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19 Cards in this Set
- Front
- Back
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What degree of scoliosis causes severe cardiac and respiratory dysfunction?
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>100degrees, if <65 degrees than respiratory impairment is minimal
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In a scoliosis patient what vital capacity should concern you for possible need for postop ventilation?
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VC<40%, if >70% patient should be fine postop
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What are the pulmonary problems encountered in severe scoliotic patients?
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restrictive lung disease(decreased VC, TLC, RV, FRC, increased VD/Vt) which causes increased A-a gradient, alveolar hypoventilation, hypoxemia, nml PaCO2; chronic hypoxia(can lead to pulm htn and cor pulmonale(RVH, RAD, RBBB)
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What cardiac valvular problem is often seen in patients with scoliosis?
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mitral valve prolapse(25%)
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What are frequent findings in CXR in patients with severe scoliosis?
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chronic aspiration pna
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What inhaled agent should you avoid in patients with severe scoliosis?
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N2O, can worsen pulm htn(as do acidosis, hypoxemia, and hypercarbia)
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What lung complication is more common in patients with severe scoliosis compared to normal patients?
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pneumothorax
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How can you tell if an injury occurs by SSEP monitoring?
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P1 component increases in latency and decreases in amplitude
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What disturbs SSEP monitoring?
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hypoxia and hypercarbia, hypothermia, hypotension, drugs(diazepam, volatiles, N2O)
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What should you do if SSEP trace changes?
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stop surgery and raise blood pressure(it may be due to stretching of the spinal cord, a bone chip, or direct cord trauma)
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Pertaining to SSEP monitoring what instrument rejects random waves and produces P1, N1, P2, N2?
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amplifier averager
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What is the cause of paralysis during harrington rod surgery?
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anterior spinal artery ischemia
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What are complications of harrington rod surgeries?
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paralysis, hemorrhage, fat and air embolism, ptx
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What hypotensive agent is preferrable for hypotensive anesthesia in adolescents and children?
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sodium nitroprusside for reliable and sustained induction of hypotension
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What is the benefit of using labetalol for inducing hypotension compared with SNP?
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effective, no associated with some of the side effects such as tachycardia, intrapulmonary shunt or increased CO
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what is a wake-up test?
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after narcotic base is established, small increments of narcan are given until the patient responds to verbal commands and moves lower extremities
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What is the benefit of autologous blood for scoliosis surgery?
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minimizes the need for donor blood
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When should you begin collecting autologous blood before surgery?
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3 weeks before the operation with 4-7 days between collections to allow for readjustment of the blood volume, don't collect within 7 days of surgery
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How much blood is typically taken from patients for autologous donation base on their weight?
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>50kg and hgb 11 full units
25-50kg and hgb 11 half units |
