Orthopedics Flashcards
What is OA?
Osteoarthritios
inflammation of the joint capsule and surrounding tissues
Develops pain/swelling of the joint
What is the most common location for OA
Weight bearing joints
Can see in cervical spine
What is the treatment for OA?
Meds
Arthroplasty
What is the anesthetic management for a patient with OA?
Assess ROM
NSAIDS
Steroids
Consider regional
What is RA?
chronic inflammatory disease that affects joints BILATERALLY
Autoimmune of unknown etiology
Activated endothelial cells start an inflammatory cascade leading to synovial hypertrophy, destruction of cartilage and articular surfaces
Who gets RA more often: Men or Women
Women
Where is the most common location to have RA?
Cervical spine – 80%
May see systemic effectsW
What are some systemic effects you can see with RA?
myocarditis
pericardial effusions
Pleural effusions
anemia
infections
amyloidosis
Adrenal insufficiency d/t steroids
How do you treat RA?
DMARDS
TNF inhibitors
Methotrexate
Steroids
NSAIDS
What is the anesthetic management of pts with RA?
Risk of Difficult airway due to
- TMJ instability
- Cricoarytenoid Arthritis
- Easy dislocation of laryngeal cartilages
Consider fiberoptic or glide scope and awake intubations
What is the level of blocked for an axillary block
Branches
What are the peripheral nerves associated with an axillary block?
Radial
Ulnar
Median
What does the axillary block cover?
Forearm and HandW
What level of blockade does the infraclavicular block cover?
Cords
What peripheral nerve is covered by the infraclavicular?
Radial
Ulnar
Median
Musculocutaneous
Axillary
What areas does the infraclavicular block cover?
Elbow
Forearm
HandW
What is the risk with an infraclavicular block?
risk of pneumothorax
not for outpatient proceduresW
What level does the supraclavicular block cover?
Distal trunk and Proximal cord
What peripheral nerves are covered by the supraclavicular block?
Radial
ulnar
median
musculocutaneous
axillaryM
What areas of the arm does the supraclavicular block?
Mid humorous
Elbow
Forearm
Hand
What is the risk with supraclavicular blocks?
Pneumothorax
What level of blockade is seen with the inter scalene?
Upper and middle trunks
What peripheral nerves are covered by the interscalene?
Entire BP
ULNAR IS NOT BLOCKED IN 15-20% OF PEOPLE
What is the application of the interscalane block?
Shoulder
Proximal and middle humorous
What is the risk associated with inter scalene block?
Phrenic nerve paresis decreases pulmonary function by 25%
What roots make up the superior trunk?
C5 & 6
What root makes up the middle trunK?
C7
What root makes up the inferior trunk?
C8 and T1
What cord does the superior trunk branch into?
Lateral and Posterior
What cord does the middle trunk branch into?
The posterior division
What Cord does the inferior trunk branch into?
Medial and Posterior divisions
The medial Cords branches into what nerves?
Median and UlnarW
The Posterior cord branches into what nerves?
Axillary and Radial
The lateral cord branches into what nerves
Musculocutaneous
Median
What are some concerns with the beach chair position?
Cerebral ischemia
Behold Jarish reflex
What are the concerns of cerebral ischemia In the beach chair position?
head is up 20-30 cm higher than BP cuff so cuff will show a BP 16-24 points higher than what the head is seeing
BP decreases 2 torr for every 1inch
Also think about the circle of willis (another 10 cm above)
Where should you zero your arterial line when you have a patient in the beach chair position?
External auditory meatus (circle of willis)C
What is the equation for CPP?
CPP = MAP - ICP or CVP
What is the Behold Jarish Reflex?
response to noxious ventricular stimuli sensed by chemoreceptors and mechanoreceptors in the LV by inducing a triad:
- HOTN
- Bradycardia
- Coronary artery dilation
Why does the Bezhold Jarish reflex work?
the heart reacts to the decrease in Preload by withdrawing SNS tone and reflexively increasing PNS toneW
When is the bezhold jarish reflex seen most often?
Awake patients with interscalene blocks
What are some concerns with tourniquet use?
eliminates flow distal to the tourniquet
What is the pain associated with the tourniquet?
Not fixed with narcotics –> DULL, ACHING, RESTLESSNESS
When does pain start with the tourniquet
30 minutes for awake, 45-60 for GA patientsW
What type of pain fibers are associated with tourniquet pain?
Type C fibers and A delta fibers
What is the treatment for tourniquet pain?
Rlease of tourniquet
but may lead to transient metabolic acidosis
What does the transient metabolic acidosis associated with tourniquet pain look like?
Increase ETCO2
HOTN
Tachycardia
How do you use the tourniquet?
LE max 2H
UE max 1.5H
Inflate 50-75 mmHg above systolic UE
Inflate 100-150 above systolic for LE
Inflation: increase in central blood volume –> increased preload and after load
When you are preparing to deflate a tourniquet, what do you need to expect?
Preload acutely drops
Post-Ischemic hyperemia
Decreased after load causes HoTN
