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Advanced Principles A (Spring 2025) Grayson's Cards > Orthopedic Anesthesia > Flashcards

Orthopedic Anesthesia Flashcards

1
Q

What are the two biggest factors associated with development of osteoporosis?

A
  • Elderly age
  • Menopause
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2
Q

What hormonal changes are characteristic of osteoporosis?

A
  • ↑ PTH
  • ↓ Vit D
  • ↓ HGH
  • ↓ Insulin-like growth factors
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3
Q

What are the four most common meds used to treat osteoporosis?

A

dronate drugs
- Fosamax (Alendronate)
- Actonel (Risedronate)
- Boniva (Ibandronic Acid)
- Reclast (Zoledronate)

meds that ↑ bone density, prevent post-menopausal osteoporosis

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4
Q

What 5 fractures are common in pts w/ osteoporosis?

A
  1. stress fractures
  2. compression fx of thoracic/lumbar spine
  3. proximal femur fx
  4. proximal humerus fx
  5. wrist fx
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5
Q

Osteoarthritis is the loss of ________ ________.

A

Articular Cartilage - bone on bone

leads to inflammation

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6
Q

What are 6 symptoms of Osteoarthritis?

A
  1. pain
  2. crepitance
  3. decreased mobility
  4. joint deformity
  5. Herberden Nodes
  6. Bouchard Nodes
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7
Q

Differentiate between Bouchard’s nodes and Heberden’s nodes.

A
  • Bouchard’s = proximal interphalangeal joints
  • Heberden’s = distal interphalangeal joints
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8
Q

What 6 meds are typically used for OA management?

A
  1. NSAIDs: Meloxicam
  2. Opioids
  3. COX-2 inhibitors: Celebrex
  4. Topical Voltaren
  5. Intra-articular steroids
  6. Chondroprotective agents: Glucosamine, Chondroitin
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9
Q

What is a risk factor w/ Voltaren being absorbed systemically?

A

Peptic ulcer disease

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10
Q

What drug is the most common chondroprotective agent that helps protect the articular joint?

A

Glucosamine

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11
Q

What anesthetic considerations should be given to glucosamine?

A

Glucosamine needs to be stopped two weeks prior to surgery due to PLT aggregation inhibition.

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12
Q

Arthritis characterized by morning stiffness that improves throughout the day is….

A

Rheumatoid arthritis

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13
Q

Arthritis that is characterized by worsening symptoms throughout the course of the day is…

A

Osteoarthritis

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14
Q

Rheumatoid Arthritis is a ________ and ________ inflammatory disease.

A

Chronic & Systemic

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15
Q

What is RA characterized by?

A

joint synovial tissue/connective tissue inflammation
* bone erosion
* cartilage destruction
* impaired joint integrity

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16
Q

What are 5 symptoms of RA?

A
  1. pain & stiffness
  2. anorexia
  3. fatigue
  4. weakness
  5. subcutaneous nodules around joints, extensor surfaces, and bony prominences
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17
Q

What labs are typically elevated in a patient with rheumatoid arthritis?

A
  • ↑ Rheumatoid factor (RF)
  • ↑ Anti-immunoglobulin antibody
  • ↑ C-reactive protein (CRP)
  • ↑ Erythrocyte Sedimentation Rate (ESR)
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18
Q

What common dose of stress dose glucocorticoid is used for RA patients?

A

50mg hydrocortisone (Solu-cortef)

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19
Q

What two TNFα inhibitors are commonly used to treat RA?

A
  • Infliximab
  • Etanercept
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20
Q

Which of the following drugs treat RA?
- Methotrexate
- Hydroxychloroquine
- Sulfasalazine
- Leflunomide

A

Trick question. All of them do
- Methotrexate: antimetabolite
- Hydroxychloroquine: antimalarial/antirheumatic
- Sulfasalazine: anti-inflammatory
- Leflunomide: disease modifying antirheumatic drugs (DMARDs)

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21
Q

What airway concerns should be considered with RA patients?

