Orthopedic Surgeries Flashcards
What is mainstay treatment for congenital hip dislocation?
Pavlick Harness.
Fluoro guided closed reduction and spica casting
Why might an LMA not be suitable for congenital hip dislocation surgery?
Manipulation of hips/casting may increase risk of laryngospasm=should use ETT
What is the greatest anesthetic concern during congenital hip dislocation surgery?
Loss of airway
What structural deformity causes congenital clubfoot?
Shortened medial tendons of the lower legs.
Shortened Achilles tendon
What type of regional anesthetic would be used for clubfoot repair?
Caudal block with bupivacaine 0.25% 1ml/kg
How many hours of analgesia would a caudal block provide for clubfoot repair?
4-6 hours
What is osteogenesis imperfecta?
Defect of collagen production resulting in abnormal bones, ligaments, teeth, and sclera
What are the four major facets of clinical presentation with osteogensis imperfecta?
- Bowing of long bones/kyphoscoliosis
- Otosclerosis/deafness.
- Hypermetabolic (not MH)
- Platelet abnormalities and decreased Factor VIII
T/F: Patients with osteogensis imperfecta typically need aggressive heat conservation measures and will need upper and lower warmers?
False; due to hypermetabolic state, should avoid anti-muscarinics and aggressive heat
Why should succinylcholine be avoided in patients with osteogensis imperfecta?
Can cause fractures d/t fasiculations
What is the etiology of cerebral palsy?
Prematurity, birth trauma, hypoglycemia, intrauterine and neonatal infections, congenital vascular malformations
What is phenobarbital’s effect on anesthesia?
Hepatic microsomal enzyme inducer and may go through NDNMBA faster.
Patients with a seizure disorder, what should be done with their medications?
Should be taken up to and including the day of the procedure
Name two medications often used for helping spasticity with CP patients?
Dantrolene and Baclofen
What three things make a fracture an urgent/emergent surgical repair?
- Vascular compromise
- Large hematoma
- Hypotension
What are 4 main anesthetic considerations for fracture repairs?
- RSI and ETT
- Analgesia as indicated (maybe caudal block as well)
- Availability of blood products
- Temperature conservation
What is myelodysplasia?
Congenital failure of the middle or caudal end of the neural tube to close resulting in 1 of 3 disorders.
What are the thee things myelodysplasia can result in?
- Spina Bifida
- Meningocele
- Myelomeningocele
Clinical presentation of meningocele?
Neural function is intact.
Spinal cord is tethered by sacral nerve roots.
Results in orthopedic and/or urologic symptoms
Clinical presentation of myelomeningocele?
Varying degrees of sensory and motor deficits.
Dilation of upper urinary tract.
Spasticity.
Scoliosis
T/F: NDNMBA should be given full dose for myelodysplasia repair?
False; NDNMBA may be avoided or used sparingly d/t use of neurometric monitoring.
When is surgical repair performed for myelodysplasia?
First day of life mostly due to lack of skin covering defect and being prone to infection and sepsis
How should myelodysplasia patient be positioned during induction?
Foam head ring surrounding lower back to decrease pressure.
What age is considered infantile scoliois?
<3 yrs
What age is considered juvenile scoliosis?
3-10yrs
What age is considered adolescent scoliosis?
> 10 yrs
What are physiological derangements of scoliosis?
- Decreased lung volumes.
- Decreased chest wall compliance
- V/Q mismatch leading to chronic hypoxemia.
- Increased PVR, Pulm HTN leading to RV failure.
What are problems with prone positioning for scoliosis repair?
- Compression of lungs
- Increased intra abd pressure
- Compression of IVC
- Epidural vein engorgement, increased bleeding
- Decreased venous return, and CO
What is typical blood loss of scoliois repair?
25ml/kg
What else should you considered after loss of one blood volume in scoliosis repair?
- Dilutional thrombocytopenia
2. Decreased factors V and VIII
What are main issues with scoliosis repair post-operative management?
- Mech vent
- Hypovolemia
- Pain
- Ileus
- SIADH
