Principles A Spring 2026 > Week 3 > Flashcards

Week 3 Flashcards

Test 1 (75 cards)

Study These Flashcards
1
Q

Spinal sx is common in pts <60 yo with _______________ (2) & >60yo with ___________

A
  1. Degenerative spine disease
  2. Herniated discs

Spinal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most spine sx require _____. why? What other considerations should we have with these sx? (2)

A

GETA (general endotracheal tube anesthesia)

dt anatomy of the patient may cause airway issues & type of sx

  1. May have large blood loss
  2. MEP/SSEP intraop monitoring if spinal cord is at risk for injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the types of spine sx? (4)

A
  1. Microdiscectomy for herniated disc
  2. Single/multilevel fusion
  3. Anterior/posterior approaches
  4. Reconstructive sx
    -scoliosis
    -kyphosis
    -kyphoscoliosis
    -revision of previous thoracolumbar fusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is scoliosis? What causes it? (3)

A

Lateral rotation of the spine greater than 10° w/ vertebral rotation

  1. Congenital
  2. Idiopathic
  3. Neuromuscular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What’s the difference between adult scoliosis & adult degenerative scoliosis?

A

Adult scoliosis: pre-existing curve

Degenerative scoliosis: wear-and-tear caused new curve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of adult scoliosis? (2)

A
  1. Back pain that worsens with standing/walking caused by:
    -arthritis
    -disc degeneration
    -spinal stenosis
  2. Radiculopathy/sciatica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

With scoliosis sx happening at the thoracic level, there will be _______ chest wall compliance & ________ lung disease. What do we need to assess preop regarding this? (3)

A

Decreased

Restrictive

  1. Exercise tolerance
  2. Pulmonary function tests (PFT)
  3. ABGs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

With scoliosis sx happening at the thoracic level, there will be chronic ______ rt _________. _________ pulmonary vascular resistance will cause ___________. What should we check preop with this? (2) what will the show? (2-1)

A

Hypoxemia

VQ mismatch

Increased

Cor pulmonale

  1. EKG
    -R ventricle hypertrophy (RVH)
    -R atrial enlargement (RAE)
  2. Echo
    -pulmonary HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What type of spine sx are at risk for large amounts of blood loss? What factors increased that risk? (7)

A

Corrective sx

  1. Surgical technique
  2. Operation time
  3. # of vertebral levels fused
  4. Mean arterial pressure (MAP)
  5. Platelet abnormalities
  6. Dilutional coagulopathy
  7. Primary fibrinolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

_______ (3) keeps the diaphragm alive. What nerve does this correlate to?

A

C3, C4, C5

Phernic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

With spinal cord injuries, we need to assess spinal cord function _____ the level of injury. Flaccid muscles are innervated by _____. Which muscles are those? (4) What do they help with?

A

Above

C5

  1. Deltoid
  2. Biceps
  3. Brachialis
  4. Brachio-radialis

These are muscles that help the diaphragm/breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T/F: injuries at C5 Will have paralysis of the diaphragm

A

F

Only partial paralysis of the diaphragm due to the phrenic nerve being C3 – C5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Injuries T5 & higher we should expect __________ which includes ___________. How do we Tx this?

A

Sympathectomy

Hypertension

Midodrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Injuries T1-T4 & higher we should expect __________ . How do we Tx this? Why?

A

Bradycardia

Epinephrine

Atropine/glycopyrrolate/ephedrine will not work bc we lost our sympathetic tone. Only epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T4 =

A

Nipple line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Complete cord transection above _________ causes ______________. What symptoms will you see above the injury? Below the injury? (4) what causes this? (2) Tx? (3)

A

Above T5/T6 (or at T4 & up)

Autonomic Hyperreflexia

Above:
Cutaneous vasodilation

Below:
1. Cutaneous vasoconstriction
2. Transient HTN
3. Bradycardia
4. Dysrhythmias

Causes:
1. Distended bladder/bowel
2. Noxious stimulus from sx

Tx:
1. Remove stimulus
2. Deepen anesthetic
3. Direct acting vasodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Injury to _______ (3) causes respiratory failure. What can injury to C5 - T7 cause? What does this put the patient at risk of? (3)

A

C3, C4, C5

Impairment of abdominal and intercostal support of respirations

Infection dt:
-atelectasis
-inability to cough/clear secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A spinal cord injury can cause _________ which is an inability to maintain constant core temperature. Why does this happen? (3) What consideration should we have with this?