A
  • Limited TMJ movement
  • Narrowed glottic opening
  • Cricoarytenoid arthritis
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22
Q

Where is the most instability typically located in the cervical spine of RA patients?

A

Atlantoaxial Junction

(be careful not to displace the odontoid process and impinge on the c-spine or vertebral arteries)

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23
Q

What are the signs and symptoms of atlantoaxial subluxation?

A
  • Headache
  • Neck pain
  • Extremity paresthesias (especially with movement)
  • Bowel/bladder dysfunction
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24
Q

What airway management techniques can be used when there is concern for atlantoaxial subluxation?

A
  1. video laryngoscopy
  2. manual in-line stabilization
  3. awake fiberoptic
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25
Q

What are the signs/symptoms of vertebral artery occlusion?

A
  • N/V
  • Dysphagia
  • Blurred Vision
  • Transient LOC changes
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26
Q

What ocular syndrome is typical of RA patients?

A

Sjogren’s syndrome

(Dry eyes and mouth)

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27
Q

What pulmonary issues are associated with RA?

A
  • Interstitial fibrosis
  • Restricted ventilation

affects a:A gradient, closing volumes, Vt, & TLC

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28
Q

What type of ventilatory settings would be utilized for an RA patient exhibiting a restrictive ventilatory pattern?

A

Pressure Control @ 5mL/kg

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29
Q

What vascular issues are associated w/ RA?

A

Vasculitis/Vascular Disease

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30
Q

What Cardiac Issues are associated w/ RA?

A
  • pericarditis
  • cardiac tamponade
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31
Q

T/F: RA can cause gastric ulcers, but does not lead to renal issues.

A

False.
RA causes gastric ulcers (NSAID use) & renal insufficiency.

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32
Q

Orthopedic Injuries are associated w/ what 3 big complications?

A
  1. significant hemorrhage
  2. shock
  3. fat emboli
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33
Q

What artery is typically injured due to pelvic fractures? Where is the bleeding located in this instance?

A

Iliac artery → retroperitoneal space bleeding

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34
Q

What is the typical worst complication of long bone fractures?

A

Bone marrow fat embolism

Leading to thromboembolic hypoxic respiratory failure

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35
Q

What technique is used for intubation of a patient who has c-spine concerns?

A

MILS

Manual In-Line Stabilization

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36
Q

Describe the MILS technique

A
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37
Q

How long and at what rate should O2 be delivered before RSI?

A

100%, 10-15 L/min @ least 3 min

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38
Q

What is the mechanism of action of warfarin?

A

Warfarin inhibits Vitamin K epoxide reductase and limits the availability of Vitamin K throughout the body

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39
Q

What is the mechanism of action of LMWH?

A

LMWH binds to antithrombin thus → no thrombin → no fibrinogen forming into fibrin

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40
Q

What are some typical triggers for delirium?

A
  • Hypoxemia
  • Hypotension
  • Hypercarbia
  • Sleep Deprivation
  • Hypervolemia
  • Infection
  • Electrolyte abnormalities
  • Pain
  • Benzos
  • Anticholinergics
  • Circadian Rhythm disruption
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41
Q

What are 3 CNS concerns that should be assessed post-op?

A
  1. attention & awareness deficits
  2. irritability & anxiety
  3. paranoia & hallucinations
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42
Q

FEV₁ decreases by ___% for each decade of life.

A

10%

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43
Q

What occurs with closing volume as we age?

A

Closing volume increases.

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44
Q

What is the goal of regional anesthesia vs general anesthesia?

A

Avoid:

  • DVT
  • PE
  • EBL
  • Respiratory complications
  • Death

& improved pain managment!

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45
Q

Fat Emboli are common w/ which types of fractures?

A
  • pelvic, femoral
  • long bone trauma
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46
Q

What causes a fat embolus?

