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Principles2 > Orthopedic Surgery > Flashcards

Orthopedic Surgery Flashcards

1
Q

Med history:

  1. should all antihypertensive and cardiac meds be continued day of surgery?
  2. should diuretics be taken or held day of surgery?
  3. antibiotics should be administered within how many minutes of incision?
A
  1. yes
  2. held
  3. 30 minutes
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2
Q

LAST:

  1. avoid what 4 drugs? (V, CCBs, BBs, LA)
  2. reduce epinephrine dose to less than what mcg/kg?
  3. bolus what mL/kg of lean body mass of 20% lipid emulsion over how many minutes?
  4. start a continuous gtt after the bolus at what mL/kg/min?
  5. if BP remains low, how should you increase the gtt rate?
  6. continue the gtt at least how many minutes after attaining circulatory stability?
  7. recommended upper limit: what mL/kg over the first how many minutes?
A
  1. vasopressin, ca channel blockers, beta blockers, local anesthetics
  2. 1 mcg/kg
  3. 1.5 mL/kg, over 1 minute
  4. 0.25 mL/kg/min
  5. double it
  6. 10 minutes
  7. 10 mL/kg first 30 minutes
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3
Q

what are the 2 most common back surgeries? (DH, SS)

A

disc herniation, spinal stenosis

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4
Q

cervical spine surgery:

  1. ensure to keep what stable by avoiding flexion and extension? (N)
  2. what 2 types of monitoring are often used? (S, E)
  3. what type of anesthesia technique is used? (N)
A
  1. neck
  2. SSEP, EMG
  3. narotic
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5
Q

scoliosis:

  1. what method is used to measure the spine angle
  2. fusion is recommended for curvature greater than what degrees?
  3. bracing is suggested for curve of what degree range?
  4. resp impairment is proportional to the angle of what curvature?
  5. VC greater than what predicted % represents adequate respiratory reserve?
  6. VC less than what predicted % represents the risk of postop ventilation requirements?
A
  1. Cobb method
  2. > 60
  3. 20-30
  4. lateral
  5. > 70%
  6. < 40%
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6
Q

Scoliosis:

  1. high incidence of what valve prolapse and htn where?
  2. ECHO shows dilation where and hypertrophy where?
  3. avoid plt inhibitor for what week range prior to surgery?
  4. encourage what type of blood donation? (A)
  5. what are 3 techniques to maintain hemodynamic stability in this surgery? (CH, CSD, VE)
A
  1. mitral valve, pulmonary htn
  2. right atrium, right ventricle
  3. 2-3 weeks
  4. autologous
  5. controlled hypotension, cell saver device, volume expanders
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7
Q

if a high thoracic approach is used, what type of ETT should be used?

A

double lumen endotracheal tube

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8
Q

what 2 tables and one frame is used for prone positioning? (J, A, W)

A

jackson table, andrews table, wilson frame

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9
Q

Prone positioning:

  1. pooling of blood where? (E)
  2. increased or decreased total lung compliance
  3. increased or decreased work of breathing?
  4. increased or decreased cerebral venous drainage and cerebral BF?
  5. compression of abd muscles may decrease what 3 C/V things?
A
  1. extremities
  2. decreased
  3. increased
  4. decreased
  5. preload, BP, CO
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10
Q

Latreal decubitus:

  1. is CO changed (unless venous return is obstructed)?
  2. increased or decreased volume in dependent lung?
  3. increased or decreased perfusion to dependent lung?
  4. pulse ox on up or down arm?
A
  1. no
  2. decreased
  3. increased
  4. down
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11
Q

Sitting:

  1. at what point is art line zeroed?
  2. pooling of blood where decreased central blood volume?
  3. increased or decreased cerebral BF?
  4. increased or decreased lung volumes and residual capacity?
  5. what 2 C/V things decrease and what 2 C/V things compensate for that?
A
  1. external auditory canal
  2. lower extremities
  3. decreased
  4. increased
  5. CO and BP, HR and SVR
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12
Q

intraoperative spinal surgery:

