neurospine

Question 1

Dexamethasone in spine surgery

Answer 1

contraindicated- bone healing

Question 2

transfusion: 4 unit PRBCs

Answer 2

1 unit FFP

Question 3

transfusion: 6 unit PRBCs

Answer 3

1 unit platelet

Question 4

transfusion: 10 unit PRBCs

Answer 4

1 cryo

Question 5

fluid management in prone preference-

Answer 5

5% albumin

Question 6

pain management contraindications in spine surgery

Answer 6

dexamethasone
aspirin/NSAIDS
gabapentin controversial

Question 7

causes of POVL

Answer 7

ischemic optic neuropathy (compartment syndrome within optic nerve)
central retinal artery occlusion

Question 8

RF for POVL

Answer 8

male, obese, DM
duration of surgery
blood loss
wilson frame

Question 9

to reduce risk of POVL in prone, what fluid consideration?

Answer 9

no greater than 40 ml/kg of crystalloid no matter EBL

albumin 5% good

Question 10

to reduce risk of POVL outside of fluids:

Answer 10

minimize hypotension and anemia

no deliberate hypotension in spine surgery (outdated practice)

Question 11

cases requiring prone:

Answer 11

posterior fusion fixation of cervical spine
posterior thoracic spine
posterior lumbar surgery

Question 12

cases able to be supine:

Answer 12

anterior fusion fixation of the upper cervical spine
anterior cervicothoracic spine surgery
ALIF

Question 13

cervical procedure considerations:

Answer 13

minimize neck motion/stabilize neck
fiberoptic/glidescope
awake intubation
MEP- no NMB
keep map >80
test for airway patency (deflate cuff) before extubating

Question 14

cases lateral:

Answer 14

anterior thoracic spine

Question 15

surgery requires prone and supine/lateral:

Answer 15

combined anterior and posterior instrumentation of the thoracic and lumbar spine

Question 16

thoracolumbar neurosurgical procedure considerations: (trans thoracic approach)

Answer 16

TIVA
OLV
no NMB if MEP

Question 17

thoracoscopic or anterior abdominal approaches:

Answer 17

NMB maintained until spine surgery complete

Question 18

general extubation considerations:

Answer 18

always extubate supine
consider leak test
if difficult intubation, may leave intubated overnight

Question 19

BP parameters in thoracolumbar surgeries: young adults and elderly

Answer 19

no MAP < 60 young adult

no MAP < 80 is elderly

Question 20

urine output prone

Answer 20

lower than expected

Question 21

increased abdominal pressure does what to HGFR?

Answer 21

decreases it

Question 22

Allows pt to be moved from supine to prone without being moved off table

Answer 22

Jackson table

Question 23

Childs pose table

Answer 23

Andrews table

Question 24

always put what for MEP?

Answer 24

soft bite blocks! to avoid tongue laceration

Question 25

Hypotension during neurosurgical procedure- things/causes to consider:

Answer 25

could be s/t: abdominal compression, decreased venous return, blood loss from epidural vein engorgement, abdominal compression, or vascular injury
if persists despite aggressive fluid/blood admin, suspect bleeding into retroperitoneal space/abdomen
alert surgeon
hemorrhage?

Question 26

Hypotension could cause:

Answer 26

nerve injury
blindness
bowel or ureteral injury

Question 27

lateral oblique position

Answer 27

brachial plexus injury

Question 28

tumor debunking, avoid:

Answer 28

narcotics, depress rest function and raise PCO2