A
  • release/displacement of fat droplets into the venous system
  • fx releases mediators that affect the solubility of lipids in circulation
  • embolus goes systemic
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47
Q

With placement of what device is fat embolism syndrome most likely to occur?

A

Femoral Medullary Canal Rod

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48
Q

What is the s/s Triad of fat embolism syndrome?
When do s/s typically present?

A
  1. Dyspnea
  2. Confusion
  3. Petechiae

Typically presents in 12 - 72 hrs

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49
Q

What lab findings are noted with fat embolism syndrome?

A
  • Fat macroglobulinemia
  • Anemia
  • Thrombocytopenia
  • ↑ ESR
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50
Q

What is ESR? What are normal values for males and females?

A
  • Erythrocyte Sedimentation Rate
  • Male: 0 - 22 mm/hr
  • Female: 0 - 29 mm/hr
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51
Q

What does the fat emboli obstruct?

A
  • end organ capillaries - fat is metabolized to free fatty acids
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52
Q

What are the systemic inflammatory responses to fat emboli?

A
  • inflammatory cell invasion
  • cytokine release = ↑ HR, ↓ BP, dyspnea, confusion
  • pulm endothelial injury
  • pulm edema
  • ARDS
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53
Q

What minor s/s can be construed to characterize fat embolization syndrome?

A
  • Fever
  • ↑HR
  • Jaundice
  • Renal Changes
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54
Q

What are the respiratory sxms of Fat Emboli Syndrome?

A
  • mild hypoxemia
  • bilateral alveolar infiltrates
  • dyspnea, edema
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55
Q

What are the neuro sxms of Fat Emboli Syndrome?

A
  • drowsiness, confusion, obtundation, coma
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56
Q

What type of rash can be seen w/ Fat Emboli Syndrome?

A
  • Petechial Rash: conjunctiva, oral mucosa, skin folds of chest/neck/axilla
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57
Q

What are the anesthetic management techniques for fat embolization syndrome?

A

Supportive Therapy
- 100% FiO₂
- No N₂O
- IV Heparin
- CV & Resp support

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58
Q

What factors contribute to the development of DVT’s?

A
  • Lack of Prophylaxis
  • Obesity
  • > 60yrs old
  • > 30min procedure
  • Tourniquet use
  • > 4 days immobilization
  • > Lower extremity fracture
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59
Q

Which three surgery types present the greatest risk for DVT formation?

A
  • Hip surgery
  • TKA
  • Lower extremity trauma
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60
Q

When does LMWH need to be initiated?

A

12 hours preop
or
12 hours postop

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61
Q

Can neuraxial anesthesia be done after LMWH has been given?

A

Yes, if 10 - 12 hours after the dose.

Delay next dose 4 hours.

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62
Q

Can an epidural be placed in a patient on LMWH anticoagulation therapy?

A

No. No indwelling catheters

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63
Q

Neuraxial catheters must be removed ___ hours before the intiation of LMWH therapy.

A

2 hours

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64
Q

Can a patient have neuraxial anesthesia if on warfarin?

A

Only if the INR is ≤ 1.5

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65
Q

Flip card for Anticoagulation guidelines for Neuraxial procedures.

A
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66
Q

Flip card for additional Anticoagulation guidelines for Neuraxial procedures.

A
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67
Q

What advantages does neuraxial anesthesia present in the prevention of DVT’s?

A
  • ↑ extremity venous blood flow (sympathectomy).
  • LA systemic anti-inflammatory properties.
  • ↓ PLT reactivity
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68
Q

What is the maximum dose of TXA? (Tranexamic Acid)

A

2.5 g

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69
Q

What is typical dosing of TXA?

A

10 - 30 mg/kg

1000mg is typical

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70
Q

What is the MOA of TXA?

A
  • anti-fibrinolytic that competitively inhibits breakdown of fibrin clots.
  • blocks binding of plasminogen and plasmin to fibrin
  • prevents breakdown of clots
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71
Q

When should we be cautious using TXA?