  1. what anesthesia technique is used? (NTWLIA)
  2. controlled hypotension is used to decrease what?
  3. SSEP monitors the function of part of the cord? (D)
  4. SSEP monitoring is very sensitive to what anesthetic agents?
  5. is close communication needed between the anesthesia provider and neuromonitoring tech?
  6. SSEP indication of SC ischemia should be promptly treated with restoring what and decreasing what? (BP, CT)
  7. no what during testing of instrumentation or with EMG monitoring? (MR)
A
  1. narcotic technique with low inhalation agent
  2. blood loss
  3. dorsal
  4. VAs
  5. yes
  6. blood pressure, cord traction
  7. muscle relaxants
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13
Q

intraoperative spinal surery:

  1. surgeon might request a wake up test which provides info about the anterior or posterior part of the spine?
  2. what minute notice is given for a wake up test?
  3. what 3 bad things can occur during a wake up test? (AE, ID, AE)
A
  1. anterior
  2. 40 minute notice
  3. accidental extubation, instrumentation dislodgement, air embolus
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14
Q

should anesthesia personnel document neuro status prior to leaving pt in recovery?

A

yes

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15
Q

what are 4 complications of spinal surgery? (BL, ND, ION, SCI)

A
  1. blood loss
  2. neuro deficits
  3. ischemic optic neuropathy
  4. SC ischemia
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16
Q

what are 3 decreased things that are benefits of arthroscopy? (BL, PP, LOS)

A
  1. blood loss
  2. postop pain
  3. length of stay
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17
Q

anesthetic management for arthroscopy depends on what 5 things? (PP, PL, P, ASL, PA)

A
  1. proposed procedure
  2. procedure length
  3. positioning
  4. anesthesia skill level
  5. patient agreement
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18
Q

what are the 4 nerves that innervate the knee? (F, LFC, O, S)

A
  1. femoral
  2. lateral femoral cutaneous
  3. obturator
  4. sciatic nerve
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19
Q

femoral nerve, lateral femoral cutaneous, and obturator nerve come arise from what lumbar range?

A

L1-L4

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20
Q

sciatic nerves arise from what spinal range?

A

L5-S2

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21
Q

regional recommendations for knee arthroscopy include blocking which two nerves?

A

femoral, adductor canal

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22
Q

adductor canal blocks sensory and minimizes what weakness in comparison to femoral blocks? (M)

A

motor weakness

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23
Q

what are 7 risks of knee arthroscopy? (BITJ, L/CD, BC, NI, BVI, I, SK)

A
  1. bleeding into the joint
  2. ligament/cartilage damage
  3. blood clot
  4. nerve injury
  5. blood vessel injury
  6. infection
  7. stiff knee
24
Q

ACL reconstruction:

  1. repair involves the use of what to replace the ligament? (G)
  2. injection of LA is where? (IA)
  3. most grafts are auto and are from what 2 places? (PT, H)
  4. substantial postop analgesia is required including a what? (FNC)
  5. goal is to resume what very quickly? (PT)
  6. what is applied postoperatively? (B)
A
  1. graft
  2. intra-articular
  3. patella tendon, hamstring
  4. femoral nerve catheter
  5. physical therapy
  6. brace
25
Q

what are 6 potential complications after ACL reconstruction? (KP/S, PGH, I, DVT, R, FTASR)

A
  1. knee pain/stiffness
  2. poor graft healing
  3. infection
  4. DVT
  5. reinjury
  6. failure to achieve symptom relief
26
Q

pneumatic tourniquet:

  1. its use increases what and decreases what? (SSV, BL)
  2. width of the cuff should cover what % of the extremity?
  3. inflation pressure should not exceed what on the upper extremity? (mmHg)
  4. inflation pressure should not exceed what on the lower extremity? (mmHg)
  5. SBP plus how much mmHg is effective in controlling bleeding?
  6. prior to tourniquet inflation, the extremity is exsanguinated with what bandage? (E)
  7. is the tourniquet inflated prior to bandage removal?
A
  1. surgical site visualization, blood loss
  2. 50%
  3. 300 mmHg
  4. 500 mmHg
  5. 100 mmHg
  6. esmarch
  7. yes
27
Q

