Test 1: Anesthesia for Orthopedic Surgery Spine Patho Flashcards
What kind of spine issues are most prevalent in patients less than 60 years old?
- Degenerative Spine disease
- Herniated disk
- Trauma
What kind of spine issues are most prevalent in patients greater than 60 years old?
- Spinal stenosis d/t aging
What type of surgery is required for a herniated disc?
- Microdiscectomy
What are the types of reconstructive spine surgeries?
- Scoliosis
- Kyphosis
- Kyphoscoliosis
- Revision of previous thoracolumbar fusion
Describe Scoliosis
- Lateral rotation of the spine > 10 degrees
- Congenital or Idiopathic
- Neuromuscular condition
Symptoms of Adult Scoliosis
- Back pain (d/t arthritis/ disk degeneration)
- Spinal stenosis
- Pain worse with standing/ walking
- Radiculopathy/ Sciatica
Effects of scoliosis on the thoracic compartment
- Decrease chest wall compliance
- Restrictive lung disease
- Increase pulmonary vascular resistance (cor pulmonale)
- Chronic hypoxemia secondary to VQ mismatch
What pre-op tests and assessments will need to be performed on scoliosis patients?
- Assess exercise tolerance
- Perform Pulmonary Function Test (ie: FEV)
- ECHO to assess for pulmonary HTN
- EKG (RVH and RAE)
If corrective surgery is needed for scoliosis, anticipate LARGE BLOOD LOSS related to these factors.
- Surgical technique
- Operative time
- Number of vertebral levels fused
- MAP
- Plt abnormalities
- Dilutional coagulopathy (too much fluid)
- Primary fibrinolysis
What are the muscles innervated by C5 discussed in the lecture?
- Deltoid
- Biceps
- Brachialis
- Brachio-radialis
If there is weakness or flaccidity to these muscles, suspect neck/ cervical spine involvement
Injuries to T5 and higher will causes what physiological change?
- Physiologic sympathectomy: hypotension
- Use midodrine to increase BP
The sympathetic cardiac accelerator fibers emerge from the ____ to ____ spinal segments. Injuries above this region will cause bradycardia.
- T1 to T4
Autonomic hyperreflexia can occur if there is complete cord transection above ______.
- T5/T6
What are the symptoms of autonomic hyperreflexia?
- Severe transient HTN
- Bradycardia
- Dysrhythmias
- Cutaneous vasoconstriction below the injury
- Cutaneous vasodilation above the injury
What are the triggers for autonomic hyperreflexia?
- Full bladder or stimulus from bowel
- Noxious stimuli (surgery)
Treatment for autonomic hyperreflexia
- Removal of stimulus
- Deepen anesthetic
- Direct-acting vasodilators
Spinal cord injury to C3 to C5
- Respiratory failure
“3, 4, 5 keep the diaphragm alive.”
Spinal cord injury to C5 to T7
- Impairment of abdominal and intercostal support of respiration
- Increase risk of infection from atelectasis
- Inability to cough/ clear secretions
What is Poikilothermia?
- Inability to maintain constant core temp
- D/t disruption of the sympathetic pathway
Monitor tempeature closely, warm air, increase OR temp, warm IVF
