Orthopedic Anesthesia pt1.5 Flashcards
What are some typical triggers for delirium?
- Hypoxemia
- HoTN
- Hypercarbia
- Sleep Deprivation/disruption
- Hypervolemia
- Infection
- Electrolyte abnormalities
- Pain
- Benzos
- Anticholinergics
FEV₁ decreases by ___% for each decade of life.
10%
What occurs with closing volume as we age?
Closing volume increases.
What are the complications are avoided by utilization of regional anesthesia vs general anesthesia?
Avoid:
- DVT
- PE
- EBL
- Respiratory complications
- Death
With placement of what device is fat embolism syndrome most likely to occur? What kind of fractures are most prevalent for fat emboli?
Femoral Medullary Canal Rod
Most common in pelvic and femoral fractures
What is the s/s Triad of fat embolism syndrome (FES)?
When do s/s typically present?
- Dyspnea
- Confusion
- Petechiae
Typically presents in 12 - 72 hrs
What lab findings are noted with fat embolism syndrome?
- Fat macroglobulinemia
- Anemia
- Thrombocytopenia
- ↑ ESR
What is ESR? What are normal values for males and females?
- Erythrocyte Sedimentation Rate
- Male: 0 - 22 mm/hr
- Female: 0 - 29 mm/hr
What minor s/s can be construed to characterize fat embolization syndrome?
- Fever >100.4
- ↑HR >120
- Jaundice
- Renal Changes
What are the anesthetic management techniques for fat embolization syndrome?
Supportive Management
- 100% FiO₂
- No N₂O
- IV Heparin
- CV & Resp support
symptoms resole 3-7 days
What factors contribute to the development of DVT’s and PE’s?
- Lack of Prophylaxis
- Obesity
- > 60yrs old
- > 30min procedure
- Tourniquet use
- > 4 days immobilization
- > Lower extremity fracture
Which three surgery types present the greatest risk for DVT formation?
- Hip surgery
- TKA
- Lower extremity trauma
When does LMWH need to be initiated for prevention of DVT associated with orthopedic surgery?
12 hours preop
or
12 hours postop
Can neuraxial anesthesia be done after LMWH has been given?
Yes, if 10 - 12 hours after the LMWH dose.
Delay next dose 4 hours.
Can an epidural be placed in a patient on LMWH anticoagulation therapy?
No. No indwelling catheters
Neuraxial catheters must be removed ___ hours before the intiation of LMWH therapy.
2 hours
Can a patient have neuraxial anesthesia if on warfarin?
Only if the INR is ≤ 1.5
Flip card for Anticoagulation guidelines for Neuraxial procedures.
Flip card for additional Anticoagulation guidelines for Neuraxial procedures.
What advantages does neuraxial anesthesia present in the prevention of DVT’s?
- ↑ extremity venous blood flow (sympathectomy).
- LA systemic anti-inflammatory properties.
- ↓ PLT reactivity
What is the maximum dose of TXA? (Tranexamic Acid)
2.5 g
What is typical dosing of TXA?
10 - 30 mg/kg (variable)
1000mg is typical
Max: 2.5 grams
Tourniquet pain typically begins ___ minutes after application.
45 min
The width of a tourniquet must be greater than ____ its diameter.
½
How long can tourniquets be placed on an extremity?
- 2 hours is typically not exceeded
- 3 hours is max.
What mmHg is typically used for thigh tourniquets? (lower extremity)
300 mmHg
(or 100 mmHg > SBP)
What mmHg is typically used for arm tourniquets? (upper extremity)
250 mmHg
(or 50 mmHg > SBP)
When utilizing a double tourniquet, it is important to remember to…
inflate proximal → deflate distal
What occurs with tourniquet deflation?
- Transient lactic acidosis
- Transient Hypercarbia (thus V̇T)
- ↑ HR
- ↓ pain
- ↓ CVP, BP, & temp
- hyperkalemia
What main symptoms can be characterized from fat embolism syndrome?
- Systemic inflammatory response
- Respiratory insufficiency
- Neurological/CNS depression
- Petechial Rach
What should be documented regarding tourniquet use?
- inflation time
- deflation time
- total inflated time
- inflation pressure (and adjustments)
