Week 15 Handout Flipped Classrooms: Arthroscopy

Question 1

What is arthroscopy?

Answer 1

A minimally invasive joint procedure using an arthroscope for diagnosis and treatment.

Question 2

Which joints are commonly treated with arthroscopy?

Answer 2

Knee, shoulder, hip, elbow, wrist, ankle.

Question 3

What are the benefits of arthroscopy?

Answer 3

Less blood loss, faster recovery, fewer complications.

Question 4

What are common indications for arthroscopy?

Answer 4

Meniscal tears, rotator cuff/labral repairs, loose body removal.

Question 5

What is the typical patient population for arthroscopy?

Answer 5

Young athletes and middle-aged adults with degenerative joint disease.

Question 6

What laboratory tests are needed for preoperative preparation?

Answer 6

CBC, BMP, PT/INR, PTT, Type & Screen (if bleeding risk).

Question 7

What patient assessments are required before arthroscopy?

Answer 7

Airway evaluation, fasting status, meds, comorbidities (e.g., obesity, OSA, diabetes).

Question 8

What equipment is needed for arthroscopy?

Answer 8

Anesthesia machine, airway tools, warming devices, nerve block kit if using regional technique.

Question 9

What are the pros of general anesthesia (GA)?

Answer 9

Full airway control, muscle relaxation.

Question 10

What are the cons of general anesthesia (GA)?

Answer 10

Higher risk of PONV, longer recovery.

Question 11

What are the pros of regional anesthesia?

Answer 11

Opioid-sparing, excellent post-op analgesia.

Question 12

What are the cons of regional anesthesia?

Answer 12

Requires provider skill, limited duration.

Question 13

What is the purpose of an interscalene block?

Answer 13

It is used for regional anesthesia in the shoulder.

Question 14

What is the purpose of a femoral/sciatic block?

Answer 14

It is used for regional anesthesia in the knee.

Question 15

What is the purpose of a lumbar plexus/sciatic or fascia iliaca block?

Answer 15

It is used for regional anesthesia in the hip.

Question 16

What is TIVA?

Answer 16

Total IV anesthesia using Propofol ± remifentanil.

Question 17

What are the pros of TIVA?

Answer 17

Less PONV, avoids volatile agents.

Question 18

What are the cons of TIVA?

Answer 18

Requires depth monitoring (e.g., BIS).

Question 19

What is the positioning for knee arthroscopy?

Answer 19

Supine with leg holder or foot drop.

Question 20

What is the positioning for shoulder arthroscopy?

Answer 20

Lateral decubitus or modified Fowler (beach chair).

Question 21

What is the positioning for hip arthroscopy?

Answer 21

Supine or lateral on fracture table.

Question 22

What are the risks associated with positioning during arthroscopy?

Answer 22

Nerve injuries, pressure injuries, reduced pulmonary compliance, hypotension.

Question 23

What airway management is needed for obese or high aspiration risk patients?

Answer 23

Secure airway.

FOOTNOTE**
Recheck ETT depth after positioning.

Question 24

What should be anticipated in lateral/beach chair positions?

Answer 24

Reduced ventilation.

Question 25

What is the purpose of tourniquet use during arthroscopy?

Answer 25

Provides a bloodless field.

Question 26

What are the risks of tourniquet use?

Answer 26

Ischemia-related pain post-op, tourniquet syndrome if prolonged.

Question 27

What can cause hypothermia during arthroscopy?

Answer 27

Irrigation fluids.

Question 28

How can normothermia be maintained during arthroscopy?

Answer 28

Use warm fluids, warming blankets, and monitor core temperature.

Question 29

What are common complications of arthroscopy?

Answer 29

Subcutaneous emphysema, pneumomediastinum, tension pneumothorax, nerve injuries, inadvertent extubation, corneal abrasions, pressure ulcers, hypotension.

Question 30

What are the signs and symptoms of tension pneumothorax?

Answer 30

Sudden hypoxemia, elevated CVP, tachycardia, absent breath sounds, cyanosis, tracheal deviation, increased airway pressures, JVD.

Question 31

What is the immediate life-saving treatment for tension pneumothorax?

Answer 31

Needle thoracostomy (o Insert in 2nd intercostal space, midclavicular line) followed by chest tube placement (o Insert into 5th intercostal space, midaxillary line).

Question 32

What is the risk of irrigation fluid management?

Answer 32

Fluid extravasation, hyponatremia, pulmonary edema, CHF exacerbation.

Question 33

What should be considered for postoperative pain management?

Answer 33

Multimodal analgesia, nerve blocks, PONV prevention, DVT prophylaxis.

Question 34

What should be prepared for during arthroscopy?

