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Amb Ortho anesthesia

Clinical exam 2 - Anesthesia for ambulatory ortho

QuestionAnswer
6 advantages to regional anesthesia are (slide 1-3): less blood loss, excellent post-op analgesia, more preemptive analgesia, higher pt satisfaction, surgi-centers can avoid GA, little or no postop drowsiness
2 disadvantages to regional anesthesia are (slide 1-3): the perception that it takes more time to implement block, block failure
What is the most common DJD? What percentage of adults suffer from it (slide 2-2)? Osteoarthritis, 22%
What is OA & some intraop concerns (slide 2-2)? loss of articular cartilage. Pain, loss of ROM, deformity. Concerned abt positioning issues, intraop pain/discomfort
What percentage of ppl have rheumatoid arthritis? Which gender does it affect more (side 2-3)? 1%, women > men
What is rheumatoid arthritis (slide 2-3)? Pain & morning stiffness in mult joints, progressive joint deformity
W/ rheumatoid arthritis, what are some airway issues to consider (2 of them) (slide 2-3)? limited TMJ (temporomandibular joint) & narrow glottic opening: use smaller tube
W/ rheumatoid arthritis, what is a cervical spine issue to consider (slide 2-3)? atlantoaxial instability: Do NOT crank their heads back!
W/ rheumatoid arthritis, what are some cardiac issues to consider (2 of them) (slide 2-3)? pericarditis & tamponade: check cardiac concerns w/ echo
W/ rheumatoid arthritis, what is an eye issue to consider (slide 2-3)? Sjogren's syndrome (consider eye ointment)
W/ rheumatoid arthritis, what is a GI issue to consider (slide 2-3)? ulcers, especially secondary to NSAIDs & ASA (these pts have chronic NSAID & ASA use)
W/ rheumatoid arthritis, what are some pulmonary issues or signs & symptoms to consider (5 of them) (slide 2-3)? interstitial fibrosis, diffusion impairment, possible hypoxemia evidenced by cough, dyspnea, PFTs show restrictive pattern
W/ rheumatoid arthritis, what is a renal issue to consider (slide 2-3)? renal insufficiency secondary to NSAIDs (these pts have chronic NSAID & ASA use)
What are the 3 drug classes that can be used to treat rheumatoid arthritis (slide 3-1)? disease modifying drugs (methotrexate, remicade, enbrel), NSAIDs, and glucocorticoids
What is a side effect of disease modifying drugs (slide 3-1)? increased risk of infection
What are 3 side effects of NSAIDs (slide 3-1)? bleeding, ulcers, renal insufficiency
What are 4 side effects of glucocorticoids? If pt is on high doses what should they be given intraop (slide 3-1)? osteoporosis, cataracts, cushingoid symptoms, & hyperglycemia. If pt is on high doses they should be "stress dosed" w/ hydrocortisone (solu-cortef) 100 mg
How can postdural puncture headache be avoided (slide 3-2)? pencil point, small gauge
For knee arthroscopy, what is the dose & duration of isobaric mepivacaine (slide 3-2)? 45 mg, block lasts 142 min
For knee arthroscopy, what is the dose & duration of chloroprocaine (slide 3-2)? 30 - 40 mg, block lasts 155 min
For knee arthroscopy, what is the dose & duration of bupivacaine (slide 3-2)? 5 - 7.5 mg, block lasts 180 min
What is transient neurologic symptoms? What is the incidence, onset & duration (slide 3-2)? pain in butt & legs; occurs more w/ spinal lidocaine. Incidence = 1 - 14%. Onset = 1 day. Duration = 2 - 5 days
What is an issue with a femoral nerve block (slide 3-2)? persistent quad weakness
Tourniquets are used primarily to _____. Width should be ____. Max safe pressure should be ____ for the arm & ____ for the leg (slide 3-3) Used to minimize blood loss. Width should be >50% diameter of the limb. Max safe pressure: 50 mmHg over max systolic for arm, 100 mmHg over max systolic for leg
Risk of tourniquet is (slide 3-3) _____ ischemic damage to underlying nerve & muscle
4 s/s of tourniquet pain are (slide 3-3): dull, aching, restlessness, & BP trends up
What may occur after tourniquet deflation & how is it treated (slide 3-3)? Transient metabolic acidosis & high CO2 levels. Increase minute ventilation. D/t vasodilation BP may also drop
Ankle block consists of 5 discrete nerves around the ankle. Which ones are terminal branches of the sciatic nerve? Which ones are terminal branches of the femoral nerve (slide 4-1)? terminal branches of sciatic nerve = posterior tibial (plantar surface), deep peroneal (interspace between 1st & 2nd toe), superficial peroneal (dorsum of foot), & sural (back of & plantar surface of foot)
Ankle block consists of 5 discrete nerves around the ankle. Which ones are terminal branches of the femoral nerve (slide 4-1)? terminal branch of femoral nerve = saphenous (medial malleolus)
The brachial plexus extends from ____ (slide 4-3) C5 - T1
The only time you can do a brachial plexus block for shoulder surgery is to do _____ block (slide 4-3) interscalene block (the others are too distal)
** In brachial plexus block the axillary approach misses the _____; must be ____ if a tourniquet is used on the upper arm (5-1) misses the intercostobrachial nerve (T2). Must be infiltrated SQ (field block)
Which blocks have a high risk of pneumothorax (slide 5-1)? Supraclavicular and infraclavicular blocks
Interscalene approach is best for ____ but doesn't reliably block ________ (slide 5-1) best for shoulders; does not reliably block hand or wrist
What is a risk of interscalene block (slide 5-2)? can block half of the diaphragm
Types of ortho cases typically done is ambulatory surgery are (there are 7)(slide 1-2): carpal tunnel release, finger/toe arthroplasty, digit amputations, repair lacerations, bunions & other podiatry, closed limb reductions/casting, shoulder & knee arthroscopies
Created by: Thommy413