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S5 - Principles III - Test 4 > GU/Ortho > Flashcards

GU/Ortho Flashcards

1
Q

what anesthetic techniques are used for common peds GU procedures?

(circumcision, hypospadius, orchiopexy, inguinal hernia)

A

GA +/- regional blocks or caudals

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2
Q

which 3 procedures are associated with a high risk of laryngospasm?

A

foreskin, hernia, and testes retraction

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3
Q

what is a hypospadius/chordee?

A

urethra opens on the underside of the penis

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4
Q

what is MAGPI?

what is it for?

A
  • meatal advancement and glanuloplasty
  • hypospadius/chordee
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5
Q

what is an orchiopexy?

A
  • undescended testes repair to pull them down into the scrotum
  • may require fixation
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6
Q

airway considerations for hypospadius vs orchiopexy?

A

hypospadius can use LMA

orchiopexy must have ETT: probable laryngospasm, need deep anesthesia & NMB

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7
Q

what block is sometimes used for circumcision?

A

penile block

*done by surgeon ptl

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8
Q

what is ureteral reimplantation for?

considerations?

A
  • reflux at the ureter/bladder junction
  • procedure lasts several hours, heavy retractor use
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9
Q

what anesthetic techniques work well for a ureteral reimplantation?

A

GA + caudal

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10
Q

what is a pyeloplasty for?

A

GU reflux at the ureter/kidney pelvis junction

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11
Q

positioning for a pyeloplasty

A

usually done lateral with kidney flexion, sometimes prone

(Lisa says 50/50)

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12
Q

anesthetic techniques used for pyeloplasties

A

regional gaining popularity

*caudals do NOT work well

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13
Q

which GU procedure is only done unilaterally - ureteral reimplantation or pyeloplasty

why?

A

pyeloplasy is only unilateral - to avoid kidney failure with bilateral swelling

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14
Q

what is a nephrectomy used for?

A
  • non-functioning, dysplastic kidney, stones, cancer
  • or chronic disease causing anemia, HTN
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15
Q

positioning for nephrectomy?

consideration if doing partial nephrectomy vs total?

A
  • lateral with kidney flexion or prone
  • partial nephrectomy has an increased risk of high blood loss
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16
Q

what is bladder and cloacal extrophy?

A

failure of abdominal wall to close over anterior bladder wall

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17
Q

what other anomalies are often seen with bladder and cloacal extrophy?

A
  • CV defects
  • cloacal exstrophy - omphaloceles, spinal defects, imperforate anus›
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18
Q

surgical plan for bladder and cloacal exstrophy?

intra-op complication often seen?

A
  • high intraoperative third space loss
  • staged repair (closure of bladder, urethra, abdominal wall)
  • requires MANY procedures, sometimes over years
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19
Q

classifications of scoliosis

A
  • idiopathic (unknown etiology)
  • congenital (spina bifida)
  • neuromuscular (Duchenne MD)
  • mesenchymal (arthrogryposis)
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20
Q

how is pulmonary compromise determined in scoliosis?

when do we see respiratory changes?

A
  • pulmonary compromise correlates with degree of curve
  • vital capacity begins to decrease at 60°
  • becomes severe at 100°
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21
Q

what is the difference in neuromuscular scoliosis patients vs others?

(patho, major risk)

A
  • deteriorating muscle function + mechanical distortion
  • prolonged PTT and decreased factor VII activity
  • higher blood loss - 5 x higher risk than idiopathics
  • TXA routine for NMs in many centers
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22
Q

what two factors indicate a high risk scoliosis repair?

A

non-ambulatory + 60º curve

23
Q

in a little toddler bby, what would be a much safer/option if possible to do instead of a big open scoliosis repair?

A

serial casting

24
Q

three huge considerations for posterior spinal fusions

A

long

bloody

high risk

25
Q

pre-op for spinal fusions

*kinda long pls break up

A
  • thorough history
  • CBC, electrolytes, coags (other diagnostics if indicated based on history)
  • PRBCs must be available – confirm with blood bank
  • detailed informed consent
  • describe post-op scenario (ICU, edema, pain mgt, etc.)
26
Q

large ass list of things that should be done before flipping

what is the very last thing done before flipping?