A

Pts @ risk of VTE, MI, CVA, TIA
* can cause CV post-op complications

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72
Q

What are the main contraindications to using TXA?

A
  • DVT/PE in 12mos
  • DVT/PE anticoagulation treatment
  • cardiac stent in 1 yr
  • DIC
  • Seizures
  • active clotting
  • SAH
73
Q

Tourniquet pain typically begins ___ minutes after application.

A

45 min

  • increased HR & BP, diaphoresis
74
Q

The width of a tourniquet must be greater than ____ its diameter.

75
Q

How long can tourniquets be placed on an extremity?

A
  • 2 hours is typically not exceeded
  • 3 hours is max.
76
Q

What mmHg is typically used for thigh tourniquets?

A

300 mmHg
(or 100 mmHg > SBP)

77
Q

What mmHg is typically used for arm tourniquets?

A

250 mmHg
(or 50 mmHg > SBP)

78
Q

What things need to be documented when a tourniquet is used?

A
  1. inflation & deflation time
  2. total inflated time
  3. inflation pressure & adjustments
79
Q

What can prolonged tourniquet inflation time (>2hrs) cause?

A
  • Nerve injury
  • ischemia, mechanical trauma
  • rhabdo

deflate every 20-30min to allow for reperfusion

80
Q

When utilizing a double tourniquet, it is important to remember to…

A

inflate proximal → deflate distal

81
Q

What 4 factors influence tourniquet pain?

A
  1. tourniquet time/position/pressure
  2. anesthesia technique multi-modal
  3. dermatomal spread/peripheral n. coverage
  4. LA dose (density)
82
Q

What occurs with tourniquet deflation?

A
  • Transient lactic acidosis
  • Transient Hypercarbia (↑ Vm to eliminate CO2)
  • ↑ HR
  • ↓ pain
  • ↓ CVP, BP, & temp
83
Q

What are some important points of assessment necessary for upper body procedures preoperatively?

A
  • Baseline vitals
  • Airway
  • Pre-existing nerve conduction issues
  • Examine pupils
84
Q

What are 4 diagnoses that require shoulder arthroscopy/arthroplasty?

A
  1. rotator cuff tear
  2. subacromial impingement (crepitus and pain w/ movement)
  3. glenohumeral instability (shoulder instability)
  4. labral tear: ring of cartilage that lines the edge of the shoulder socket
85
Q

What are the cardiac consequences of sitting/Beach Chair position?

A
  • ↓ CO & BP
  • ↑ HR & SVR

Due to pooling of blood in lower body (↓ VR)

86
Q

What are the respiratory consequences of sitting/Beach Chair position?

A
  • ↑ FRC & lung volumes
87
Q

West Perfusion Zone 1:

A
  • PA > Pa > Pv
  • apex of lung - no blood flow during lung dz or PPV
88
Q

West Perfusion Zone 2:

A
  • Pa > PA > Pv
  • Middle portion of the lung - gets blood flow during ↑ pressures (ejection)
89
Q

West Perfusion Zone 3:

A
  • Pa > Pv > PA
  • bottom portion of lung - gets perfusion throughout entire cardiac cycle (↓ PVR)
90
Q

West Perfusion Zone 4:

A
  • Compression of the vessels in the very bottom of the lung d/t gravity
  • no perfusion
91
Q

What portions of the lung receive better perfusion and what portions receive better ventilation?

A
  1. perfusion: bottom/dependent parts of the lung (lower resistance)
  2. ventilation: bottom/dependent parts of the lung (alveoli more compliant)
92
Q

What are the neurologic consequences of sitting/Beach Chair position?

A

↓ CBF

  • Cerebral hypoperfusion - A-line placed @ tragus (level w/ circle of Willis)

Air embolism
pneumocephalus

↓ CPP

93
Q

What is a possible nerve damaged in sitting/beach chair?

A

Sciatic nerve - if Hips flexed >90 degrees

94
Q

How is venous air embolism prevented in a beach chair patient?

