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Spr25 AdvPrin A > Spinal Surgery Anesthesia > Flashcards

Spinal Surgery Anesthesia Flashcards

1
Q

What is scoliosis?

A

Lateral rotation of the spine > 10° with vertebral rotation.

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2
Q

What are the effects of thoracic spine scoliosis?

A
  • ↓ Chest wall compliance
  • Restrictive lung disease
  • ↓ exercise tolerance

Get PFTs!

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3
Q

What EKG/cardiac findings might one suspect to find on a scoliosis patient? (Select all that apply)

a. RVH
b. RAE
c. LVH
d. Bi-atrial enlargement

A

a & b

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4
Q

The increased pulmonary vascular resistance of chronic, significant scoliosis can lead to ___ _______.

A

cor pulmonale

Enlarged RV due to lung disease.

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5
Q

What muscles would you expect to be effected from a C5 injury?

A
  • Partial diaphragmatic paralaysis
  • Deltoids
  • Biceps
  • Brachialis
  • Brachio-radialis
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6
Q

What are the hemodynamic consequences of injuries T5 and higher?

A

Physiologic Sympathectomy
- ↓BP
- ↓HR

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7
Q

Autonomic Hyperreflexia is most often seen with cord transection above the ____ level.

A

T5/T6

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8
Q

What s/s are seen with autonomic hyperreflexia?

A
  • Severe, transient HTN
  • Bradycardia
  • Dysrhythmias
  • Cutaneous dilation and constriction
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9
Q

In autonomic hyperreflexia, cutaneous vasodilation is seen _____ the site of injury, whilst cutaneous vasoconstriction is seen ____ the site of injury.

A

above ; below

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10
Q

What is the basic pathophysiology of Autonomic Dysreflexia?

A
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11
Q

What are the most common causes of Autonomic Dysreflexia?

A
  1. Distended bladder/bowel
  2. Noxious stimuli (think surgical pain)
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12
Q

What is the treatment for Autonomic Dysreflexia?

A
  1. Removal of stimulus
  2. Deepen anesthetic
  3. Direct-acting Vasodilators
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13
Q

Injury to C3-C5 results in….

A

Diaphragmatic respiratory failure

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14
Q

Is respiratory function affected by injury to C5-C7?

A

Yes; impairment of abdominal and intercostal respiratory support

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15
Q

Why is there an increased risk of pulmonary infection with cervical spine injuries?

A
  • Inability to cough/ clear secretions
  • Atelectasis
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16
Q

What is poikilothermia?

A

Inability to maintain constant core temp

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17
Q

What is the pathophysiology of poikilothermia?

A
  • SNS disruption
  • Temperature sensation disruption
  • Inability to vasoconstrict below spinal cord injury
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18
Q

Spinal deformities are associated with _______ respiratory patterns, often necessitating PFT’s and an ABG.

A

Restrictive

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19
Q

Flaccidity in which two muscles would indicated possible cervical spine fracture?

A
  • Deltoids
  • Biceps
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20
Q

What is the greatest risk with a total sitting position?

A

VAE (Venous Air Embolism)

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21
Q

An anterior approach for a thoracic spine procedure requires what position and equipment?

A
  • Lateral position with bag
  • Double Lumen ETT or bronchial blocker

May have to drop lung for access.

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22
Q

A posterior approach for a thoracic spine procedure requires what position and equipment?

A
  • Prone with arms tucked or 90° abduction
  • Single lumen ETT.
23
Q

What are the three causes of postoperative vision loss secondary to prone positioning?

A
  • Ischemic Optic Neuropathy (ION)
  • Retinal vessel occlusion
  • Cortical brain ischemia
24
Q

T/F. Ischemic optic neuropathy occurrence requires direct pressure placed on the eyes?

A

False. Can occur without direct pressure.

*Occurs due to ↓ blood flow or O₂ delivery.

25
Q

What are risk factors for ION?

A
  • Male
  • Obesity
  • Wilson Frame Use
  • > 6 hour surgery
  • ↓ colloid usage
  • Blood loss > 1000 mL
26
Q

What is the typical onset of ION?