A

Poikilothermic

  1. Disruption of sympathetic pathways
  2. Temperature sensation disruption
  3. Inability to vasoconstrict below level of injury

Considerations:
Warm the patient (warm air, warm OR, warm IVF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Airway issues are more common in _______ (2) spine cases.

A
  1. Cervical
  2. Thoracic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T/F: there might be cardiovascular compromise from pathology with spine sx

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do we need to evaluate in preop with our spine sx pts? (8)

A
  1. Range of motion
  2. Sx positioning
  3. Sensory/motor deficits
  4. Flaccid deltoid & biceps (rt C5)
  5. Labs based on comorbidities & type of procedure
  6. C-spine clearance
  7. Neuro deficits
  8. Atlanto-axial instability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

T/F: you can do nueraxial w/ MEP/SSEP

A

F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If you have SSEP/MEP/EEG monitoring, what considerations should you have? (4)

A
  1. No nitrous
  2. Only 0.5 MAC max
  3. No NDMB (only sux upon intubation)
  4. Bite block for MEP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When would you want to awake intubate you’re pt that has cervical instability vs sedated? (4)

A

UNSTABLE PATIENTS

  1. Trauma
  2. Risk of cord compression
  3. Pt in halo/traction
  4. Severe cervical spine instability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What spine sx can neuraxial be useful in? (2)
1. Lumbar laminectomy (1-2 levels) 2. Intervertebral disc sx (Lumbar decompression)
26
What considerations should we have with positioning with spine sx? (4)
1. Avoid injury to eyes 2. Avoid injury to peripheral nerves 3. Avoid injury to Bony prominences 4. Maintain low venous pressure to surgical site (decrease blood so surgeon can see -- decreased BP)
27
What are the positions for cervical spine sx? (3)
1. Anterior cervical = **Supine** w/ arms tucked & head on padded head rest 2. Posterior cervical = **Prone** w/ arms tucked & head in **Mayfield Pins** 3. Sitting - uncommon dt risk of venous air embolism (VAE)
28
What considerations should we have with positioning with posterior cervical sx?
Putting the mayfield pins on are very stimulating. Make sure the pt is deep enough prior to putting the pins on.
29
What are the positions w/ thoracic spine sx? (2) What is required w/ these positions?
1. Anterior thoracic = **Lateral decubitus** w/ bean bag -Requires **DLT or bronchial blocker** 2. Posterior thoracic = **Prone** w/ arms tucked or <90 degrees & head on proneview -Single lumen ETT
30
What are the positioning for lumbar spine sx? (2)
1. Supine (Anterior approach) 2. Prone (Posterior approach)
31
T/F: Lumbar sx can have 2 positionings during the procedure
T Supine --> Prone
32
When pts are going to be in the prone position, we should consider giving a _______ in preop such as _______ to help decrease secretions. What other airway considerations should we have? (3)
Antisialogogue Glycopyrrolate Considerations: 1. Add corrugated adapter to ETT -- decreases risk of kinking with prone pillow 2. Assess breath sounds after turning -- unintentional extubation 3. Use mirror/peak pressures/etc to assess for airway edema.
33
What can we use for eye protection while in the prone position? (3)
1. Tape 2. Tegaderm 3. Lacrilube
34
POVL =
Postop visual loss
35
POVL has a _____ incident rate. What pathologies causes this? (3)
36
Ischemic optic neuropathy (ION) which causes _____ occurs without ________ to the eyes. Which spinal sx is most likely to cause this? Why? What causes this?
POVL pressure Posterior spinal sx dt prone positioning Causes: Decreased blood flow/O2 delivery
37
What are the risk factors for Ischemic optic neuropathy (ION)? (6)
