Orthopedic Anesthesia Pt1 Flashcards
What are the two biggest factors associated with development of osteoporosis?
- Elderly age
- post-Menopause
What hormonal changes are characteristic of osteoporosis?
- ↑ PTH
- ↓ Vit D
- ↓ growth hormone
- ↓ Insulin-like growth factors
What are the four most common meds used to treat osteoporosis? Seeing these would indicate pt likely has osteoporosis history.
dronate drugs
- Fosamax (Alendronate)
- Actonel (Risedronate)
- Boniva (Ibandronic Acid)
- Reclast (Zoledronate)
Differentiate between Bouchard’s nodes and Heberden’s nodes.
- Bouchard’s = proximal interphalangeal joints
- Heberden’s = distal interphalangeal joints
Osteoarthritis Management may consist of what non-pharmacological interventions?
- OT
- Wt loss
- acupuncture
- TENS
What drug is the most common chondroprotective agent that helps protect the articular joint?
Glucosamine
What anesthetic considerations should be given to glucosamine?
Glucosamine needs to be stopped two weeks prior to surgery due to PLT aggregation inhibition (risk for bleeding).
Arthritis characterized by morning stiffness that improves throughout the day is….
Rheumatoid arthritis
Arthritis that is characterized by worsening symptoms throughout the course of the day is…
Osteoarthritis
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?
Rheumatoid arthritis
What labs are typically elevated in a patient with rheumatoid arthritis?
- ↑ Rheumatoid factor (RF)
- ↑ Anti-immunoglobulin antibody
- ↑ C-reactive protein (CRP)
- ↑ Erythrocyte Sedimentation Rate (ESR)
What common dose of stress dose glucocorticoid is used for RA patients? What other medication groups may be utilized for RA treatment?
50mg hydrocortisone (Solu-cortef)
- NSAIDS
- opioids
What two TNFα inhibitors are commonly used to treat RA?
- Infliximab (Remicade)
- Etanercept (Enbrel)
Which of the following drugs treat RA?
- Methotrexate
- Hydroxychloroquine
- Sulfasalazine
- Leflunomide
Trick question. All of them do
- Methotrexate
- Hydroxychloroquine
- Sulfasalazine
- Leflunomide
What main airway concerns should be considered with RA patients?
- Limited TMJ movement
- Narrowed glottic opening
- Cricoarytenoid arthritis
Where is the most instability typically located in the cervical spine of RA patients?
Atlantoaxial Junction
-affects neck flexion
(be careful not to displace the odontoid process and impinge on the c-spine or vertebral arteries)
What are the signs and symptoms of atlantoaxial subluxation (partial dislocation)?
- Headache
- Neck pain
- Extremity paresthesias (especially with movement)
- Bowel/bladder dysfunction
What are the signs/symptoms of vertebral artery occlusion?
- N/V
- Dysphagia
- Blurred Vision
- Transient LOC changes
What ocular syndrome is typical of RA patients?
Sjogren’s syndrome
(Dry eyes and mouth from failure of moisture glands to produce moisture)
What pulmonary issues are associated with RA?
- Interstitial fibrosis
- Restrictive ventilation
What type of ventilatory settings would be utilized for an RA patient exhibiting a restrictive ventilatory pattern?
Pressure Control @ 5mL/kg
What artery is typically injured due to pelvic fractures? Where is the bleeding typically located in this instance?
Iliac artery → retroperitoneal space bleeding
The emergent nature of an orthopedic injury fixation/repair would indicate what as a significant consideration?
Full stomach (most likely needs RSI)
What is the typical worst complication of long bone fractures?
Bone marrow fat embolism
In general, what immediate treatment options are warranted for fat embolism?
- 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
What technique is used for intubation of a patient who has c-spine concerns?
MILS
Manual In-Line Stabilization
Describe the MILS technique
What are the main components of Rapid Sequence Induction (RSI)?
- 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
What is the mechanism of action of warfarin?
Warfarin inhibits Vitamin K epoxide reductase and limits the availability of Vitamin K throughout the body
What is the mechanism of action of LMWH?
LMWH binds and enhances antithrombin thus → inhibits thrombin → no fibrinogen forming into fibrin
