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spinal surgery Flashcards

(61 cards)

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1
Q

most common reasons for spinal surgery

A

stenosis
herniation

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2
Q

most common location

A

c2-c3 through L5 to S1

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3
Q

Minimally invasive surgery

A

percut. endoscopic lumbar discectomy
vertebroplasty
cervical discectomy & foraminectomy
intradiscal electrothermal therapy

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4
Q

places minimally invasive sx can be done

A

IR : IV & Local
General: prop, dec, remi

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5
Q

Prone increases

A

SVR & PVR

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6
Q

prone decreases

A

SV & CO

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7
Q

> 60 degree head rotation

A

beginning of compression of contralateral vertebal artery blood flow

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8
Q

> 80 degree rotation of head

A

complete occlusion of contralateral vertebal artery blood flow

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9
Q

Garden Wells Tongs? Mayfield pins

A

Used to provide stability of cervical spine & eliminated pressure on face

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10
Q

POVL associated with

A

prone
general anesthesia

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11
Q

POVL risk factors

A

Male
Obese
OSA
Wilson Frame
Hemorrhage
Crystalloid
Low colloid %
hypotension
>6hr anesthesia duration
Prone

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12
Q

Main causes of POVL

A

retinal vascular occlusion (pressure)
ischemic optic neuropathy (o2)

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13
Q

S/S POVL

A

Bilateral
Painless
No light perception
No color
24-48 hours
Non reactive pupils

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14
Q

Interventions to POVL

A
  1. 5-10 degree reverse trend during spinal surgery in prone
  2. stage procedures
  3. q15 m checks
  4. Steep Trend? 5 min rest at 4 hour mark
  5. Instill Cosopt drops w/ elevated IOP
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15
Q

ASA recommendations for PO blindness

A
  1. inform patient
  2. monitor BP
  3. colloids + crystalloid
  4. montor H&H, oxygenation
  5. a adrenergic case by case
  6. avoid direct pressure
  7. neutral head, higher than heart
  8. stage procedures
  9. assess vision when alert
  10. optho consult
  11. MRI to rule out other causes
  12. antiplt, steroids, IOP have not been shown effective
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16
Q

eras

A

high demand for spinal surgeyr
wide variations in LOS, complication rates, PO pain, functional recovery
high pain levels

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17
Q

ERAS multumodal pain meds

A

tylenol
gabapentin
lidocaine
magnesium
ketamine
dexamethosone
dexmedtomadine

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18
Q

ACDF positioning

A

supine
arms tucked
shoulder roll
foam headrest

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19
Q

induction of ACDF

A

GA with Oral ETT

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20
Q

maintenance ACDF

A

Probably TIVA if using neuromonitoring

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21
Q

emergence ACDF

A

neutral neck
Assess RLN damage
Assess hematoma

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22
Q

S/S RLN damage

A

Unilateral: hoarseness
Bilateral: emergency

Left: branches around vagus nerve (thoracic and cardia cases)
Right: aortic aneurysm and mitral stenosis

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23
Q

Lumbar Laminectomy fusion usually at

A

L4-L5 or L5 S1

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24
Q

most common anesthetic choice for lumbar lami or lumbar instrumentation

A

general anesthesia w/ SSEP or EMG

neuromonitoring? no regional/spine

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25
epidural for lumbar lami
reduced blood loss and shrinks epidural veins analgesia t7-t8 is required??/ what does this mean
26
spinal w. Lumbar Lami
hypotension w/ position changes
27
periop lumbar lami max fluid
40ml/kg of crystalloid
28
emergence lumbar lami
Extubate supine to assess neuro deficits. When would you leave them intubated? Post-operative complications include hemorrhage, neurologic deficits, and visual loss
29
thorasic and lumbar instrumentation level ABOVE ___ needs double lumen ETT
t8 & may require removal of 10th or 6th rib?
30
cobb angle greater than what needs corrective surgery
40-50
31
Vital capacity >40% change from baseline =
remain intubated?
32
wake up test consequences
movement VAE from forced inhalation
33
what SC injury is incompatible with survival
c2 to c4
34
Rheumatoid Arthritis spontaneous dislocation
c1 on c2 vertebrae
35
Nontraumatic cause of spinal cord transection
multiple sclerosis
36
Where is temperature regulation lost, reflexes lost & flaccid paralysis occurrence in SC injuries?
below the level of the injury
37
What is the spinal shock triad?
Bradycardia, hypotension, hypothermia Unable to constrict vessels or shiver to produce heat or to dilate ves sels to dissipate heat. The patient’s body temperature has a tendency to migrate toward the environmental level.
38
Autonomic dysreflexia
ABOVE T6 chronic spinal cord injury
39
induction w/ SC injuries
succ probably not a good idea careful with neck ketamine is good unless head injury occurs' trauma = full stomach video intubation
40
Autonomic dysreflexia symptoms
severe hypertension reflex bradycardia headache sweating Seizures Severe pulmonary edema MI Renal injury ICH
41
autonomic dysreflexia treatment
remove stimulous positioning changes if that doesnt drop BP below 150 --> nitrates, nifedipine, hydralazine, labetolol
42
emergence w/ SCI
prevent coughing, bucking remifent?
43
post-operative considerations
airway obstruction respiratory insufficiency bleeding neuro deficits DVpneumonia
44
Evoked Potentials are electric potentials measured in response
to a particular type of stimulus
45
eps can be affected by 4 things
hypothermia hypotension anemia positioning
46
latency
time after stimulus
47
amplitude
intensity of evoked response voltage
48
what % change of EP
>50% decrease in amplitude >10% increase in latency
49
What agents interfere with 1 neuronal membrane conduction 2 subcortical conduction 3 increase interpeak latencies 4 control conduction time
lipophilic agents
50
what depressed EP waveforms
inhalational agents > IV anesthetics
51
synergistic effects depressant effect on SSEP waveform
combo of inhalational and IV anesthetics
52
SSEP monitors what pathway
dorsal root ganglia dorsal (posterior) column
53
SSEPs stimulate the peripheral nerve ____ to surgery
distal
54
nerves used for SSEP
posterior tibialis (most common) ulnar median
55
SSEPs are sensitive to
all inhalational agents and NO less effected by IV agents
56
what meds increase SSEP amplitude
ketamine (no change latency) etomidate (increased latency)
57
decrease amp increase latency
halogenated agents Nitrous Oxide propofol opioids barbituates
58
little effect on SSEP
barbituates
59
MEPs monitor the _____ pathway
anterior motor pathway. compliments but does not replace SSEP
60
where are MEPs most susceptible to anesthetic agents
motor cortex anterior horn cells (alpha motor & interneurons)
61
MEP change
80% or more decrement

Advanced 3rd semester (3 decks)

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