Orthopedic Surgery Flashcards
Anesthesia Mngt issues associated with orthopedic procedures?
Airway Positioning Blood/Fluid Loss Temperature Conservation *Post-op pain
How is Congenital dislocation of the hip caused?
Prolonged displacement of the fetal femoral head in from the acetabulum resulting in posterior dislocation during hip flexion
-Severity ranges fro joint laxity to irreducible displacement
What is the treatment for congenital dislocation of the hip ? (CHD)
- Pavlick Harness
- Fluoroscopy guided closed reduction and spica casting
T/F: the procedure for CHD is long and painful?
FALSE
Short and not painful
What is the greatest concern during CHD repair?
LOSS OF AIRWAY
- IH via mask, LMA, ETT
- Pt lifted from OR table to the spica casting frae then back to OR table
- Disconnect circuit during position changes, ( remember to DC N2) prior to circuit disconnect )
- Monitor breath sounds continuously
What is another big concern during CHD surgery?
Laryngospasm
A lot of movement, pt must be in STAGE III to prevent this, strict attention to securing the device so it does not becomes dislodged during position changes
- Easiest is to use ETT
Congenital Clubfoot, a structural deformity- shortened medial tendons of the lower leg, Achilles tendon- what was does the foot point?
Downward and inward
Plantar and inversion
What is the treatment for Congenital club foot?
- Manipulation and casting
- Surgical Correction and casting at 3-6 months
What are our options for anes. mngt during congenital clubfoot?
General and Regional
- IH and then caudual injection with bupivacaine 0.25% 1ml/kg
- Analgesia for 4-6 hours, decreases IHA requirement
- IV opioids instead of caudal
- -Fentanyl 2-5 mcg/kg
- -MSO4 0.1 mg/kg
Do we want to use an ETT or maintain SV during congenital club foot repair?
ETT- cnt monitor breath sounds
- Tourniquets are utilized
- Position and padding up upper extremities
- Intraop glucose monitoring and USE of glucose containing solution
- Temperature conservation
*Usually have sx 3-6 months of age
What is osteogenesis Imperfects?
Defect of collagen production resulting in abnormal bones, ligaments, teeth, sclera
**Pts suffer fractures after innocuous contact or trauma
What are clinical presentations of Osteogenesis Imperfecta?
- Bowing of long bones and kyphoscoliosis
- Ostosclerosis and deafness ( bones in inner ear don’t vibrate )
- Hypermetabolic-NOT MH
- Platelet abnormalities and decreased Factor VIII levels in 30%
Anesthetic Management of OI?
- *VITAL gentle manipulation of the C-spine and airway
- -Atlantooccipital instability
- -Cervical and mandibular fxs occur easily
- -Airway cartilages and teeth are easily damaged
How do you management a normal vs difficult airway in its with OI?
Normal-routine IH or IV induction and intubation
Difficult: Awake fiberoptic
When do you give muscle relaxants in pts with OI?
Only AFTER adequate mask ventilation is established
What medications can we give for analgesia in OI?
Fentanyl 2-5 mcg/kg
MSO4 0.1 mg/kg
Special considerations on anes. mango with pts who have OI?
- Meticulous attention to positioning and padding of extremities
- Avoid aggressive heat conservation measures and anti-muscarinics - signs like MH
- Tourniquets are utilized
- Succinylcholine induced fasciculations can cause fractures
T/F: Cerebral Palsy ( CP) is evolving encephalopathy or any progressive central motor deficit r/t hypoxic or anoxic cerebral damage in the perinatal period?
FALSE
STATIC encephalopathy
NONprogressive
What is the etiology of CP?
Prematurity Birth Trauma Hypoglycemia Intrauterine and neonatal infections Congenital vascular malformations
What other diseases is CP associated with?
Mental Retardation
Seizures Disorders
Abnormalities of Vision, Speech, hearing, behavior and cognition
What is the clinical presentation on CP?
Skeletal muscle spasticity and contractures
- Impairment of laryngeal and pharyngeal reflexes- GERD, aspiration
- Poor dental hygiene
How do we management CP patients peri-operatively ?
- Mod-sev airway ETT r/t predisposition to aspiration
- Pre - medicate individualized
- -Intra Nassal Midazolam 0.2-0.3 mg/kg
- -Intra muscular ketamine 5-10 mg/kg
- -SCh does NOT produce exaggerated K release
- Response to NDNMB normal
- Opioids are okay but caution with impaired alertness or airway reflexes
- Caudal decrease IHA requirement and provides post op analgesia
What are disorders and drug interactions we need to be aware of with patients and CP?
Seizure Disorder:
- Phenobarbital, phenytoin, carbamazepine - TAKE day of procedure
- Phenobarbital- hepatic enzyme INDUCER
Spasticity:
- Dantrolene
- Baclofen
Why are fractures common in this population?
Trauma
-Evaluate for injury to c-spine and other organ systems