1. Male gender 2. Obesity 3. Wilson frame use 4. sx > 6hr 5. Decreased colloid use (Use colloids) 6. Blood loss > 1000 ml
38
Ischemic optic neuropathy (ION) has an onset of ______ postop. What are the symptoms? (4)
24 - 48 hrs 1. Bilateral 2. Painless visual loss 3. Nonreactive pupils 4. No light perception
39
What is the Tx for Ischemic optic neuropathy (ION)? (6) What is the goal of Tx?
1. Azetazolamide 2. Diuretics 3. Corticosteroids 4. Increasing BP 5. Increasing Hgb 6. Hyperbaric O2 To decrease intraocular pressure & increase blood flow
40
What are preventative measures for Ischemic optic neuropathy (ION)?
1. Keep head neutral/midline 2. Blood transfusion or colloids 3. Minimize hypotension
41
Compare & contrast central retinal artery occlusion & occlusion of the retinal aterial branch.
Both cause POVL Central retinal artery occlusion is decreased blood flow to the **ENTIRE** retina Occlusion of the retinal aterial branch is decreased blood supply to **part** of the retina
42
What are the 2 types of prone pillows? What do they help with?
1. Proneview 2. Shiley headrest Pillows help with: 1. Preventing pressure on nose, mouth, eyes 2. Preventing pressure on ears and breasts
43
What consideration should we have with the prone position? (8)
Head/neck: 1. Avoid excessive flexion/extension 2. Avoid lateral rotation Arm position: 3. Superman position 4. <90° abduction 5. No tension on shoulder musculature Iliac crest/genitalia: 6. Avoid compression -- someone must check Hips/knees: 7. Slightly flexed 8. No pressure on fibular heads -- use pillow/pads
44
Is the prone position, intraabdominal pressure is __________ & intrathoracic pressure is _________. What effects does this have? (4)
Increased Increased 1. Decreased FRC 2. Decrease the pulmonary compliance 3. Decreased venous return 4. Increased bleeding from epidural veins
45
What's the difference between the Wilson frame and the Jackson spine table? Which is preferred?
Wilson frame has partial compression of the abdomen & partial support of the pelvis Jackson spine table what's the abdomen pain-free and the pelvis is fully supported The Jackson spine table is preferred
46
Which prone positioning tool is the most stable?
Mayfield tongs
47
What cardiac effects does the prone position have? (3)
1. Decreased preload 2. Decreased CO 3. Decreased BP
48
What respiratory effects does the prone position have? (2)
1. Decreased total lung compliance 2. Increased work of breathing
49
What neuro effects does the prone position have? (2)
Extreme head rotation may cause: 1. Decrease cerebral venous drainage 2. Increased cerebral blood flow (CBF)
50
What factors increase the risk of blood loss with spine sx? (6)
1. # of levels 2. > 50 yo 3. Obesity 4. Sx for tumors 5. Increased intraabdominal pressure 6. Traspedicular osteotomy
51
What considerations should we have with blood transfusions with spinal sx? What is a more cost effective than using donor blood?
1. Comorbidities 2. Hemodynamic profile 3. Higher allowable blood loss 4. Transfuse hgb 7-8 Cell saver
52
Preop autologous blood donation is used when there is an anticipated EBL of ___________. When is it contraindicated? (2)
500 - 1000 ml 1. Cardiac disease 2. Infection
53
__________ are used to avoid further blood loss in pt during spine sx. What 2 drugs are these? When do you d/c these drugs?
Antifibrinolytics 1. Tranexamic acid (TXA) 2. Aminocaproic acid (Amicar) Both of these drugs are d/c at the end of the procedure
54
Drug dose: Tranexamic acid
Bolus: 10 mg/kg IV Infusion: 2 mg/kg/hr
55
Drug dose: Amincaproic acid
Bolus: 100 mg/kg IV Infusion: 10 - 15 mg/kg/hr
56
What is intraoperative hemodilution?
Remove 450-500 ml blood after induction --> Main normovolemia with crystalloids/colloids --> transfuse blood at end
57
