• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/97

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

97 Cards in this Set

  • Front
  • Back
True or False: Lumbar laminectomy may be done under general anesthesia in the supine or prone position.
True
It is important to document what type of baseline deficits prior to doing a lumbar lami?

a. pulmonary
b.cardiac
c. renal
d.neurological
all are important but document any neuro deficits that are underlying prior to the start of the case. You dont want to get blamed for a pre-exisiting issue.
All of the following are issues in what type of orthopedic surgery?,abdominal cavity compression, eye injury potential,prone position,. head and neck concerns.

a. knee arthroplasty
b. ankle arthroplasty
c. hip arthroplasty
d. spine procedures
D, spine procedures
Preventing retinal ischemia can be achieved by which of the following: Choose all that apply
a. avoid hypotension
b. avoid fluid overload
c. maintain hematocrit
d. all of the above
d
___________is caused by decreased introcular blood flow.

a. retinal ischemia
b. ischemic optic neuropathy.
a. retinal ischemia
___________is caused by hypoperfusion of vessels supplying the optic nerve.

a. retinal ischemia
b. ischemic optic neuropathy
B. Ischemic optic neuropathy
Compression of the abdominal cavity with spine surgery in the prone position causes which of the following:

a. increased FRC
b. organ displacement
c. engorgement of the venous network = greater blood loss
d. Decreased FRC, TV, and increased airway pressure.
B, C, D.
-Use chest rolls, wilson frame, andrew frame, or jackson frame to aid in positioning the prone patient.
What position is used for a Total Knee Replacement procedure?
Supine
What two types of anesthesia can a Total Knee Replacement be done under?
general or regional

Regional: SAB or epidural catheter
What is used during Total knee replacement surgery to provide a relatively bloodless surgical field?
pneumatic tourniquet
A risk of Total knee replacement that has the following clinical manifestations is known as?

hypoxia, hypotension, dysrhythmias (including heart block and sinus arrest), pulmonary HTN (increased PVR), and decreased cardiac output.
Bone cement implantation syndrome
A monitoring tool that is recommended for total knee replacement surgery that is useful in detecting embolization by a rise in PVR.
PAOP measurement
Most patients who undergo a total hip replacement suffer from what two conditions?
OA or RA
What is the standard position for the total hip replacement procedure.

a. supine
b. prone
c. lateral decubitus
d. sitting
lateral decubitus
Life threatening complications of total hip replacement include all except?

a. Bone cement implantation syndrome

b. DIC

c. Perioperative hemorrhage

d. Thromboembolism
DIC
This condition causes degenerative disease affecting the articular surface of joints and often times the spine is involved.

a. OA
b. RA
OA
Common reasons for the cause of Osteoarthritis include (choose 2)

a. repetitive joint trauma
b. Hairline fractures
c. Obese patients
d. smokers
a & c
This condition is caused by immune mediated joint destruction with chronic and progressive inflammation in synovial membranes

a. Rheumatoid arthritis
b. Osteoarthritis
c. Scoliosis
a
Although the effects of this disease are most clearly seen in joints, the disease is systemic.

a. RA
b. OA
RA
___________ is a condition that causes protrusion of the odontoid process into the foramen magnum and is seen in patients with Rheumatoid arthritis
Atlantoaxial subluxation
What 2 hemodynamic values may the prone position significantly increase?

a. C.O.
b. SVR
c. Stroke Volume
d. PVR
SVR and PVR
In the prone position, lung zone II ________ and zone III ________
In prone position lung zone II decreases and zone III increases
Extreme head rotation in prone position may cause what?
may decrease cerebral venous drainage and CBF
The following are Characteristics of knee arthroscopy: (except 1)

a. Usually inpatient
b. Reduced blood loss
c. Less postoperative pain
d. Reduced length of rehab.
>Usually outpatient.
>Reduced blood loss.
>Less postoperative pain.
>Reduced length of rehabilitation.
What anesthetic technique can be used for knee arthroscopy?
Any technique (general, regional, MAC)
Which kind of LA is associated with less tourniquet pain:

hyperbaric or isobaric?
isobaric-dont really know why yet.
Which kind of nerve fibers are more difficult to anesthetize: a delta or C?
C
Why should you use opiates judiciously when using a tourniquet?
When tourniquet is deflated, the pt is all narced up and tourniquet pain goes away on deflation, leading to less stimulation to breathe.
Which LA is isobaric?