A

↑ CVP (above 0) to prevent a “suction” effect

95
Q

What is the patho of a VAE?

A
  • entrain air into open vessels
  • goes to RV & interferes w/ blood flow into pulmonary artery pulmonary air lock
  • pulm edema & reflex bronchoconstriction occur
  • air can reach cerebral & coronary circulation via patent foramen ovale
  • death from CV collapse & arterial hypoxemia
96
Q

In what percent of the population is a patent foramen ovale present?

97
Q

How does one treat venous air embolism?

Besides prevention…

A
  • Inform surgeon → irrigation & occlusive dressing
  • DC N₂O if being used
  • Bilateral compression of jugular veins (prevent neuro consequences)
  • Place patient in head down position to trap in right atrium
  • Withdraw air through right atrial catheter
  • CV & Resp support
98
Q

The ultrasound transducer is being utilized to located venous air embolism in a patient. Where do you place the probe?

A

2ⁿᵈ - 3rd ICS right of sternum

Over the Right Atrium

99
Q

Though ultrasound over the right atrium is the most sensitive indicator of VAE (venous air embolism), the most definitive is….

100
Q

The characteristic sound of a VAE is a _____________ murmur.

A

“Mill-Wheel” murmur

101
Q

What would be an indicator of a sudden decreased perfusion to the lungs?

A

↓ EtCO₂

indicating an air lock from VAE & no gas exchange happening

102
Q

________ of the neck in a sitting position patient can accidentally extubate them.

A

Hyperextension

103
Q

What can hyperflexion of the neck cause to happen with the ETT?

A
  • Endobronchial intubation - mainstem
  • Hits carina and causes pt bucking on vent
104
Q

In a sitting position patient, where would one zero their art line?

A

Tragus of the ear

Establishes knowledge of brain BP & thus perfusion.

@ the level of the circle of willis

105
Q

What happens with the bed used for shoulder surgery?

A

The leg component is moved to the head component

106
Q

What ocular conditions do we want to avoid due to the hypotension inherent to the sitting position?

A
  • Retinal Ischemia
  • Ischemia Optic Neuropathy

Also avoid corneal abrasion.

107
Q

What 3 problems can occur w/ induced HoTN in shoulder surgeries?

A
  1. stroke
  2. retinal ischemia
  3. ischemic optic neuropathy
108
Q

What arteries supply the Circle of Willis?

A
  • internal carotid arteries - become the middle cerebral arteries
  • vertebral arteries - become the basilar artery (posterior COW)
109
Q

Circle of Willis

What does the basilar artery supply?

A
  • anterior side of PONS
  • supplies: brainstem, cerebellum, occipital lobes, thalamus, hypothalamus
110
Q

Circle of Willis

What does the Middle Cerebral Artery supply?

A
  • frontal lobe, parietal lobe, temporal lobe
111
Q

What does the Anterior Cerebral Artery supply?

A

2 parts:
* A1: part of COW, A2: extends from COW

  • Supplies: frontal lobe, parietal lobe, corpus callosum, cingulate gyrus (emotion), motor & sensory cortex (contralateral lower extremity)
112
Q

Circle of Willis

What does the posterior cerebral artery supply?

A
  • off back & posterior portion of brain

2 parts:
* P1: part of COW, P2: extends from COW

  • Supplies: occipital lobe (vision), temporal lobe (memory), thalamus, midbrain (visual reflexes & motor coordination), corpus callosum
113
Q

There is a 40cm distance from the patients heart to their brain. The patient’s BP measured on the arm is 120/70. What is the estimated BP in the brain?

A

40cm x 0.77mmHg = 30.8mmHg

120 - 30.8 = 89.2mmHg
70 - 30.8 = 39.2mmHg

The patient’s brain BP is 89/39 Thus indicating hypotension and necessary correction.

114
Q

A standing patient’s NIBP on the arm is 134/92. The distance between the patient’s knee and the NIBP cuff is 120cm. What is the BP in the patient’s knee?