Pneumatic tourniquet:

  1. inflation greater than how many minutes causes tourniquet pain?
  2. inflation greater than how many hours results in postoperative neuropraxia?
  3. what are 3 muscle changes? (CH, A, CL)
  4. what 2 systemic pressures increase d/t inflation? (A,P)
A
  1. 60 minutes
  2. 2 hours
  3. cellular hypoxia, acidosis, capillary leakage
  4. arterial, pulmonary
28
Q

systemic effects after tourniquet deflation:

  1. metabolic acidosis or alkalosis?
  2. transient increase or decrease in BP?
  3. transient increase or decrease in ETCO2?
  4. transient increase or decrease in core temp?
A
  1. metabolic acidosis
  2. decrease
  3. increase
  4. decrease
29
Q

45-60 minutes post inflation, pts experience:

  1. what 3 pain symptoms in order? (A,B,EP)
  2. post inflation pain is mediated by myelinated or unmyelinated A-delta or C fibers?
  3. tingling post deflation is mediated by myelinated or unmyelinated A-delta or C fibers?
A
  1. aching, burning, excruciating pain
  2. unmyelinated C fibers
  3. myelinated A-delta fibers
30
Q

what 2 things accelerate tourniquet pain? (H, A)

A

hypoxia, acidosis

31
Q

tourniquet should not be inflated for more than how many hours?

A

2 hours

32
Q

shoulder arthroscopy:

  1. preop regional block or indwelling perineural catheter where? (I)
  2. surgeons prefer controlled BP but be careful since pt is sitting up which decreases what? (CP)
  3. BP cuff should always be on arm or leg?
  4. transducer should be at level of what? (B)
A
  1. interscalene
  2. cerebral perfusion
  3. arm
  4. brainstem
33
Q

Beach-chair position:

  1. enhanced venous pooling occurs d/t dependent extremities increases what tone? (S)
  2. combo of venous pooling and paradoxical increased vagal tone results in sudden, profound what 2 things that can be difficult to rapidly reverse? (B, H)
  3. prophylaxis to prevent hypotension and bradycardia events include aggressive treatment of what 2 things? (FD, BL)
  4. what can be applied to lower extremities to minimize venous pooling? (SS)
A
  1. sympathetic tone
  2. bradycardia, hypotension
  3. fluid deficits, blood loss
  4. supportive stockings
34
Q

Bezold-Jarisch reflex is a hypotensive bradycardic episode which includes:

  1. decrease in HR of at least how many beats per minute within how many minutes?
  2. any HR less than how many beats per minute?
  3. and/or a decrease in SBP more than how many mmHg within how many minutes or any SBP less than what?
A
  1. 30 beats per minute in 5 minutes
  2. 50 beats per minute
  3. 30 mmHg in 5 minutes, or less than 90 mmHg
35
Q

shoulder arthroscopic anesthesia complications:

  1. 3 complications related to positioning (E, NI, CA)
  2. what can be perforated during trochar placement? (BV)
  3. pressurized irrigation fluid can result in what 3 things? (CHF, PE, VO)
  4. what are 4 other complications? (SE, TP, P, H)
A
  1. extubation, nerve injury, corneal abrasion
  2. blood vessels
  3. CHF, pulmonary edema, volume overload
  4. subcutaneous emphysema, tension pneumo, pneumomediastinum, hypothermia
36
Q

S/S of tension pneumo:

  1. what are 7 of them? (H, T, ABS, TS, A, H, JVD)
  2. increased or decreased airway pressure?
  3. increased or decreased CVP?
A
  1. hypoxia, tachycardia, absent breath sounds, tracheal shift, agitation, hypotension, jugular vein distention
  2. increased
  3. increased
37
Q

hip arthroplasty:

  1. what are 5 complications? (I, BC, LI, ND, D)
  2. is blood loss significant at this fx site?
  3. if hypoxic, what could it be? (FE)
  4. what table is used for this surgery? (FT)
A
  1. infection, blood clot, length inequality, nerve damage, dislocation
  2. yes
  3. fat embolism
  4. fracture table
38
Q

prosthesis component of knee arthroplasty is secured with what? (M)

