Term
What are the overall considerations associated with ortho surgeries?
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Definition
1. Pt comorbidities
2. Positioning challenges
3. Temperature in room is cold, cold, cold!
4. Xray exposure
5. Bleeding (cold can lead to additional coagulopathies)
6. Pain!! |
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Term
| Pts with CAD undergoing ortho surgery are usually considered what risk? Why are they difficult to assess? |
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Definition
"Intermediate" risk--and surgery places patients under enough stress that they may have a cardiac event intra-op.
The patients are difficult to assess because they can't do exercise tolerance tests |
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Term
What type of tests may be necessary to determine cardiac risk for a patient with CAD?
What drugs might be useful? |
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Definition
Nuclear testing
Beta blockers |
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Term
| A patient with rheumatoid arthritis may have atlantoaxial instability. What does that mean to me? |
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Definition
| This may lead to subluxation of the odontoid process, and normal intubation with neck extension can result in spinal cord injury |
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Term
| What other problems associated with intubation might patients with rheumatoid arthritis present? |
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Definition
TMJ problems with limited movement of the mouth
Larynx--lack of mobility |
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Term
| What drugs might patients with rheumatoid arthritis be on? How does this impact us? |
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Definition
| NSAIDS or steroids. Emergent surgeries may need platelets, steroid replacement is likely going to be necessary. |
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Term
| What are some of the respiratory effects of scoliosis? |
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Definition
1. Respiratory failure and death can occur by the age of 45
2. Decreased vital capacity
3. V/Q mismatch with hypoxia
4. Hypercapnia develops with age (and worsening of compensatory mechanisms)
5. Frequently requires post-op ventilation |
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Term
What determines the severity of scoliosis? What does this not account for?
How do you determine the probability of post-op ventilation? |
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Definition
COBBS angle--the more severe the angle, the worse the progression. This does NOT account for the twisting of the spine.
Vital capacity--those with a VC less than 40% predicted will often require post-op vent |
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Term
| What typically happens with pulmonary function after surgery for scoliosis? |
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Definition
| Pulmonary function often deteriorates for 7-10 days post-op before it gets better! |
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Term
The chronic hypoxia/lack of ventilation which leads to V/Q mismatching, will also eventually lead to what other problems?
What other anomalies are often present? |
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Definition
Chronic pulmonary vasoconstriction, increased pulmonary vascular resistance, increased pulmonary pressures, and right ventricular hypertrophy.
MVP, coarctation, and cyanotic heart disease |
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Term
Concerning positioning, how would you position the pts head if one arm was abducted?
What can happen with rotation of the neck? |
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Definition
Turn towards the abducted arm
Compromised circulation of carotid or vertebral artery, leading to neurological or spinal cord ischemia |
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Term
What anesthetic technique might be necessary with a lateral approach to spinal surgery?
How does the approach of the surgery affect fluid management? |
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Definition
A double lumen ETT and dropping a lung
Potential for large or small evaporative loss, need to be aware of the exposure! |
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Term
| Anterior cervical spine surgery utilizes an incision near the SCM muscle. What structures could potentially be affected? |
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Definition
Carotid artery, interrupting blood flow, stimulating baroreceptors
Recurrent laryngeal nerve paralysis |
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Term
| What position is usually used for anterior cervical spine surgery? |
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Definition
| Supine, usually with extensive flexion of the neck by the surgeon. May utilize Mayfield pins. |
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Term
What type of anesthetic plan is usually used for anterior cervical spine surgery?
How much blood loss usually occurs? |
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Definition
GETA, but if a trauma with unstable neck, be prepared for stabilization and difficult intubation
Minimal EBL |
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