Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Principles A > Ortho - Spine > Flashcards

Ortho - Spine Flashcards

1
Q

Most spine surgeries require what type of anesthetic?

A

GETA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Long procedures (6-8 hrs) that are associated with decreased chest wall compliance + restrictive lung disease + risk of large blood loss

A

Scoliosis surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What findings might be present on EKG in a patient with scoliosis?

A

RVH: V1-V4 R wave progression
RAE: wide P wave in lead II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

anticipate _______ with corrective scoliosis surgery

A

large blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

______ ________ can occur If patient has received > 2 L crystalloids intraop

A

dilutional coagulopathy (need to give albumin or blood products)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

scoliosis surgery may require ________, but can have consequences if autoregulation/CPP not maintained.

A

intentional hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Expect partial paralysis of diaphragm & cervical spine injury if these 4 muscles are noted to be flaccid?

A

deltoid
biceps
brachialis
brachio-radialis
** innervated by C5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Occurs with complete spinal cord transection above T5/T6

A

autonomic hyperreflexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

C3,4,5 keeps….

A

the DIAPHRAGM alive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SCI above the cardiac accelerator nerves leads to:

A

BRADYCARDIA
T1-T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SCI at T5 & higher leads to:

A

sympathectomy = hypotension
** DOC = midodrine (A1 agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the DOC for hypotension r/t SCI at or below T5?

A

midodrine (A1 agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Severe transient HTN, bradycardia, dysrhythmia’s, severe HA, vision changes, N/V, & anxiety are symtpoms of:

A

autonomic hyperreflexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Below the level of SCI, you would expect the patient to have cold, dry skin d/t:

A

autonomic hyperrelflexia (reflexive SNS response to pain)
cutaneous vasoconstriction & HTN BELOW level of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Above the level of the SCI, you would expect the patient to have hot, diaphoretic skin d/t:

A

autonomic hyperreflexia (lack of PNS compensation)
cutaneous vasodilation ABOVE injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some causes of autonomic hyperreflexia in a patient with a SCI?

A
  • distended/full bladder or bowels
  • noxious stimuli (surgical)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How can we prevent autonomic hyperreflexia?

A
  • deepen anesthetic
  • remove stimuli (drain bladder)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If autonomic hyperreflexia does occur, how do we treat it?

A

deepen anesthetic + direct/fast acting vasodilators (nitroprusside, hydralazine, phentolamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SCI at C3-C5 can result in:

A

diaphragm paralysis –> respiratory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

SCI at C5 - T7 can result in:

A

risk of infection from atelectasis & inability to cough d/t impairment of abdominal & intercostal support of respirations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

inability to maintain constant core temperature

A

poikilothermic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

inability to vasoconstrict BELOW level of SCI and disrupted temp sensations leads to:

A

poikilothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can we help a SCI patient maintain constant core temp?

A
  • warm IVF
  • warm air/bare hugger
  • increase OR temp if possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

airway management issues are more common in _____ & _____ spine cases

A

cervical & thoracic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

severe kyphoscoliosis can result in:

A

CV compromise (pulm HTN~cor pulmonale)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

flaccid deltoid & biceps can be a sign of:

A

cervical spine fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Recall the 6 P’s of a neurovascular assessment:

A
  • pain
  • poikilothermia
  • paraesthesia
  • paralysis
  • pulselessness
  • pallor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What type of X-ray may be required to better visualize atlanto-axial instability?

A

LATERAL x-ray
**esp in RA pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When is regional or neuraxial anesthesia good for spine pts?

A
  • lumbar laminectomy 1-2 levels (if no upper level involvement)
  • disc surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How can we facilitate low venous pressure to surgical site (aka minimize blood loss) with positioning?

A
  • maintaining a free abdomen
  • reverse trendelenburg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Position for a cervical spine surgery with an ANTERIOR approach?

A

SUPINE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Position for a cervical spine surgery with an POSTERIOR approach?

A

PRONE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

This position is uncommon in spine procedures and is associated with what risk?

A

sitting = VAE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which THORACIC surgical approach requires a DLT or bronchial blocker to drop a lung?

A

ANTERIOR approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

A patient undergoing an anterior thoracic surgery will require what airway equipment?

A

DLT or bronchial blocker

36
Q

Placement of a DLT to collapse the lung on the operative side may be required for surgery above ____

A

T8

37
Q

A patient undergoing a posterior (prone) thoracic surgery will require what airway equipment?

A

single lumen ETT

38
Q

What does supine laparotomy mean for an anterior lumbar spine procedure?

A

pt is supine + a surgical incision into the abdominal cavity

39
Q

What preop medication should a patient receive if procedure requires the prone position?

A

anti-sialogogue
- scope patch, glycopyrrolate
glyco safer in elderly (does not cross BBB = less confusion)

40
Q

After a patient has been turned prone and anes circuit is reconnected, what should you check?

A

assess for BL breath sounds

41
Q

You notice the patient has periorbital &/or circumoral edema after being prone for the procedure, this may also indicate:

A

likely vocal cords also have edema –> caution with extubation (may need to go to ICU and keep intubated until edema subsides)

42
Q

If using a wilson frame what should you check on the patient?

A
  • males = genitalia
  • females = breasts
    **free from pressure
43
Q

Where should arms be if patient is in the prone position?

A

superman or surrender position with <90 degree adduction

44
Q

Abdominal pressure from prone position can lead to:

A
  • increased intrathoracic pressure
  • decreased FRC & pulm compliance
  • decreased venous return
  • increased bleeding from epidural vein pressure
45
Q

What’s a major complication for pts when going prone?

A

POVL - postop visual loss

46
Q

What are 3 causes of POVL?

