Ortho- Spine Flashcards
1
Q
Positioning for spine surgery:
anterior approach
A
- Used for access to upper thoracic and cervical spine
- GETA- possibly awake fiberoptic
- Supine, bilateral arms tucked
- Good IV access- possibly 2 IVs d/t tucking of arms
- Possible airway edema
- EBL is minimal if no vascular surgery
- SSEP monitoring
2
Q
Positioning for spine surgery:
posterior approach
A
- For access to mid thoracic spine and below
- GETA on stretcher
- Prone- chest rolls or specialized frame
- Arms often in superman position
- Facial edema, eyes
- check eyes frequently
- risk for blindness
- Pad pressure points, groin and breasts
- SSEP
3
Q
Positioning for spinal surgery:
lateral approach
A
- For access to thoracic spine
- May require one-lung ventilation
- double lumen ETT, bronchial blocker, lung packed
- A-line to check ABGs
- Causes VQ mismatch
- Axillary chest roll
- ***some spine surgeries will require position changes to all these positions
4
Q
What is your first consideration with cervical spine surgery?
A
- Is the neck stable?
- Position pts head to comfort while awake
- avoid sniffing position and cricoid pressure
- Consider awake fiberoptic intubation
- If procedure is long with prolonged traction, may want to leave them intubated
5
Q
Anesthetic considerations for cervical spine surgery
A
- Requires GA
- Airway compromise and vascular injury can occur
- hematoma/carotid artery damage causes rapid blood loss
- unilateral recurrent nerve damage
- Post op pain can be controlled with cervical plexus block
6
Q
What approach is usually used for cervical spine surgery?
A
- Anterior approach
- Esophagus and trachea medial
- sternocleidomastoid and carotid sheath lateral
- Following discectomy, vertebrae fused with bone, plates, and or screws to prevent dislocation
- *retraction of trachea extremely stimulating
- arms tucked- check IVs before tucking
- Also can be done with posterior approach
- sitting- risk for air embolism
- prone- risk for eye damage, fluid overload, and airway edema
7
Q
What is spinal stenosis?
A
Narrowing of the spinal canal
8
Q
What is scoliosis?
What problems is it associated with?
A
- Lateral and rotational curvature of spine
- Restrictive pulmonary dysfunction
- chronic hypoxia
- hypercapnia
- pulmonary vascular constriction
- this can eventually lead to right ventricular hypertrophy and cor pulmonale
9
Q
Thoracolumbar spinal surgery:
What are the types of surgery?
position?
What kind of monitoring may be required?
A
- Types of thoracolumbar spine surgery
- discectomy
- harrington rod
- fracture stabilization
- scoliosis correction
- tumor resection
- Positioning: prone, maybe anterior or lateral
- monitoring?
- SSEP
- MEPS
- wake up test
10
Q
What are hemodynamic concerns during thoracolumbar surgery?
Monitoring?
A
- Considerable EBL
- depends on number of segments fused
- 3-4 units autologous
- cell saver
- induced hypotension (MAP 55-60)
- Aline, CVP, PA cath, foley
- Risk of VAE
11
Q
Lumbar spine surgery:
What types are there?
positioning?
EBL?
A
- Discectomy, laminectomy, fusion
- Prone position
- EBL depends on number of segments fused
12
Q
What is SSEP?
A
- Helps determine surgical impingement on spinal roots
- monitors dorsal column pathways of posterior spinal cord (sensory)
- SSEPs recorded by stimulating peripheral afferent nerves
- If nerve is intact, electrical potential will transmit to contralateral sensory cortex
- Recording electrodes are placed on the scalp and on the cervical spine
- Amplitude, shape, and latencies of the responses are monitored
- Need to establish a reproducible baseline recording prior to any positioning or surgical manipulations
- Changes from baseline are most important indictors of neurological dysfunction
13
Q
How does anesthetic gas affect SSEP?
A
14
Q
What are the anesthetic considerations when monitoring SSEPs?
A
- Inhaled anesthetics can alter the evoked responses
- VA at 0.5 MAC with 50% N2O decrease amplitude and prolong latency of SSEP
- IV anesthetics have no affect- TIVA is a good option
- NMB do not impact SSEP
- Decrease in SSEP signal despite no change in anesthetic or no surgical changes may mean hypotension- Nerves need blood too!
15
Q
What is MEPS?
A
- Motor evoked potentials
- recorded from muscles following transcranial stimulation of the motor cortex to the peripheral muscles
- Used to ensure the integrity of the descending motor tracts of the spinal cord
- sensitive to volatile anesthetics
- affected by muscle relaxation
- sometimes ok with only two twitches
- have bite block in mouth because stimulations can movement
- communicate with neuro monitoring tech
