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.Spr25 AdvPrin A > Orthopedic Anesthesia Pt1 > Flashcards

Orthopedic Anesthesia Pt1 Flashcards

1
Q

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

A
  • Elderly age
  • post-Menopause
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2
Q

What hormonal changes are characteristic of osteoporosis?

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

What are the four most common meds used to treat osteoporosis? Seeing these would indicate pt likely has osteoporosis history.

A

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

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4
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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5
Q

Osteoarthritis Management may consist of what non-pharmacological interventions?

A
  • OT
  • Wt loss
  • acupuncture
  • TENS
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6
Q

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

A

Glucosamine

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7
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 (risk for bleeding).

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8
Q

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

A

Rheumatoid arthritis

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9
Q

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

A

Osteoarthritis

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10
Q

Chronic and systemic inflammatory dz of joint synovial tissue/connective tissue inflammation that can lead to bone erosion, cartilage destruction, and impaired joint integrity is characteristic of what dz?

A

Rheumatoid arthritis

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11
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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12
Q

What common dose of stress dose glucocorticoid is used for RA patients? What other medication groups may be utilized for RA treatment?

A

50mg hydrocortisone (Solu-cortef)

  • NSAIDS
  • opioids
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13
Q

What two TNFα inhibitors are commonly used to treat RA?

A
  • Infliximab (Remicade)
  • Etanercept (Enbrel)
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14
Q

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

A

Trick question. All of them do
- Methotrexate
- Hydroxychloroquine
- Sulfasalazine
- Leflunomide

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15
Q

What main airway concerns should be considered with RA patients?

A
  • Limited TMJ movement
  • Narrowed glottic opening
  • Cricoarytenoid arthritis
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16
Q

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

A

Atlantoaxial Junction
-affects neck flexion

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

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17
Q

What are the signs and symptoms of atlantoaxial subluxation (partial dislocation)?

A
  • Headache
  • Neck pain
  • Extremity paresthesias (especially with movement)
  • Bowel/bladder dysfunction
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18
Q

What are the signs/symptoms of vertebral artery occlusion?

A
  • N/V
  • Dysphagia
  • Blurred Vision
  • Transient LOC changes
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19
Q

What ocular syndrome is typical of RA patients?

A

Sjogren’s syndrome

(Dry eyes and mouth from failure of moisture glands to produce moisture)

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20
Q

What pulmonary issues are associated with RA?

A
  • Interstitial fibrosis
  • Restrictive ventilation
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21
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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22
Q

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

A

Iliac artery → retroperitoneal space bleeding

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23
Q

The emergent nature of an orthopedic injury fixation/repair would indicate what as a significant consideration?

A

Full stomach (most likely needs RSI)

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24
Q

What is the typical worst complication of long bone fractures?

A

Bone marrow fat embolism

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25
Q

In general, what immediate treatment options are warranted for fat embolism?

A
  • Respiratory support: likely intubation and ventilation management. Focused on low tidal volume.
  • Oxygen therapy as needed
  • Hemodynamic stabilization with fluids or pressors
  • prevent further fat embolism release by immobilizing the fracture
26
Q

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

A

MILS

Manual In-Line Stabilization

27
Q

Describe the MILS technique

A
28
Q

What are the main components of Rapid Sequence Induction (RSI)?

A
  • MILS
  • 100% 10-15L/min Preoxygenation 3 min minimum
  • 10 lbs Cricoid pressure (until ETT confirmation)
  • Fast onset muscle relaxation (high dose Roc or SCh)
  • DL, combitube, or LMA…difficult airway algorithm
29
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

30
Q

What is the mechanism of action of LMWH?

A

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

31
Q

What are some typical triggers for delirium?

A
  • Hypoxemia
  • HoTN
  • Hypercarbia
  • Sleep Deprivation/disruption
  • Hypervolemia
  • Infection
  • Electrolyte abnormalities
  • Pain
  • Benzos
  • Anticholinergics
32
Q

FEV₁ decreases by ___% for each decade of life.

A

10%

33
Q

What occurs with closing volume as we age?

A

Closing volume increases.

34
Q

What are the complications are avoided by utilization of regional anesthesia vs general anesthesia?

A

Avoid:

  • DVT
  • PE
  • EBL
  • Respiratory complications
  • Death
35
Q

With placement of what device is fat embolism syndrome most likely to occur? What kind of fractures are most prevalent for fat emboli?

A

Femoral Medullary Canal Rod

Most common in pelvic and femoral fractures

36
Q

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

A
  1. Dyspnea
  2. Confusion
  3. Petechiae

Typically presents in 12 - 72 hrs

37
Q

What lab findings are noted with fat embolism syndrome?

A
  • Fat macroglobulinemia
  • Anemia
  • Thrombocytopenia
  • ↑ ESR
38
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
39
Q

What main symptoms can be characterized from fat embolism syndrome?

A
  • Systemic inflammatory response
  • Respiratory insufficiency
  • Neurological/CNS depression
  • Petechial Rach
40
Q

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

A
  • Fever >100.4
  • ↑HR >120
  • Jaundice
  • Renal Changes
41
Q

What are the anesthetic management techniques for fat embolization syndrome?

A

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

symptoms resole 3-7 days

42
Q

What factors contribute to the development of DVT’s and PE’s?

A
  • Lack of Prophylaxis
  • Obesity
  • > 60yrs old
  • > 30min procedure
  • Tourniquet use
  • > 4 days immobilization
  • > Lower extremity fracture
43
Q

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

A
  • Hip surgery
  • TKA
  • Lower extremity trauma
44
Q

When does LMWH need to be initiated for prevention of DVT associated with orthopedic surgery?

A

12 hours preop
or
12 hours postop

45
Q

Can neuraxial anesthesia be done after LMWH has been given?

A

Yes, if 10 - 12 hours after the LMWH dose.

Delay next dose 4 hours.

46
Q

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

A

No. No indwelling catheters

47
Q

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

A

2 hours

48
Q

Can a patient have neuraxial anesthesia if on warfarin?

A

Only if the INR is ≤ 1.5

49
Q

Flip card for Anticoagulation guidelines for Neuraxial procedures.

A
50
Q

Flip card for additional Anticoagulation guidelines for Neuraxial procedures.

A
51
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
52
Q

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

A

2.5 g

53
Q

What is typical dosing of TXA?

A

10 - 30 mg/kg (variable)

1000mg is typical

Max: 2.5 grams

54
Q

Tourniquet pain typically begins ___ minutes after application.

A

45 min

55
Q

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

A

½

56
Q

How long can tourniquets be placed on an extremity?

A
  • 2 hours is typically not exceeded
  • 3 hours is max.
57
Q

What mmHg is typically used for thigh tourniquets? (lower extremity)

A

300 mmHg
(or 100 mmHg > SBP)

58
Q

What mmHg is typically used for arm tourniquets? (upper extremity)

A

250 mmHg
(or 50 mmHg > SBP)

59
Q

What should be documented regarding tourniquet use?

A
  • inflation time
  • deflation time
  • total inflated time
  • inflation pressure (and adjustments)
60
Q

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

A

inflate proximal → deflate distal

61
Q

What occurs with tourniquet deflation?

A
  • Transient lactic acidosis
  • Transient Hypercarbia (thus V̇T)
  • ↑ HR
  • ↓ pain
  • ↓ CVP, BP, & temp
  • hyperkalemia

.Spr25 AdvPrin A (12 decks)

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