A. tetracaine
B. bupivicaine
B
Which LA is hyperbaric?

A. tetracaine
B. bupivicaine
A
T/F - Knee arthroscopies require lateral position with foot of bed lowered.
F - Knee arthroscopies require SUPINE position with foot of bed lowered.
With knee arthrosopy, what complication can result in non-operative leg?
Potential thrombus formation - B&J puts SCD on non-operative leg.
What two positions can be used for shoulder arthroscopy?
Modified fowler's (Beach chair) or lateral decubitus
In Beach Chair position watch for venous __ _______.
venous air embolism
The common torniquet underpad used before a torniquet cuff is placed on the patient's skin is called:
Webril
Name two functions of pneumatic tourniquets
1. Decreases blood loss
2. Reduces operative time
Pneumatic tourniquets are usually inflated between_______ to _____mmHg above patient's initial systolic blood pressure
-90-100mmHg
Before inflating the tourniquuet cuff, the extremity is exsanguinated using an-----------
Esmarch bandage.
The word Laparoscopy is coined from the Greek words "Laparo" which means------------------ and "Skopein" for------------------
-Flank
-To examine
Define Laparoscopy
-Looking at abdominal contents using an endoscope
What decade did Laparoscopy gained traction and in what year was the first laparoscopic cholecystectomy done?
-1980's
-1987
Air within the peritoneal cavity is known as:
Pneumoperitoneum
In laparoscopic procedures, pneumoperitoneum is created using which two techniques and with which two instruments?
1. Open technique-using Hasson (1.5-3 cm incision)
2. Closed technique-using Veress needle.
All the following are properties of a perfect gas EXCEPT:
1. Colorless
2. Nonphysiological inertness
3. Lack of flammability
4. Excretion via pulmonary route.
2. Nonphysiological inertness (A perfect gas should HAVE physiological inertness)
The preferred or most common gas used in insuflation during laparoscopic procedures is:
CO2
Name other gases which can be used for insuflation and the reason why they are not commonly used.
Air: supports combustion and increased risk for emboli
N2O: supports combustion
Helium: not very absorbable and can create emboli.
All the following are advantages of CO2 EXCEPT: It

1. is inexpensive
2. does not support combustion
3. is not readily absorbed from the vascular system
4. is readily excreted via the pulmonary system.
3. It is not readily absorbed from the vascular system (CO2 is actually readily absorbed).
True or False:
The reason why CO2 is the commonly used gas for insuflation during laparoscopic procedures is because of its bright color when introduced into the abdomen.
False (CO2 is a colorless gas and it is the commonly used gas because of this and other properties).
Which ONE of the following is an effect of tourniquet inflation?

a. increased arterial and pulmonary artery pressure
b. decreased SVR
c. less pain
d. decreased preload
A is correct
Which ONE is NOT an effect of tourniquet deflation?