A

methylmethacrylate

39
Q

methylmethacrylate:

  1. increases or decreases PVR?
  2. increases or decrease SVR?
  3. increases or decreases CO?
  4. these changes result in a significant or even complete collapse of what?
A
  1. increases
  2. decreases
  3. decreases
  4. C/V
40
Q

what are 7 complications from knee arthroplasty? (D, I, ATMC, AI, ND, CKS/LOM, IF)

A
  1. DVT
  2. infection
  3. allergy to metal components
  4. artery injury
  5. nerve damage
  6. chronic knee stiffness/loss of motion
  7. implant failure
41
Q

ankle arthroplasty:

  1. is failure rate high?
  2. what are 5 complications? (D, I, CRPS, ND, CF)
A
  1. yes

2. DVT, infection, chronic regional pain syndrome, nerve damage, component failure

42
Q

what neuraxial technique is preferred for hip and knee replacements?

A

combined spinal/epidural

43
Q

what are 3 complications that can occur when the prosthesis is inserted that can be caused by methylmethacrylate, fat embolism or bone marrow embolism? (H, H, CC)

A
  1. hypotension
  2. hypoxia
  3. C/V collapse
44
Q

Fat embolism syndrome associated with multiple what type of injuries and surgery involving what type of fractures? (T, LB)

A
  1. multiple traumatic injuries

2. long bone fractures

45
Q

risk factors for fat embolus syndrome:

  1. male or female
  2. what age range?
  3. what type of shock?
  4. what type of arthritis?
  5. instrumentation where? (I)
  6. what 2 types of surgeries? (BTK, THAWC)
A
  1. male
  2. 20-30
  3. hypovolemic
  4. rheumatoid arthritis
  5. intramedullary instrumentation
  6. bilateral total knees, total hip arthroplasty with cement
46
Q

major symptoms of fat embolus syndrome:

  1. petechiae where? (A/S)
  2. edema where? (P)
  3. what system depression disproportionate to hypoxemia?
  4. what other symptom? (H)
A
  1. axillary/subconjunctival
  2. pulmonary edema
  3. CNS
  4. hypoxemia
47
Q

minor symptoms of fat embolus syndrome:

  1. unexplained decrease in what 2 CBC labs?
  2. fat globules in what 2 fluids? (U, S)
  3. fat emboli where? (R)
  4. what other 2 symptoms? (H, T)
A
  1. plt, hematocrit
  2. urine, sputum
  3. retina
  4. hyperthermia, tachycardia
48
Q

fat embolus syndrome occurs is what hour range after injury?

A

12-40 hours

49
Q

block where for these upper extremity arthroplasties?

  1. shoulder
  2. elbow
A
  1. interscalene

2. axillary

50
Q

Upper extremity arthroplasty:

  1. IV on same or opposite side of surgical extremity?
  2. BP cuff on same or opposite side of surgical extremity?
  3. do we use controlled hypotension?
  4. is there potential for increased intraoperative blood loss since a tourniquet isn’t used?
  5. what are the 2 positions for the surgery?
A
  1. opposite
  2. opposite
  3. yes
  4. yes
  5. lateral, fowlers
51
Q

what are 3 frequent ankle procedures? (F, JF, ATR)

A

fractures, joint fusions, achilles tendon repair

52
Q

what are 3 frequent foot procedures? (B, PF, HDC)

A

bunionectomy, plantar fasciotomy, hammertoe deformity correction

53
Q

what 4 nerves can be blocked for ankle or foot procedures? (FSSP)

A

femoral, sciatic, saphenous, popliteal

54
Q

what are 3 blocks for forearm and hand surgery? (A, DN, B)

A

axillary, digital nerve, bier

55
Q

what are 4 common forearm and hand surgeries? (CT, DRF, FF, UNE)

A

carpal tunnel, distal radius fx, finger fx ulnar nerve entrapment

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