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.Spr25 AdvPrin A > Orthopedic Anesthesia Pt2 > Flashcards

Orthopedic Anesthesia Pt2 Flashcards

1
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
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2
Q

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

A
  • ↓ CO & BP
  • ↑ HR & SVR

Due to pooling of blood in lower body.

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3
Q

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

A
  • ↑ FRC & lung volumes
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4
Q

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

A

↓ CBF

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5
Q

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

A

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

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6
Q

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

A

20 - 30 %

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7
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
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8
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

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9
Q

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

A

TEE

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10
Q

The characteristic sound of a VAE is a _____________ murmur.

A

“Mill-Wheel” murmur

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11
Q

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

A

↓ EtCO₂

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12
Q

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

A

Hyperextension

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13
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.

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14
Q

What are 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.

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15
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.

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16
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

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17
Q

What is the Bezold-Jarisch reflex?

A

Cardiac inhibitory reflex resulting in signification HoTN & ↓HR.

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18
Q

What are possible complications of a brachial plexus block?

A
  • Respiratory depression
  • Horner Syndrome
  • Hoarseness
  • Dysphagia
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19
Q

Why can respiratory depression occur with brachial plexus blocks?

A

Hemidiaphragmatic Paresis from Phrenic nerve blockade.

20
Q

What is the triad of Horner Syndrome?

A
  • Ptosis
  • Miosis
  • Anhydrosis
21
Q

What are the respiratory consequences of a lateral decubitus position?

A

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

22
Q

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

A

Right lung (nondependent lung)

23
Q

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

A

Left lung (dependent lung)

24
Q

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

A

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

25
Q

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

A

Dependent hand to ensure that there is no neurovascular compromise

26
Q

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

A

Musculocutaneous nerve

27
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.

28
Q

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

A
  • ↓ delirium
  • ↓ DVT
  • ↓ hospital stay
  • Better pain control
29
Q

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

A
  • BCIS
  • Hemorrhage
  • VTE
30
Q

What chemical is bone cement?

A

PolyMethylMethAcrylate

31
Q

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

A

Release heat and pressurize (500mmHg!)

Possible embolization of fat, bone marrow, and cement.

32
Q

What is the anesthetic management of BCIS?

A
  • Combat ↓BP and ↓Volume
  • ↑ FiO₂ & SpO₂
33
Q

What are the s/s of BCIS?

A
  • Hypoxia
  • Hypotension
  • Arrythmias
  • pHTN
  • ↓CO
34
Q

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

A

Dependent ; independent

35
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

36
Q

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

A

Elbow at the condylar groove and cubital tunnel.

37
Q

How is ulnar nerve nerve injury avoided?

A

Supinate hands (palms up!)

38
Q

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

A

Ketamine/Propofol Mix
Succinylcholine

39
Q

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

A
  • Blood loss on deflation (note for 24hrs)
  • Peroneal Nerve Palsy
40
Q

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

A
  1. Tibial Component
  2. Femoral Component
  3. Patellar Component
  4. Plastic Spacer
41
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
42
Q

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

A
  • Neuroleptics
  • Antidepressants
  • Na⁺ channel blockers
43
Q

What nerve innervates the plantar surface?

A

Posterior Tibial nerve

44
Q

What nerve innervates the medial malleolus?

A

Saphenous nerve

45
Q

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

A

Deep Peroneal nerve

46
Q

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

A

Superficial saphenous nerve

47
Q

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

A

Sural nerve

.Spr25 AdvPrin A (12 decks)

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