a. fall in core temp
b. increased pain
c. metabolic acidosis
d. increase in EtCO2
e. transient increase in lactate and K+ levels.
B is false.
In general, when is the onset of tourniquet pain after inflation?
a. immediate
b. 45-60min
c. 90-120min
d. 15min
B
T/F: Tourniquet pain is easily treatable with iv analgesics or anesthesia.
False: once the pain starts it is often resistant to anesthesia or analgesics. The most effective tx is tourniquet deflation.
Which type of nerve fibers are assoc with the most discomfort from tourniqet pain?
a. A delta
b. C fibers
c. B fibers
d. A alpha fibers
B. C fibers. These are the slow unmylenated fibers; resistant to anesthetics; cause burning/aching feeling
T/F: Isobaric local anesthetics (Bupivicaine) is assoc with less tourniquet pain then hyperbaric agents (Tetracaine).
TRUE
What does the SSEP evaluate?
Integrity of the spinal cord
A _________ in amplitude and _________ in latency suggests that damage is occuring in the neural pathway
decrease in amplitude
increase in latency
Posterior cord ischemia and brain ischemia cause a diminish in _______ _____.
transmit ion
What type of regional anesthesia is used for foot and ankle surgery?
Posterior tibial nerve block, mayo block and beir block
Foot and ankle surgery patients are often candidates for what type of anesthesia?
Regional anesthesia
What type of regional anesthsia is used for forearm and hand surgery?
axillary blocks and Beir blocks
What positions can be used for ankle and foot surgery?
Supine and prone
Forearm and hand surgery patients are often injured from?
Trauma
MMA (methylmethacrylate) is a bone cement.What is the name of the reaction from it that can lead to complications?
Exothermic Reaction
Name threee complications of exothermic reactions from MMA.
1. Embolization of fat, bone marrow, or cement
2.Air into femoral venous chamber
3.Release of tissue thromboplastin
What are the 5 clinical manifestations of an exothermic reaction?
1. Hypoxia
2. Pulmonary HTN
3. Hypotension
4. decreased cardiac output
5. dysrhythmias
Name 6 ways to help prevent perioperative hemorrhage.
1. Controlled hypotension
2. Regional technique
3. consider autologous blood donation
4. Erythropoietin preop
5. Cell saver if case not dirty
6. High dose aprotinin-high risk case
In ortho cases with high risk of bleeding what shoud we always be sure of preop?
Verify type and cross
T or F. Treatment of venous thromboembolism is easy.
F- dfficult
Name 2 ways to decrease the risk of venous thromboembolism.
1. Use SCD's
2. Regional decreases incidence
Name 2 position that a lumbar lami can be done in.
prone(posterior approach) or supine(anterior approach)
What is an important preop assessment for a pt having lumbar lami?
Know their deficits, if any, preop
Airway issues for pt having lumbar lami are usually related to what?
Arthritic changes
Can a LMA be used with laproscopic surgery?
Yes, but it is controversial. See Nag pr 777 box 32-5
What are 2 concerns with LMA for laproscopic surgery?
Increase intraabdominal and intrathorasic pressure and increased risk of GERD and pulmonary aspiration
What is the safest type of case to use LMA(laproscopic)?
GYN procedures(lower abd)
Use of nitrous is controversial with laproscopic surgery. Name a reason
Bowel distension
What post-op complication could there be an increased risk for if using Nitrous for laproscopic case?
PONV(as high as 50% in laps alone Nitrous increases the risk.
PONV increased with Nitrous.
T or F
T and F !! Very controversial some studies confirm others deny
Pain with laproscopic surgery is what type and what is the cause?
Visceral. caused by mechanical or chemical factors
Co2 increases/decreases intraperitoneal pH.
Decrease to as low as 6
Why do pt get shoulder pain with laproscopic surgery?
Irritation of phrenic nerve
What class of drugs are best to releive pain associated with laproscopic surgery?
NSAIDS(Toradol)
What types of anesthesia can be used for D&C, TAB, and D&E?
Local with Mac
Regional
GA
What position are GYN cases usually put in?
Lithotomy
During GYN surgery what may cause a vagal response?
Tugging on the uterus
What drug can be added to IV to help control bleeding for GYN?
Pitocin 20-30 units per liter.(causes uterus to contract)
Name 3 cause for post op bleeding for D&C or D& E or TAB
Retained placenta
artery perforation
cervical injury
Name another position besides lithotomy for GYN cases
Supine
Risks of lithotomy?
Soft tissue or nerve injury, circulatory insufficeincy leading to compartment syndrome
What is a cause of crush injury with lithotomy in GYN?
Fingers get stuck in bed when putting the bottom of the table back up. Also tucked arms
Injury to the common peroneal nerve can cause________.
foot drop
Where is the pressure that causes common peroneal nerve injury?
Pressure at head of fibula(fibular nerve)
What position increase risk of obturator nerve injury?
Hips flexed> 90 degrees
What causes saphenous nerve injury in lithotomy?
Compression( techs leaning on the legs)
In lithotomy how can you decrease the risk of femoral nerve injury?
Avoid excess abduction of the thigh and external rotation of the hip
Where does the femoral nerve get trapped to cause injury?
Under inguinal ligament
What cause Sciatic nerve injury in lithotomy?
Thighs and legs externally rotated and knees hyperextended