Answer 34

Positional risks, respiratory compromise, irrigation fluid complications, postoperative pain control.

Question 35

What factors influence anesthesia choice for arthroscopy?

Answer 35

Surgical site, duration, and patient condition.

Question 36

What is the key point regarding tension pneumothorax?

Answer 36

It is a clinical diagnosis—treat immediately to prevent cardiac arrest.

Question 37

What is used for irrigation fluid management?

Answer 37

Irrigation fluid is used under pressure (gravity/mechanical) pressurization.

Question 38

What should be monitored in fluid management?

Answer 38

Monitor irrigation inflow vs. outflow to prevent fluid overload.

Question 39

What are the risks associated with fluid management?

Answer 39

Risks include fluid extravasation, hyponatremia, pulmonary edema, and CHF exacerbation.

Question 40

How should fluid choice be tailored?

Answer 40

Tailor fluid choice (crystalloids vs colloids) based on patient status.

Question 41

What is multimodal analgesia?

Answer 41

Multimodal analgesia includes NSAIDs, acetaminophen, and opioids PRN.

Question 42

What is the purpose of nerve blocks?

Answer 42

Nerve blocks extend pain control and reduce opioid use.

Question 43

How can PONV be prevented?

Answer 43

Use antiemetics if volatile anesthetics are used.

Question 44

What are the DVT prophylaxis measures?

Answer 44

DVT prophylaxis includes early ambulation, compression devices, and anticoagulants for high-risk patients.

Question 45

What is the conclusion about arthroscopy?

Answer 45

Arthroscopy is common, minimally invasive surgery.

Question 46

What should one be prepared for during arthroscopy?

Answer 46

Be prepared for positional risks, respiratory compromise, irrigation fluid complications, and postoperative pain control.

Question 47

What factors influence anesthesia choice?

Answer 47

Anesthesia choice depends on surgical site, duration, and patient condition.

Question 48

What does proactive management do?

Answer 48

Proactive management reduces complications and enhances recovery.

Question 49

Student Question: Which nerve block is most appropriate for postoperative pain relief in shoulder arthroscopy? A. Femoral nerve block B. Interscalene block C. Sciatic nerve block D. Fascia iliaca block E. TAP block

Answer 49

Correct Answer: B. Interscalene block Rationale: Interscalene block targets the brachial plexus, providing excellent analgesia for shoulder procedures.

Question 50

Student Question: What is the recommended immediate treatment for a suspected intraoperative tension pneumothorax? A. Order a STAT chest X-ray B. Begin CPR C. Administer diuretics D. Needle thoracostomy followed by chest tube

Answer 50

Correct Answer: D. Needle thoracostomy followed by chest tube Rationale: Tension pneumothorax is a clinical diagnosis requiring immediate decompression—do not delay for imaging.

Question 51

Student Question: Which factor is most likely to contribute to hypothermia during arthroscopy? A. Ketamine administration B. Use of cold irrigation fluids C. Forced-air warming devices D. Supine positioning

Answer 51

Correct Answer: B. Use of cold irrigation fluids Rationale: Irrigation fluids, especially during shoulder and hip arthroscopy, significantly lower core body temperature.

Question 52

Student Question: Which of the following patients is most likely to require preoperative CBC testing before arthroscopy? A. ASA I healthy athlete B. ASA II patient undergoing minor elbow arthroscopy C. ASA III patient with CKD undergoing shoulder arthroscopy D. ASA I elderly patient with no comorbidities E. ASA II patient with mild asthma

Answer 52

Correct Answer: C. ASA III patient with CKD undergoing shoulder arthroscopy Rationale: According to NICE guidelines, CBC is indicated in ASA III/IV patients or those with chronic disease such as kidney dysfunction. Reference: Gropper et al., 2020, p. 9

Question 53

Student Question: Why is it critical to level the arterial line transducer at the external auditory meatus during beach chair positioning? A. To monitor thoracic perfusion B. To avoid intracranial pressure spikes C. To reflect cerebral perfusion pressure accurately D. To maintain urine output E. To reduce risk of spinal ischemia

Answer 53

Correct Answer: C. To reflect cerebral perfusion pressure accurately Rationale: Measuring MAP at the level of the brain prevents underestimating cerebral hypoperfusion.

Question 54

Student Question: What is the primary concern with placing a patient in the beach chair position during shoulder arthroscopy? A. Femoral nerve entrapment B. Spinal cord compression C. Aspiration risk D. Shoulder dislocation E. Cerebral hypoperfusion

Answer 54

Correct Answer: E. Cerebral hypoperfusion Rationale: Beach chair positioning can lower cerebral perfusion pressure; BP should be measured at brain level.