A

120 x 0.77 = 92.4

134 + 92
92 + 92

Patient’s “knee” BP standing up is 226/184

115
Q

Is general or regional preferred for shoulder arthroplasty/arthroscopy?

A
  • GETA w/ muscle relaxation = need secure airway

Regional could be primary or additive w/ GETA - less GA w/ block

116
Q

What is the Bezold-Jarisch reflex?

A

Cardiac inhibitory reflex resulting in signification HoTN & ↓HR.

Stimulus: ↓ VR, hypovolemia

Afferent signal: vagus n. to medullary vasomotor center

Effect: increased PSNS & decreased SNS activity

can avoid this reflex w/ increasing preload & 5-HT3 antagonist

117
Q

What are the 2 approaches for a brachial plexus block?

A
  1. Interscalene: b/w middle & anterior scalene muscles
  2. Supraclavicular approach anatomy: 1st rib, SC artery, brachial plexus
118
Q

What are possible complications of a brachial plexus block?

A
  • Respiratory depression
  • Horner Syndrome
  • Hoarseness
  • Dysphagia
119
Q

Why can respiratory depression occur with brachial plexus blocks?

A

Hemidiaphragmatic Paresis from Phrenic nerve blockade.

Especially w/ the interscalene approach

120
Q

What is the triad of Horner Syndrome?

A
  • Ptosis
  • Miosis
  • Anhydrosis

These are really SE of the brachial plexus block

121
Q

What can hoarseness & dysphagia from a brachial plexus block lead to?

A
  • less control of secretions
  • passive/active regurg/vomiting
  • unable to protect airway = apsiration pneumonitis risk
122
Q

What things should we assess post-op in shoulder surgery?

A
  • nerve injury
  • pain management
  • delirium/confusion in elderly
123
Q

What position are elbow surgeries usually performed?

A
  • supine or lateral
124
Q

Is CO affected in the lateral decubitus position?

A

NO - unless venous return is obstructed by using kidney rest

ABP may fall d/t ↓ vascular resistance (R side > L side)

125
Q

What are the respiratory consequences of a lateral decubitus position?

A

(VQ mismatch)
- ↓ ventilation of dependent lung.
- ↑ perfusion of dependent lung.

  • this is true for mechanically ventillated pts, spont. breathing will have better ventilation to dependent lung.
126
Q

During mechanical ventilation in left lateral decubitus patient, which lung is overventilated?

A

Right lung (nondependent lung) (↑ compliance)

127
Q

During mechanical ventilation in left lateral decubitus patient, which lung more perfused?

A

Left lung (dependent lung) - gravity

128
Q

Where is an axillary roll placed on a lateral decubitus patient?

A

Caudad to the axilla to avoid compression of the neurovascular bundle.

129
Q

What other positioning concerns are there w/ lateral decubitus?

A
  • upper arm on pillows or in allen arm rest
  • pillow b/w knees, lower leg slightly flexed to prevent nerve stretching
  • check for eye pressure & dependent ear pressure
  • breasts/genitalia free of pressure
130
Q

Where should a pulse oximeter be placed in a lateral decubitus patient?

A

Dependent hand to ensure that there is no neurovascular compromise

131
Q

Elbow surgeries need what additional block (in comparison to shoulder surgeries) ?

A

Musculocutaneous nerve

Can hit this nerve when doing an axillary block

132
Q

Elbow Surgery

Axillary block nerves covered:

A
  1. median
  2. ulnar
  3. radial
  4. musculocutaneous (in the coracobrachialis muscle)
133
Q

If a bean bag is being used for lateral decubitus positioning, what should we ensure?

A
  • there is enough room for excursion of the abdomen when pt is breathing
  • The bean bag can cause ↓ Vt & FRC; ↑ CV b/c of no excursion room!
134
Q

What are common diagnoses requiring forearm/hand surgeries?

