Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Advanced Principles > Anesthetic Considerations for Orthopedic Procedures > Flashcards

Anesthetic Considerations for Orthopedic Procedures Flashcards

(60 cards)

Start Studying
1
Q

What is a common complication associated with orthopedic surgeries?

A

Major blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What comorbidities are commonly associated with patients undergoing an orthopedic procedure?

A

CAD
Rheumatoid arthritis with systemic pulmonary, cardiac and musculoskeletal involvement
Osteoarthritis
Mental status (large population are elderly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Rheumatoid arthritis?

A

Chronic inflammatory disease affecting multiple joints and organ systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the most common joints rheumatoid arthritis affects?

A

C-spine, hips, shoulders, knees elbows, wrists and metecarpophalangeal joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are systemic effect of rheumatoid arthritis?

A

Anemia, pericarditis, cardiac tamponade, myoocarditis and pulmonary interstitial fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What affect does RA have on the immune system?

A

It impairs the immune system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What complications can occur when trying to intubate a patient with RA?

A

Cervical cord compression or compression of vertebral arteries from subluxating C2 at the odontoid process when flexing the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why are patient with RA difficult to ventilate?

A

Restrictive lung disease from pulmonary fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is ankylosing spondylitis?

A

Abnormal immobility of joint caused by fibrous growth in joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are common characteristics of ankylosing spondylitis?

A

Ossification of ligaments at attachment to bone
Progressive ossification
Seronegative for rheumatoid factor –> may go undiagnosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What characteristic of ankylosing spondylitis is of interest to the anesthetic provider?

A

Axial skeleton disk space “bamboo spine”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What population is ankylosing spondylitis more common in?

A

Caucasian Males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are symptoms of ankylosing spondylitis?

A

Low back pain, sacroilitis, multiplane rigidity of spine, chest stiffness and uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why are patients with ankylosing spondylitis difficult to intubate?

A

Atlantoaxial instability and spine fractures during airway manipulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why are patients with ankylosing spondylitis difficult to ventilate?

A

Rigid chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the purpose of using a tourniquet in orthopedic cases?

A

Allows a bloodless field and minimizes blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the maximum a tourniquet should be inflated?

A

100mmHg greater than systolic BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is known to occur if a tourniquet is inflated for longer than two hours?

A

Inflation greater than 2hrs routinely leads to transient muscle dysfunction and may be associated with permanent peripheral nerve injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When does tourniquet pain usually begin to appear?

A

30-45min after inflation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What type of nerve fibers are thought to transmit tourniquet pain?

A

Unmyelinated C fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the definitive treatment for tourniquet pain?

A

Tourniquet release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What position are patients typically placed in for shoulder surgeries?

A

Beach chair position, flexed at hips and knees, 10 to 20 degree reverse trendelenburg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What nerve is at risk of injury in the beach chair position?

A

Brachial plexus injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What occult blood loss can occur with a hip fracture?

A

Extracapsular and Subcapsular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Which type of fracture to the hip is associated with a higher occult blood loss?
Extracapsular fracture: femoral neck, intratrochanteric and subtrochanteric
26
In what order does the most occult blood loss occur from injury to the hip?
Subtrochanteric > Intertrochanteric > base of femoral neck > transcervical > subcapital
27
What syndrome is highly associated with a hip fracture?
Fat Embolism Syndrome
28
What is the triad of symptoms seen with fat embolism syndrome?
Dyspnea Confusion Petechiae on chest, upper extremities, axilla & conjunctiva
29
When is fat embolism syndrome most likely to occur?
72hrs following long bone or pelvic fracture
30
What are the signs of fat embolism syndrome during general anesthesia?
Decreased EtCO2 and arterial saturation
31
What is the treatment for fat embolism syndrome?
Early fracture stabilization and supportive care
32
What position is a total hip replacement usually done in?
Lateral decubitus, higher degree of visibility and range of motion
33
What is the most common indication for a total hip arthroplasty?
Osteoarthritis (Degenerative joint disease)
34
What are the surgical steps to a total hip arthroplasty?
Dislocation and removal of femoral head Reaming of acetabulum Insertion of acetabular cup Reaming of femur and insertion of femoral component
35
What are the three life threatening complications of a total hip arthroplasty?
Bone cement implantation syndrome Perioperative hemorrhage (reaming and insertion) Thromboembolism
36
What is bone cement implantation syndrome?
Hardening and expansion against components causes intramedullary HTN forcing embolization of fat, bone marrow, cement and air into femoral venous channels
37
What effect does residual methylmethacrylate monomer produce?
Vasodilation and decreased SVR
38
What can trigger platelet aggregation, and produce pulmonary microthrombi and CV stability in bone cement implantation syndrome?
Release of tissue thromboplastin
39
What are the clinical manifestation of bone cement implantation syndrome?
``` Hypoxia HoTN Dysrhythmias Pulmonary HTN Decreased CO ```
40
How can the anesthetic provider intervene if bone cement implantation syndrome is suspected?
Increased FiO2 Maintain euvolemia Ask the surgeon to perform a high pressure lavage of femoral shaft to remove debris
41
What is a significant cause of morbidity and mortality in patients that undergo an orthopedic procedure?
Venous thrombosis
42
What can be done to prevent venous thrombosis in the post operative period?
Regional anesthesia Intermittent leg compression devices Low-dose anticoagulant prophylaxis
43
What can occur when the tourniquet is released after a total knee arthroplasty?
HoTN
44
Why might the surgeon request muscle relaxation to facilitate a closed reduction?
Once fractured, the muscles tend to spasm and pull fracture together to try to heal. Does not heal properly
45
What position are spine cases typically performed in?
Prone position
46
What are some considerations with the prone position?
``` Neck must be neutral Shoulders abducted less than 90 degrees Ischemia to ears, eyes, nose, forehead female breasts or male genitalia HoTN Ventilation difficulties ```
47
Why is it so important for a patient's abdomen to be free from pressure while in the prone position?
If pressure on the abdomen it increases venous blood flow which increases after load causing an increase in blood loss
48
What complications are associated with spinal surgery?
Large blood loss Vision loss VAE
49
What two tests can be used for spinal cord monitoring?
Wake up test | SSEP, MEP monitoring
50
What can cause vision loss after a spinal procedure?
Optic neuropathy Retinal artery occlusion Cerebral ischemia
51
What changes are observed in SSEPs if spinal cord dysfunction occurs?
Changes in the latency and amplitude
52
How do volatiles affect SSEPs?
Decrease amplitude and increase latency
53
What anesthetics have no clinically relevant effect on SSEP signals?
Propofol, Ketamine and narcotics
54
What is the most reliable monitoring tool for spinal procedures?
The wake up test
55
When should volatiles be discontinued if planning to perform a wake up test?
An hour prior to wake up test
56
If paralytic is used, what should be done in order to prevent interference with the wake up test?
Maintain 2-3 twitches on TOF/no reversal, the patient must have sufficient toe movement
57
When is an anterior and posterior fusion performed on a patient with scoliosis?
If the curvature is greater than 90 degrees
58
When is controlled HoTN required during an anterior and posterior approach for scoliosis?
Posterior portion, MAP should be 60mmHg or more to prevent blindness or cord ischemia
59
Why does right ventricular hypertrophy and pulmonary HTN occur after an anterior and posterior approach for scoliosis?
Prolonged alveolar hypoxia due to hypoventilation and V/Q mismatch --> irreversible vasoconstriction and pulmonary HTN
60
What are some considerations for patients undergoing limb reimplantation?
Keep the patient warm Euvolemic Anemia if tolerated DO NOT use pressirs

Advanced Principles (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions