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Anaesthesia for Spine Surgeries (part- II)

Anaesthesia for Spine Surgeries (part- II). SYSTEMIC CHANGES. BLOOD GASES. RESPIRATORY. Abnormal thoracic cage ↓compliance. LUNG VOLUMES. GAS EXCHANGE ABNORMALITIES. VENTILATION- PERFUSION MALDISTRIBUTION: Abnormal chest wall Abnormal pulm vs Inc. Vd / Vt Inc (A-a) DO2

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Anaesthesia for Spine Surgeries (part- II)

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  1. Anaesthesia for Spine Surgeries (part- II)

  2. SYSTEMIC CHANGES BLOOD GASES

  3. RESPIRATORY Abnormal thoracic cage ↓compliance

  4. LUNG VOLUMES

  5. GAS EXCHANGE ABNORMALITIES VENTILATION- PERFUSION MALDISTRIBUTION: Abnormal chest wall Abnormal pulm vs Inc. Vd / Vt Inc (A-a) DO2 Affects the blood gases

  6. ARTERIAL BLOOD GASES RESTING VENTILATION – WNL CC > FRC V/Q ABNORMALITIES

  7. CARDIOVASCULAR SYSTEM

  8. CARDIOVASCULAR SYSTEM contd…. • Hypoxemia • Pulmonary vasoconstriction • Inc. Pulm. Art resistance • Irreversible changes in pulm. Vasculature PAH RVHT RHF

  9. CARDIOVASCULAR SYSTEM contd…. • Valvular heart disease: • Most common – MVP • Antibiotic prophylaxis before bladder catheterisation and laryngoscopy • Associated neuromuscular diseases: • DMD:Cardiomyopathy in 2nd decade • Unable to exercise – warning symptom • ECG- Tachycardia, prolonged PR, QRS intervals, ST anomalies, bundle branch block, Q waves in lt. leads, tall R waves in rt. Leads

  10. Marfan’s syndrome: • MR, AR, Aneurysm of proximal ascending aorta, • Anomalies of conducting system

  11. ANESTHETIC CONSIDERATIONS

  12. PRE ANAESTHETIC CHECKUP • HISTORY: • HOPI: • Location of curve (thoracic – PFTs, cervical- airway) • Nature of curve- Rt convex- n, Lt convex- Cnab • Age of onset (<6 yrs- PFT deranged, PAH, RVF) • Severity >60 – PFTS deranged • >100 – impaired gas exchange H/S/O other muscular dystrophies or neuromuscular disease H/S/O of other congenital heart diseases or syndromes

  13. Cardiopulmonary reserve • Exercise tolerance • Pulmonary symptoms- wheeze (coexisting COAD) • Cough (parenchymal disease) • Cardiac symptoms- palpitations, syncope

  14. PAC • PHYSICAL EXAMINATION: • Vitals- (esp if frank or impending respiratory failure) • G/P/E – Pallor( massive blood loss) • JVP • Cyanosis • Clubbing • Pedal edema • Café- au- lait spots, cutaneous neurofibromas • High arched palate

  15. Respiratory – • Shape of thorax • A-P:TRANVERSE RATIO • Mediastinal shift • Lungs- Wheeze, crepts • Cardiac- • Apex impulse • S1, S2, gallop rhythm • Loud P2 • RV heave, pulsating hepatomegaly

  16. Muscle dystrophies (DMD)

  17. GOWER’S SIGN

  18. Muscular dystrophy

  19. MARFAN’S SYNDROME

  20. NEUROFIBROMATOSIS

  21. NEUROFIBROMATOSIS

  22. AIRWAY: • CERVICAL SPINE • Positioning due to abnormal contour of spine • Mouth opening • Dentition • TM joint • MMPC • Macroglossia, high arched palate

  23. Neurologic examination- • HMF • Pupils • Sensory and motor examination • Reflexes- superficial, deep and plantar • Bowel and bladder • DOCUMENT INORDER TO AVOID CONFUSION ABOUT POST-OP COMPLICATIONS

  24. investigations • Mild to moderate • scoliosis • without any • co-existing disease: • CBC

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