

scoliosis

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

spine

Both Anterior and Posterior Approach: ____ approaches during surgery

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

abdominal anterior vertebrae

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

prone

Both Anterior and Posterior Approach: ____ vs ____

ALIF vs PLIF

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

cervical, thoracic, and lumbar

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

neuromuscular

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

saturation monitor toe retractors

Wilson frame:

spinal operation bed device that uses a convex saddle frame

Mirrored ___ ___ for prone positioning

face cradle

__-___ for spinal sx

O-arm

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

elderly, frail, debilitated, dehydrated

Hip Fracture: ____ postition

supine

Hip Fracture: ____ table

fracture

Hip Fracture: ____ is applied to the fracture

traction

Hip Fracture: ____ post

perineal

Hip Fracture: ____ arm is placed on chest

ipsilateral

Hip Fracture: hypo____ and hyper____ ____ can be used

hypobaric hyperbaric SAB

Hip Fracture: ___ embolism common

fat

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 ___ ____

carefully traction ipsilateral brachial plexus

Hip Replacement: typical patient is ____, likely ___ hx

elderly arthritic

Hip Replacement: blood ____ can be large

loss

Hip Replacement: ____ ___ position allowing greater ROM

lateral decubitis

Hip Replacement: ____ incision

large

Hip Replacement: prosthetic can be _____ or _____

cemented or uncemented

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

pulm fxn

Hip Replacement: ____/____ roll

axillary/chest

Hip Replacement: ___ arm supported and stabilized

upper

Hip Replacement: down ____ should be flat or no pressure

ear

Knee Replacement: usually elderly, ____

arthritic

Knee Replacement: ____ position

supine

Knee Replacement: _____ utilized

tourniquet

Knee Replacement: more ____ than hip replacement

painful

Knee Replacement: high incidence of ____

DVT

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

femoral LFC, Obt, FN Femoral

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

arthoscopic

Knee Replacement: prosthetics cemented to ____ and ____

femur and tibia

Closed Reduction: usually very ____ procedures

short

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

hips, shoulders, wrists, elbows, fingers

Closed Reduction: shorting acting _____ usually required

paralysis

Closed Reduction: may be done with ____ ventilation

mask

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

propofol

Methylmethacrylate Cement: used to bind _____ to bone

prosthetic

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

exothermic blood cells

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

intermedullary

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

SVR thromboplastin

Bone Cement Implantation Syndrome: ___ migrate to pulmonary system

emboli

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

hypotension hypoxia CO shunt FiO2 hydration

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

blood loss

Pneumatic Tourniquet: exsanguination - ____ bandage, distal to proximal

esmarch

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

nerve bundle

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.

BP pulse 100 50

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

>2 hrs nerve

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

SVR CVP PVR

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)

acidosis HR Temperature hypotension

physiologic changes caused by limb tourniquets

Tourniquet Pain: usually an ____ after tourn. inflation

hour

Tourniquet Pain: increase in ___ & ___

HR & BP

Tourniquet Pain: ischemia, ___ ___ compression

nerve fiber

Tourniquet Pain: burning, ____ aching, ____ pain

dull throbbing

Tourniquet Pain: __-____ - unmyelinated, slow conducting

C-fibers

Tourniquet Pain: ___ analgesics minimally effective

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

opioids

Tourniquet Pain: deflation for __-__ ___ can help

10-15 mins

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

level

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

A-fibers

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

femur and tibia

Long Bone Fractures: fat embolism syndrome (triad)

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

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

DVT PE VAE

Fat embolus: common in fractures of ____ and ____

femur and tibia

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

pulm pulm alveolar pulm

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

12-24 (petechiae, dyspnea, confusion)

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

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

urine conjuctiva

Fat embolus: coexisting ____ disease at greater risk

lung

Fat embolus: treatment is (3)

- O2 - fluids - steroids

Fat embolus: aggressive ____

ventilation

DVT and PE: more common after ____ and ____

THA and TKA

DVT and PE: mechanisms (3)

- venous stasis - hypercoagulable state - plt aggregation

DVT and PE: ____ greatly contributes to problem

tourniquet

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

reduces plasminogen and plasminogen activators

DVT and PE: may be attributed to allowing early _____

ambulation

DVT and PE: utilization of _____

anticoagulants

Orthopedic PE Case Study

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?

Orthopedic PE Case Study cont’d

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

Orthopedic PE Case Study cont’d

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.

Post Op Pain Mgmt - ____ and IV ____

NSAIDs and IV opioids

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

- improved anesthesia - decreased total opioid consumption - increased pt/nurse satisfaction

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

opioids and LAs

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

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