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Adv Principles A > Exam 1 part 3 > Flashcards

Exam 1 part 3 Flashcards

1
Q

scoliosis surgeries take approx _______ hours

A

6-10

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2
Q

scoliosis is defined as lateral rotation >_____ degrees

A

10

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3
Q

the pain from adult scoliosis is typiacally worse when:

A

standing or walking

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4
Q

which type of scoliosis typically has decreased chest wall compliance?

A

thoracic

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5
Q

which type of scoliosis typically has increased pulmonary vascular resistance?

A

thoracic

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6
Q

which type of scoliosis typically has RV hypertrophy and RA enlargement?

A

thoracic

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7
Q

anticipate ____ blood loss in patients having spine surgery

A

large

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8
Q

after about 2 L of crystalloid, think about administering blood or colloids to prevent:

A

dilutional coagulopathy

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9
Q

what are 4 muscles that are innervated by C5?

A

deltoid
biceps
brachialis
brachio-radialis

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10
Q

if muscles innervated by c5 show signs of weakness, what other important muscle may be weak?

A

diaphragm

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11
Q

why could injuries about T1-T4 cause bradycardia?

A

these are the cardiac accelerator nerves

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12
Q

spinal injuries above T5 are at risk for physiologic ________. what does this cause and what is the treatment?

A

sympathectomy
hypotension, midodrine

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13
Q

what can result if there is complete cord transection above T5 or T6?

A

autonomic hyperreflexia

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14
Q

what are 5 signs/symptoms of autonomic hyperreflexia?

A

severe+transient HTN and bradycardia
dysrhythmias
cutaneous vasoconstriction BELOW injury
cutaneous vasodilation ABOVE injury

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15
Q

what typically sets off autonomic hyperreflexia?

A

some afferent noxious stimulus (full bowel or bladder, surgery) produces a massive sympathetic response

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16
Q

what are 3 treatment options intra op for autonomic hyperreflexia?

A

deepen anesthetic
remove stimulus
direct-acting vasodilators

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17
Q

injury to which cord levels can lead to impairment of abdominal and intercostal muscles that support breathing?

A

C5-T7

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18
Q

define poikilothermic

A

inability to maintain constant core body temp due to disruption of sympathetic pathways

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19
Q

spinal cord injury pts typically have issues with vasoconstriction ______ the level of injury

A

below

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20
Q

airway management issues are ____ common in thoracic and thoracic cases

A

more

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21
Q

spinal deformities typically lead to _____ respiratory patterns

A

restrictive

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22
Q

cardiac issues can be seen in pts with severe:

A

kyphoscoliosis

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23
Q

pts with RA can have this type of cervical instability:

A

alanto-axial instability

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24
Q

what is the most common anesthetic plan for spinal surgeries?

A

GETA

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25
if SSEP/MEP/EMG is being used, what is the preferred muscle relaxant fpr intubation?
succs
26
what is the positioning of pts head and arms in prone for surgery?
arms tucked, head in mayfield pins ***head should still be neutral
27
what is a major concern for the sitting position for cervical spine procedures?
risk of VAE **uncommon positioning
28
what kind of tube needs to be used for anterior approach of thoracic? pt position?
DLT or bronchial blocker lateral
29
what kind of tube needs to be used for posterior approach of thoracic? pt position?
single lumen ETT prone, arms tucked
30
what can you give to decrease drooling in prone pts?
0.2 glyco in preop
31
what are 3 causes of post op vision loss
ischemic optic neuropathy retinal artery/vein occlusion cortical brain ischemia
32
ION occurs ___ pressure to the eyes
without **caused by decreased blood flow/O2 delivery
33
6 risk factors for ION?
male obesity wilson frame use surgery > 6 hours decreased colloid use (using crystalloid) blood lodd > 1 L
34
when does ION onset? 4 signs/symptoms?
24-48 hours postop bilateral, painless vision loss, nonreactive pupils, no light perception
35
treatment for ION?
diuretics , Azetazolamide, hyperbaric O2, increased BP or Hgb
36
3 ways to prevent ION?
head neutral use of blood or colloids for fluid minimize intentional hypotension
37
if the head is flexed too much, ETT moves towards:
carina
38
which surgical positioning increased abdominal and thoracic pressures?
prone
39
what are 2 pulmonary changes in prone?
decreased FRC and pulmonary compliance
40
what patient position sees and increase in bleeding from epidural veins?
prone
41
what is the most stable head positioning device for prone?
mayfield tongs
42
extreme head rotation can _____cerebral venous drainage and CBF
decrease
43
6 risk factors for increased blood loss
increased # of levels >50 y/o obesity tumors increased abdominal pressure transpedicular osteotomy
44
1 indication and 1 contraindication to pre-op autologous blood donation
EBL> 500-1000 mL expected significant cardiac disease or infection
45
TXA dose for spine surgery dose and infusion rate
10 mg/kg 2 mg/kg/hr
46
Amicar dose for spine surgery dose and infusion rate
100 mg/kg 10-15 mg/kg/hr
47
deliberate hypotension is ____ recommended in spine surgery
NOT
48
what does SSEP detect?
dorsal column pathways pf proprioception and vibration ***afferent
49
what does MEP detect?
anterior/motor portion of spinal cord **efferent
50
what does EMG detect?
nerve root injury during pedicle screw placement and nerve decompression
51
what are 5 adverse events to MEPs?
cognitive defects seizures intraop awareness scalp burns cardiac arrhythmias
52
what airway device should be placed when MEPs are being used?
bite block
53
what are 3 contraindications to MEPs?
cochlear implants active seizures vascular clips in brain
54
what 4 clinical conditions alter SSEP/MEP?
hypotension hypothermia hypocarbia anemia
55
amplitude= latency=
-signal strength -time for signal to travel through spinal cord
56
what effects do volatiles have on SSEP/MEP?
dose dependent decrease in amplitude + decrease in latency **usually not an issue with less than 1 MAC
57
which volatile should not be used during MEP?
N2O
58
what does N2O do to MEP?
decreased amplitude
59
what does propofol do to MEP?
depresses
60
MEPS are least affected by what 3 drugs?
midazolam opioids ketamine
61
what is a good dose of intrathecal morphine for postop spine pts?
0.1-0.2 mg
62
what is a good dose of epidural dilaudid for postop spine pts?
0.5-1 mg
63
what peripheral nerve block is good for postop spine pts?
erector spinae
64
which type of spine surgery has the highest risk of VAE?
laminectomy **lots of exposed bone, surgical site above heart
65

Adv Principles A (5 decks)

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