A
  1. nerve conduction issues
  2. fractures, nerve impingement
  3. traumatic amputation
135
Q

Anesthesia management in forearm/hand surgeries:

A
  1. supine on hand table
  2. airway - tube tree on opposite side of surgeon
136
Q

What are the steps to a bier block?

A
  1. IV start
  2. Exsanguinate the arm w/ plastic wrapped around the arm
  3. double cuff
  4. inflate both cuffs when we inject lidocaine
  5. deflate distal 1st so it diffuses a little - then deflate proximal cuff
  6. keep tourniquet 100mmHg > SBP
137
Q

What do we do if the cuff leaks w/ a bier block?

A
  • DO NOT DEFLATE THE CUFF
  • if the pt seizes: BZD & Lipid emulsion
138
Q

What is the lipid emulsion dose for LAST?

A

1.5mL/kg bolus over 1 min (can repeat q 3-5 min)

Gtt: 0.25-0.5mL/kg/min until stable

Max total: 8mL/kg

139
Q

What 4 things can increase 1 yr mortality in Hip Fractures?

A
  1. cardiac & pulmonary conditions
  2. DVT
  3. Delirium
  4. large amounts of extravasated blood
140
Q

What things do we need to assess/consider pre-operatively in Hip Fracture Surgeries?

A
  1. pain management
  2. IVF status
  3. h&H
  4. central line/art line?
  5. v/s
  6. full stomach - trauma pt
141
Q

Is a patient with a hip fracture induced on the OR table or on the bed/stretcher?

A

Bed/Stretcher to avoid pain from movement to OR table.

142
Q

What are the benefits of neuraxial anesthesia for hip fracture repairs?

A
  • ↓ delirium
  • ↓ DVT
  • ↓ hospital stay
  • Better pain control
143
Q

What are 8 etiologies for a total hip arthroplasty?

A
  1. OA
  2. RA
  3. degenerative synovium or cartilage disease
  4. Avascular necrosis (femoral head dies)
  5. tumors
  6. congenital deformity
  7. dislocation
  8. failed reconstruction
144
Q

What position are total hip arthroplastys?

A

Lateral decubitus
* operative side up
* ax roll padding

145
Q

Regional or General for Total Hip Arthroplasty?

A

General - muscle relaxation required

146
Q

What are the 4 parts of a total hip arthroplasty?

A
  1. Acetabular component
  2. Plastic Liner
  3. Femoral Head
  4. Femoral Stem
147
Q

What are the three life-threatening complications of total hip arthroplasty?

A
  • BCIS
  • Hemorrhage
  • VTE
148
Q

What chemical is bone cement?

A

PolyMethylMethAcrylate

149
Q

What does bone cement do when introduced to the intramedullary bone surface?

A
  1. Release heat and pressurize (500mmHg!) intramedullary HTN
  2. Possible embolization of fat, bone marrow, and cement
  3. systemic absorption - vasodilation (HoTN)
  4. plt aggregation - thrombus formation (tissue thromboplastin release)
  5. microthrombus in lungs
  6. CV instability
150
Q

What are the 4 intramedullary contents?

A
  1. yellow marrow (fat)
  2. red marrow (hematopoiesis)
  3. Blood vessels & nerves
  4. endosteum: inner membrane - osteoprogenitor cells (bone growth & remodeling)
151
Q

What is the anesthetic management of BCIS?

A
  • Combat ↓BP and ↓Volume
  • ↑ FiO₂ & SpO₂
152
Q

What things can be done to prevent BCIS?

A
  1. minimize HoTN & hypovolemia
  2. maximize FiO2 & SpO2
  3. vent hole in femur (surgeon)
  4. lavage femoral shaft
  5. avoid bone cement
153
Q

What are the s/s of BCIS?

A
  • Hypoxia
  • Hypotension
  • Arrythmias
  • pHTN
  • ↓CO
154
Q

What are 5 common complications in post-op THA?