A

24 - 48 hours

27
Q

What are the symptoms of ION?

A

Bilateral
- Painless vision loss
- Non-reactive pupils
- No light perception

28
Q

What are the treatments for ION?

A
  • Acetazolamide
  • Corticosteroids
  • Hyperbaric O₂
29
Q

What time of frame pictured below?

A

Wilson Frame

30
Q

What are the respiratory effects of prone positioning?

A

↓ FRC
↓ compliance

Due to ↑ intrabdominal pressures → ↑ intrathoracic pressures.

31
Q

Does venous return increase or decrease in prone positioning?

A

decrease

32
Q

Which of the following positioning devices is the most stable?

A

Mayfield Tongs

33
Q

What cardiac consequences are there to prone positioning?
Why?

A
  • ↓ preload
  • ↓ CO
  • ↓ BP

Due to pooling of blood in extremities and compression of abdominal contents and muscles.

34
Q

What neurological consequences occur due to prone positioning?

A

↓ cerebral venous drainage and ↓ CBF

35
Q

What risk factors are there for increased blood loss during spinal surgery?

A
  • Number of vertebrae
  • > 50 yo
  • Obesity
  • Tumor surgery
  • ↑ intrabdominal pressure
  • Transpedicular osteotomy
36
Q

When is autologous blood donation contraindicated in spinal surgery?

A
  • Significant cardiac disease
  • Infection
37
Q

What is the push dose of TXA?

A
  • 10 mg/kg IV
38
Q

What is the infusion dose of TXA?

A

2 mg/kg/hr

39
Q

What is the push dose of aminocaproic acid?
Infusion dose?

A

Push dose: 100 mg/kg IV
Infusion: 10 - 15 mg/kg/hr

40
Q

Somatosensory Evoked Potentials (SSEPs) are associated with what spinal column and sensations?

A

Dorsal column pathways
- Proprioception
- Vibration

41
Q

Motor Evoked Potentials (MEPs) are associated with what spinal column and sensations?

A

Anterior/ Motor Column

42
Q

During spinal surgery, electromyogram (EMG) is used to monitor for what during pedicle screw placement and nerve decompression?

A

Monitor for nerve root injury.

43
Q

What is an SSEP?

A

Impulse from a peripheral nerve that is measured centrally.

44
Q

What are Motor Evoked Potentials (MEPs)?

A

Impulse triggered in the brain (centrally) and monitored in specific muscle groups.

45
Q

What are possible adverse effects associated with MEPs?

A
  • Cognitive defects
  • Seizures
  • Intraoperative awareness
  • Scalp burns
  • Cardiac arrythmias
  • Bite injuries (bite block necessary)
46
Q

In what patients should MEPs be avoided?

A
  • Patients w/ active seizures
  • Patients w/ vascular clips in brain
  • Patients w/ cochlear implants
47
Q

Differentiate amplitude and latency in regards to neurophysiologic monitoring.

A

Amplitude: signal strength
Latency: time for signal to travel through spinal cord.

48
Q

What physiologic factors commonly can affect amplitude and latency of neurophysiologic monitoring?

A
  • Hypothermia
  • Hypotension
  • Hypocarbia
  • Anemia
  • VAAs
49
Q

How do VAAs affect neurophysiologic agents?

A

Dose dependent
- ↓ amplitude
- ↑ latency

50
Q

Out of the following drugs, which affects our MEPs the most?
- Opioids
- Midazolam
- Ketamine
- Propofol

A

Propofol depresses MEPs.

The others have little effect on MEPs.

51
Q

How much does muscle relaxant requirement increase when using MEPs?

A

Trick question. No muscle relaxants after intubation.

52
Q

What type of nerve block might be used for spinal surgery?

A

Erector Spinae block

53
Q

During what surgery is venous air embolism at its greatest risk of happening?

A

Laminectomies
- Large amount of exposed bone
- Surgical site above the heart

54
Q

What are some s/s of VAE?

A
  • Unexplained ↓BP
  • ↑ EtN₂
  • ↓ EtCO₂

Spr25 AdvPrin A (11 decks)

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