Is deliberate hypotension recommended in spine sx? Why?
No 1. Can cause spinal cord ischemia 2. Can cause end-organ ischemia
58
During corrective sx, we need to use _________ monitoring. What strategies do we have to do this? (4) Briefly describe each
Neurophysiological 1. Intraop wake up test -Follows completion of instrumentation -Evaluate motor of UE/LE 2. Somatosensory evoked potential (SSEP) -Afferent 3. Motor evoked potential (MEP) -Efferent 4. Electromyogram -Shows motor nerve root injury during pedicle screw placement & nerve decompression
59
What are potential complication of the intraop wake up test? (3)
1. Inadvertent Extubation 2. Air embolism 3. Violent movements --> movements of instruments
60
SSEP which is _________________ travel ______ through the _________ pathways of ________ & ________. What does this mean?
Somatosensory evoked potential Afferent Dorsal column proprioception Vibration Impulses from the peripheral nerves are measured centrally
61
MEP which is _________________ travel ______ through the _________ portion of the spinal cord. What does this mean?
Motor evoked potential Efferent Anterior/motor Impulse is triggered in brain and monitored in specific muscle group
62
What are adverse effects of MEP's? (5)
1. Cognitive defects 2. Seizures (absolute contraindication) 3. Intraop awareness 4. Scalp burns 5. Cardiac arrhythmia
63
________ are required with MEP's. What do they prevent?
Soft bite blocks Prevents tongue biting & dental injury
64
What are absolute contraindications for MEP's? (3)
1. Active seizures 2. Vascular clips in the brain 3. Cochlear implants
65
With neurophysiologic monitoring, what are we assessing? (2) what are these? What are things that can affect neurophysiological monitoring? (6)
1. **Amplitude** -- signal strength 2. **Latency** -- time for signal to travel through spinal cord Things that affect amplitude/latency: 1. Hypotension 2. Hypothermia 3. Hypocarbia 4. Hypoxia 5. Anemia 6. Anesthetics/VA
66
Volatile anesthetics ________ amplitude & _________ latency with neurophysiological monitoring.
Decrease Increase
67
________ is the max MAC of VA that can be used with Neurophysiological monitoring. What VA cannot be used during MEP? Why?
0.5 Nitrous It decreases the amplitude -- cannot be used during MEP's
68
_____ is the preferred anesthetic method with neurophysiological monitoring. Which medications least affect MEPs? (3)
TIVA 1. Opioids 2. Midazolam 3. ketamine
69
T/F: Propofol depresses MEPs
T
70
When can you use muscle relaxants with neurophysiological monitoring?
SSEP - you can use them whenever MEP - Sux upon intubation -DO NOT USE ANY AFTER INTUBATION
71
If you have acute changes in amplitude/latency with neurophysiological monitoring during dx, what should you do? (3)
1. Stop sx 2. Make sure the BP is normal to 20% of baseline 3. Stop decrease VA/sedation
72
What factors increase the risk of postop ventilation w/ spine sx? (4)
1. Prolonged procedure procedures >4 hrs dt edema 2. Thoracic cavity invasion 3. EBL > 30 ml/kg or > 2000ml 4. Facial/laryngeal edema
73
What analgesia consideration should we have with spine sx? (6)
1. Multimodal 2. Caution w/ NSAIDS 3. Opioids/PCA 4. Wound local anesthetic infiltration w/ surgeon 5. Intrathecal morphine 6. Continuous epidural infusion -double epidural for multiple levels
74
What is the PNB that is appropriate for spine sx?
Erector spinae block
75
Venous air embolisms are at the highest risks in ______ spine sx. What causes this specifically for this sx? (2) What are the signs of this? (3)
Laminectomy 1. Large amount of exposed bone 2. Surgical site above heart Signs: 1. Unexplained hypotension 2. Increase in end-tidal nitrogen 3. Decrease ETCO2
Principles A Spring 2026
flashcards
Decks in class (9)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions