Orthopedic Anesthesia pt2.5 Flashcards
Is a patient with a hip fracture induced on the OR table or on the bed/stretcher?
Bed/Stretcher to avoid pain from movement to OR table.
What are the benefits of neuraxial anesthesia over general anesthesia for hip fracture repairs?
- ↓ delirium
- ↓ DVT
- ↓ hospital stay
- Better pain control
What are the three life-threatening complications of total hip arthroplasty?
- Bone Cement Implantation Syndrome (BCIS)
- Hemorrhage
- VTE
What chemical is bone cement?
PolyMethylMethAcrylate (PMMA)
What does bone cement do when introduced to the intramedullary bone surface?
Release heat and pressurize (>500mmHg!) = intramedullary HTN
Possible embolization of fat, bone marrow, and cement.
What is the anesthetic management of Bone cement implantation syndrome?
- Combat ↓BP and ↓Volume
- ↑ FiO₂ & SpO₂
What are the s/s of BCIS?
- Hypoxia
- Hypotension
- Arrythmias
- pulmHTN
- ↓CO
In a supine position, spontaneous ventilation favors _______ lung segments, whilst closing volume favors ________ lung segments.
Dependent ; independent
The most common postoperative peripheral neuropathy is:
a. Ulnar neuropathy
b. Brachial plexus injury
c. Median nerve injury
d. Sciatic nerve compression
a. Ulnar Neuropathy
keep arms supinated, not pronated
Where are the two major sites of injury in ulnar nerve injury?
Elbow at the condylar groove and cubital tunnel.
How is ulnar nerve nerve injury avoided?
Supinate hands (palms up!)
What common drugs are often used for “conscious sedation” of a hip dislocation?
Ketamine/Propofol Mix
Succinylcholine
What are the possible complications of tourniquet placement for knee surgeries?
- Blood loss on deflation (note for 24hrs)
- Peroneal Nerve Palsy
What are the 4 artificial components of a TKA (Total Knee Arthroplasty) ?
- Tibial Component
- Femoral Component
- Patellar Component
- Plastic Spacer
What three conditions (that anesthesia can control) are most often associated with wound infections?
- Peri-operative glucose control
- Post-op hypoxia
- Post-op hypothermia
What medication classes can be used to treat phantom pain from amputation?
- Neuroleptics
- Antidepressants
- Na⁺ channel blockers
What nerve provides sensory innervation to the plantar surface?
Posterior Tibial nerve
What nerve innervates the medial malleolus?
Saphenous nerve
What nerve innervates the interspace between the great & 2ⁿᵈ toes?
Deep Peroneal nerve
What nerve innervates the space between the dorsum of the foot and the 2ⁿᵈ - 5th toes?
Superficial peroneal nerve
What nerve innervates the lateral foot and lateral 5th toe?
Sural nerve
Why would total hip arthroplasty and arthroscopy typically require GETA?
Muscle relaxation is typically required
What are the main reactions that can occur with use of bone cement?
- Exothermic reaction
- Systemic absorption⇒vasodilation/HoTN
- Platelet aggregation
- microthombus in lungs
- CV instability
- Anaphylaxis
What are the main respiratory consequences in the supine position?
- Increased perfusion to dependent lung (VQ mismatch)
- FRC decreases (~800mL)
- abdominal viscera displaces diaphragm cephalad (pushes up): further exacerbated by obesity and pregnancy
What is a significant preoperative consideration that should be made for all orthopedic procedures, specifically trauma cases?
NPO status: trauma typically entails inadequate NPO times, warranting RSI
What peripheral nerve blocks would be beneficial for a total knee arthroplasty?
- femoral block
- sciatic block
What comorbidities commonly accompany a patient undergoing amputation and may need to be assessed?
- diabetes
- pressure ulcers
- sensory deficits
Phantom pain is commonly triggered by what 3 things?
- weather changes
- emotional stress
- pressure on remaining area
