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My Foundations 2 > Quiz 8 > Flashcards

Quiz 8 Flashcards

1
Q

Bone Cement Implantation Syndrome

A
  • Hypoxia (increased pulmonary shunt)
  • Hypotension
  • Dysrhythmias (heart block and sinus arrest)
  • Pulmonary htn (increased PVR)
  • Decreased Cardiac Output
  • Embolization most frequent during prosthetic insertion
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2
Q

Strategies to minimize effects of MMA

A

-Increase inspired O2 prior to mma
-Maintain euvolemia
-Vasopressor as needed
Surgical methods:
-venting distal femur
-high pressure lavage of femoral shaft

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3
Q

Prolonged cuff time 45-60 min associated with:

A
  • htn
  • tachycardia
  • sympathetic stimulation (sweating)
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4
Q

Cuff deflation drops ___ and ___ (and pain). ___ increases, ________ decreases

A

CVP

MAP

HR

core temp

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5
Q

which fibers are responsible for tourniquet pain

A

C fibers (slow conduction)

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6
Q

Metabolic Changes after cuff deflation

A

Increase:

  • PaCO2
  • ETCO2
  • lactate
  • potassium

Decreased:

  • PaO2
  • pH
  • See increase in minute volume in spont breathing pt and possibly dysrhythmias
  • Reperfusion injuries from free radical formation
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7
Q

Fat Embolism Syndrome

A

-Classic presentation w/in 72 h of long bone or pelvic Fx

Triad of:

  • dyspnea
  • confusion
  • petechiae

Also seen with CPR, liposuction, IV lipids

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8
Q

Pathogenesis: fat globules released by disrupted fat cells in fx bone and enter circulation through tears in _________________

A

medullary vessel

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9
Q

Fat embolism syndrome diagnosis

A
  • Petechiae
  • Fat globules - retina, urine, sputum
  • Coagulation abnl: thrombocytopenia, prolonged clotting time sometimes seen
  • Progressive pulm involvement from mild hypoxia and clear CXR to ARDS
  • Under GETA see decline in ETCO2 and SPO2 and rise in PAP (peak airway pressures)
  • Treatment is supportive. Early stabilization is key to prevention.
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10
Q

Deep Venous Thrombosis and PE risk factors (including highest)

A

-post pelvic and lower extremity surgery

Risk factors:

  • age > 60yr
  • obesity
  • tournique
  • procedures >30 min
  • lower extremity fx
  • immobilzation > 4 days

-Highest risk are in knee and hip replacements

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11
Q

Role of Neuraxial Anesthesia in less chance of DVT

A
  • Sympathectomy induced increases in venous blood flow
  • Antiinflammatory effects of local anesthesia
  • Decreased platelet activity
  • Decreased rise in factor VIII and Von Willebrand factor
  • Less fall in antithrombin III
  • Less stress hormone release
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12
Q

______ itself is not a contraindication to neuraxial anesthesia.

A

Aspirin

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13
Q

Placement of epidural needle or catheter (or removal) should not be undertaken within ____ h of a SQ minidose of heparin or within _____ h of LMWH

A

6-8

12-24

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14
Q

________ anesthesia associated with lower risk of hematoma than ________ anesthesia

A

Spinal

epidural

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15
Q

Hallmarks of hematoma from spinal/epidural are _____________ and __________________

A

back pain

lower extremity weakness

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16
Q

Selection of Anesthesia:

A

Regional

  • Pt with multiple medical problems
  • Pt with full stomach

General

  • May need rapid sequence induction
  • If remote, mask or LMA maybe okay
17
Q

Hip Fracture Predictors of peri-op mortality (5):

A
  • Age >85 yrs
  • H/o cancer
  • Baseline/pre-op alteration in neuro status
  • Post-op chest infection
  • Post-op wound infection
18
Q

Hip Fracture: Benefits of regional anesthesia

A
  • Reduced blood loss
  • Reduced dvt / pe (advantage over general)
  • Quicker return to baseline neuro

Will lose benefit of regional if…

  • Pt oversedated
  • Pt is allowed to become hypoxic
  • After two months, no difference in mortality for regional vs general
19
Q

Hip fracture: Minimize postop cognitive impairment

A 
-Minimize use of midazolam in older pt
Maintain:
-oxygenation
-hemoglobin 
-normocapnea
20
Q

THA intraop management: Embolic event most frequent at ___________________________

A

insertion of femoral component

21
Q

THA intraop: Blood Loss

A

400-1500 ml, 2000 ml for revisions

22
Q

TOTAL KNEE ARTHROPLASTY TKA: EBL

A

EBL less intraop (100-200 ml) as limited by tourniquet

23
Q

Highest rate of dvt of all ortho procedures

A

TKA

24
Q

TKA: Less bone cement syndrome than hip, but release of emboli w/tourniquet deflation may increase __________

A

hypotension (Check BP after tourniquet goes down)

25
Q

Use of tourniquet is better where?

A

better to use upper leg/arm d/t only being 1 bone

26
Q

Re-implantations: anesthetic concerns

A
  • Maintain body temp!!!
  • Regulation of fluids be on heavy side of fluids
  • Maintenance of blood flow
    - Optimal HCT 28-30%
    - Keep warm
    - Avoid vasoconstrictors (ephedrine better choice if needed)
    - Dextran or heparin infusion intraop
27
Q

Interscalene block

A

Roots, trunk - shoulder to hand

28
Q

Supraclavicular block

A

trunks - upper arm to hand

29
Q

Infraclavicular block (3 Cords)

A

lateral cord - forearm flexion

post cord - wrist extension

medial cord - fingers and thumb

30
Q

Axillary block (3 Nerves)

A

median nerve - forearm pronation, wrist flexion

ulnar nerve - finger flexion, thumb opposition

radial nerve - wrist extension

31
Q

Femoral nerve block

A

loss of quad function

32
Q

Look at slide 64

A

.

33
Q

Anatomic structures in femoral (medial to lateral)

A

VAN - vein, artery, nerve

34
Q

look at slide 67

A

.

35
Q

intralipid dosing

A

Bolus:
1.5mg/kg over 2-3 mins

Infusion:
0.25mg/kg/min

My Foundations 2 (10 decks)

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