A

last thing: disconnect EVERYTHING

  • 2 large IVs (at least 1 warmed)
  • blood set-up
  • arterial line
  • foley
  • esophageal temp probe
  • bite block
  • eyes lubed/taped securely
  • evoked potential electrodes in place
27
Q

positioning for spinal fusion

what can be used to minimize cardiac (??) effects?

A

prone

Jackson table may minimize cardiac effects

28
Q

major positioning risk for spinal fusions

A

post-op vision loss usually due to ischemic optic neuropathy and unrelated to globe pressure

*document eye checks

29
Q

T/F: post-op vision loss after spinal fusion is usually due to increased globe pressure

A

false

usually due to ischemic optic neuropathy and unrelated to globe pressure

30
Q

biggest risk factors for complications from positioning for spinal fusions

A

>6 hours

high blood loss

[I think these are the risk factors for vision loss specifically]

31
Q

a 2º C drop in core temp has what effects?

A

3 times increased risk of wound infection

32
Q

what monitors are used for spinal fusion?

A
  • standards
  • art line
  • SSEP/MEP
  • foley
33
Q

do we use NMBs in spinal fusion cases?

why or why no?

A

no - need to use SSEP

34
Q

considerations/complications for spinal fusions

(not related to their eye balls)

A
  • huge 3rd space loss
  • high blood loss
  • long procedures (5-10 hrs)
35
Q

post-op considerations for spinal fusions

A
  • ICU post-op
  • consider PCA for post-op pain mgt
36
Q

*dumb as heck

instruments used for spinal fusions

A
  • pedicle screws
  • vertical expandable prosthetic titanium rib rod (VEPTR)
  • Harrington rods
37
Q

MAP goal for controlled hypotension?

considerations and meds often used

A
  • MAP goal: 50-65 mmHg
  • must have AL
  • drugs: opioids, precedex, clonidine, calcium channel blockers
38
Q

what can be used for hemodilution?

A

either colloid or crystalloid

39
Q

what is the most common antifibrinolytic used for spinal fusion?

what type of patients benefit from this the most?

A

TXA

neuromuscular scoliosis pts show the most significant results

40
Q

if the patient has dilutional thrombocytopenia, what do we give?

A

platelets

41
Q

if the patient is “oozy” what do we give?

A

FFP

and draw coags

42
Q

if the patient has refractory bleeding what do we give?

A

novo 7

43
Q

what are ways to manage blood loss during spinal fusions? (8)

A
  • controlled hypotensin
  • hemodilution
  • autologous and/or directed donation
  • antifibrinolytics
  • cell saver
  • plts
  • FFP
  • novo 7
44
Q

which is more vulnerable to ischemia during hardware insertion - motor pathways or sensory pathways?

why?

A

motor - perfused by single anterior spinal artery

45
Q

what are the three ways to check for intact motor pathways during spinal fusion?

which one isnt used much anymore?

A
  • SSEP (used with MEP) – doesn’t this only tests sensory, not motor?
  • MEP (now being used alone)
  • wake-up test - not used as much
46
Q

anesthetic effects on SSEP?

A
  • decrease amplitude
  • increase latency
47
Q

what is key to successful evoked potential monitoring?

A

communication

48
Q

what drugs should be avoided when monitoring evoked potentials?

A
  • nitrous - significant EP depression
  • volatiles > 0.5 MAC
  • muscle relaxants (if using MEPs; little effect on SSEPs)
49
Q

what drugs preserve EP and are ok to use during SSEP monitoring? (6)

A
  • propofol
  • opioids
  • ketamine
  • etomidate
  • dexmedetomidine
  • clonidine
50
Q

common anesthetic technique when monitoring SSEP

A

propofol infusion +

opioid infusion (remifentanil or sufentanil)

51
Q

why is wake-up testing sometimes done?

what is an absolute must?

A
  • ensure sensory and motor pathways remain intact throughout procedure
  • must have good pre-op education
52
Q

how do we do wake-up testing?›

A
  • anesthetic lightened after hardware insertion
  • patient told to move feet
  • after bilateral foot movement confirmed, patient “re-induced
53
Q

problems with wake-up testing

A
  • HTN
  • tachycardia
  • blood loss
  • risk of recall during period of light anesthesia

S5 - Principles III - Test 4 (7 decks)

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