A
  1. cardiac events
  2. PE
  3. pneumonia
  4. resp. failure
  5. infection
155
Q

In a supine position, spontaneous ventilation favors _______ lung segments, whilst controlled ventilation favors ________ lung segments.

A

Dependent ; independent

156
Q

What are 4 indications for a hip arthroscopy?

A
  1. femoro-acetabular impingement
  2. acetabular labral tears
  3. loose bodies - bone fragments
  4. OA
157
Q

The most common postoperative peripheral neuropathy is:
a. Ulnar neuropathy
b. Brachial plexus injury
c. Median nerve injury
d. Sciatic nerve compression

A

a. Ulnar Neuropathy

158
Q

Where are the two major sites of injury in ulnar nerve injury?

A

Elbow at the condylar groove (medial epicondyle of the humerus) and cubital tunnel.

159
Q

How is ulnar nerve nerve injury avoided?

A

Supinate hands (palms up!)

160
Q

What common drugs are often used for “conscious sedation” of a hip dislocation?

A

Ketamine/Propofol Mix
Succinylcholine

requires closed reduction - no incision

161
Q

What are 3 different anesthetic techniques that can be used for a knee arthroscopy?

A
  1. General
  2. Neuraxial/Regional
  3. Sedation w/ extra-articular or intra-articular injections
162
Q

What are 2 types of PNB that can be used for knee surgery?

A
  1. Femoral
  2. Sciatic
163
Q

What are the possible complications of tourniquet placement for knee surgeries?

A
  • Blood loss on deflation (note for 24hrs)
  • Peroneal Nerve Palsy
164
Q

What are the steps to a TKA (Total Knee Arthroplasty) ?

A
  1. Tibial Component: plastic spacer & metal plate
  2. Femoral Component
  3. Patellar Component: articular of patella cut to receive a button that will glide over the femoral component (prosthesis)
  4. Plastic Spacer
165
Q

What three conditions (that anesthesia can control) are most often associated with infection of knee replacements?

A
  • Peri-operative glucose control
  • Post-op hypoxia
  • Post-op hypothermia
166
Q

Wound Infections

Clean Wound:

A

Not inflamed or contaminated
* does not involve an internal organ

167
Q

Wound Infections

Clean-Contaminated Wound

A

no evidence of infections
* involves an internal organ

168
Q

Wound Infections

Contaminated

A

involves an internal organ w/ spillage of contents from the organ

169
Q

Wound Infections

Dirty Wound:

A
  • known infection at the time of surgery
170
Q

What 4 things can be done to prevent wound infections?

A
  1. decreased traffic in/out of OR
  2. prep and drape
  3. pre-op abx
  4. use of hoods
171
Q

What comorbidities are associated with amputations?

A

Diabetics, pressure ulcers

172
Q

What medication classes can be used to treat phantom pain from amputation?

A
  • Neuroleptics
  • Antidepressants
  • Na⁺ channel blockers
173
Q

What are 3 triggers to phantom pain?

A
  1. weather changes
  2. emotional stress
  3. pressure on remaining area
174
Q

What are physiologic causes of phantom pain?

A
  • MRI/PET Scan
  • remapping of circuitry
  • damaged nerve endings
  • scar tissue impeding blood supply
  • physical memory
  • pain prior to amputation
175
Q

Ankle Block

What nerve innervates the plantar surface?

A

Posterior Tibial nerve

176
Q

Ankle Block

What nerve innervates the medial malleolus?

A

Saphenous nerve

177
Q

Ankle Block

What nerve innervates the interspace between the great & 2ⁿᵈ toes?

A

Deep Peroneal nerve

178
Q

Ankle Block

What nerve innervates the space between the dorsum of the foot and the 2ⁿᵈ - 5th toes?

A

Superficial peroneal nerve

179
Q

Ankle Block

What nerve innervates the lateral foot and lateral 5th toe?

A

Sural nerve

Advanced Principles A (Spring 2025) Grayson's Cards (12 decks)

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