A
  • ischemic optic neuropathy (ION)
  • retinal artery/vein occlusio
  • cortical brain ischemia
47
Q

Cause of POVL that can occur without any pressure on the eyes?

A

ION - ischemic optic neuropathy
** blood loss >1000mL, long surgery >6hrs, male, obese, decreased colloid use

48
Q

How can we prevent ION (ischemic optic neuropathy)?

A
  • head neutral/midline
  • blood transfusion/colloids
  • minimize intentional hypoT
49
Q

Cortical brain ischemia can lead to POVL from:

A

intentional hypotension

50
Q

Which 2 table frames allow the abdomen to “hang free” = no pressure on abdomen?

A
  • andrew’s frame
  • jackson spine table
51
Q

Prone effects on the cardiovascular system:

A
  • pooling of blood in extremities
  • compression of abdominal muscles
  • decrease VR/preload, CO, BP
52
Q

Prone effects on respiratory system:

A
  • compression of abdomen & thorax
  • decrease total lung compliance
  • increase WOB
53
Q

Prone effects on neuro system?

A

extreme head rotation = decrease venous drainage & CBF

54
Q

What is the most stable prone positioning device?

A

Mayfield tongs (pins in head)

55
Q

What should you have ready to prepare for possible blood loss & transfusion in a spine case?

A
  • 2 large bore PIVs
  • 2 units PRBCs in OR cooler
  • blood tubing primed & set up in blood warmer
56
Q

What is a cell saver?

A

“Cell savers” are instruments that collect blood lost during surgery. The RBCs are washed with normal saline and concentrated to make an approximate 225 mL unit with a hematocrit of ~ 55%. RBC units can be either directly transfused into the patient or washed again and stored

57
Q

What is the ABL formula?

A

(Initial Hct - target Hct) / initial Hct

58
Q

When EBL is anticipated to be 500-1000mL, what can be done preoperatively?

A

autologous blood donation 2-4 wks prior

59
Q

Autologous blood donation is contraindicated in:

A

significant cardiac disease & infection

60
Q

Tranexemic acid (TXA) dosages:

A

10 mg/kg IV bolus
gtt: 2 mg/kg/hr
**max = 2.5g

61
Q

Aminocaproid acid (Amicar) dosages:
**not as common anymore

A

100 mg/kg IV bolus
gtt: 10-15 mg/kg/hr

62
Q

This is done in shoulder & hip surgeries but is not recommended for spinal surgeries d/t risk of end-organ ischemia:

A

intentional hypotension
**surgeon may still request it

63
Q

used to assess/preserve sensory & motor neurological function during spine procedures?

A

neurophysiologic monitoring
- SSEP
- MEP
- EMG

64
Q

SSEP stands for:

A

somatosensory evoked potential

65
Q

MEP stands for:

A

motor evoked potential

66
Q

What does SSEP monitor?

A

the dorsal (afferent) column pathways of the spinal cord that are responsible for proprioception & vibration
**impulse comes from peripheral nerve & measured centrally

67
Q

What does MEP monitor?

A

the anterior (efferent) portion of spinal cord
**impulse triggered in brain and monitored in specific muscle groups

68
Q

These are adverse effects of which neurophysiological monitoring:
- cognitive defects
- seizures
- intraop awareness
- scalp burns
- cardiac arrhythmia’s
- bite injuries

A

MEPs

69
Q

MEP monitoring should be avoided in what 3 main patients?

A
  • active seizures
  • vascular brain clips (heat)
  • cochlear implants
70
Q

monitors nerve root injury during pedicle screw placement & nerve decompression:

A

EMG - electromyogram

71
Q

describes the signal strength

A

AMPLITUDE

72
Q

the time it takes for a signal to travel through spinal cord

A

LATENCY

73
Q

Name 6 cofounding factors that can affect amplitude & latency of neuro monitoring?

A

o Hypotension
o Hypothermia
o Hypocarbia
o Hypoxia
o Anemia
o Anesthetics

74
Q

How do volatile agents affect amplitude & latency of neuro monitoring?

A

dose dependent (keep at 0.5 MAC or less)
- decrease in amplitude
- increase in latency

75
Q

Which anesthetic agent should be eliminated with MEP monitoring?

A

Nitrous Oxide

76
Q

Best anesthetic option for procedures requiring neuro monitoring?

A

TIVA - opioids, ketamine, versed
**but MEPs are depressed with propofol

77
Q

If performing MEPs, what meds should be avoided?

A
  • NMBA (but ok for induction)
  • propofol
78
Q

If there are acute changes in amplitude/latency then:

A

STOP surgery

79
Q

Spine surgery pts may require postop ventilation if:

A
  • long case (>4 hrs = prone/airway edema)
  • thoracic cavity invasion
  • EBL >30ml/kg or > 2L
  • facial/laryngeal edema
  • preop VC < 30-35% of predicted
80
Q

How do you assess for laryngeal edema if pt has facial swelling after being prone in a spine case?

A

deflate ETT cuff –> check for leak
– if no cuff leak = airway edema = keep intubated & go to ICU

81
Q

Caution with this multimodal analgesic in postop spine cases:

A

NSAIDs = bleeding

82
Q

What are some multimodal analgesics for postop pain mgmt for spine cases?

A
  • multimodal
  • systemic opioids (PCA)
  • LA infiltration wound
  • intrathecal (spinal) morphine: 0.1-0.2 mg + LA
  • continuous epidural infusion
  • erector spinae block
83
Q

What’s the dose of epidural hydromorphone PF (preservative free)?

A

0.5 - 1 mg

84
Q

What spine procedure has the highest risk for VAE?

A

LAMINECTOMY
** b/c large amount of exposed bone & surgical site is above heart

85
Q

Signs of VAE intraop?

A

unexplained hypotension
increased end-tidal nitrogen
decreased ETCO2

Advanced Principles A (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions