Nagelhout Ch 40: Anesthesia for Orthopedics
and Podiatry ACTUAL Questions and
CORRECT Answers
Cefazoline should be given within how long before incision - CORRECT ANSWER -1
hour
Vancomycin should be given within how long before incision - CORRECT ANSWER -2
hours
Pneumatic Tourniquet:
The degree of hypoxia & acidosis is partially influenced by _________ - CORRECT
ANSWER - Duration of insufflation
- For this reason, the inflation device also comes w/ a built-in timer, generally set for 60-minute
increments, w/ an alarm that will sound as a warning when the allotted time has been exhausted.
Maximum tourniquet time considered safe - CORRECT ANSWER - 2 hours
The pressure to which the tourniquet should be inflated depends on the _______ & _________ -
CORRECT ANSWER - BP & the shape & size of the extremity
Deflation of the tourniquet results in the release of _________ into the systemic circulation. -
CORRECT ANSWER - Metabolic Waste
Release of metabolic wastes after the tourniquet deflates can result in ________ (5) - CORRECT
ANSWER - - Metabolic acidosis
- Hyperkalemia
,- Myoglobinemia
- Myoglobinuria
- Renal failure
The deflation may be marked by transient changes in the hemodynamics or pulse ox.
Most of these resolve quickly, except in those patients w/ extreme conditions r/t their cardiac or
vascular status.
Box 40-2: Tourniquets
Application of a tourniquet for more than ______ causes tourniquet pain & HTN - CORRECT
ANSWER - 60 mins
Box 40-2: Tourniquets
Application for >____ may result in postop neuropraxia - CORRECT ANSWER ->2
hours
Box 40-2: Tourniquets
Abolition of somatosensory evoked potentials & nerve conduction occurs w/in _____ (time) -
CORRECT ANSWER - 30 min
Box 40-2: Tourniquets - Muscle changes (4) - CORRECT ANSWER - • Cellular hypoxia
develops within 2 minutes.
, • Cellular creatinine value declines.
• Progressive cellular acidosis occurs.
• Endothelial capillary leak develops after 2 hours.
Box 40-2: Systemic effects of Tourniquet *Inflation* - CORRECT ANSWER - Elevation
in arterial & pulmonary artery pressures develops.
Usually slight to moderate if only one limb is occluded.
The response is more severe in patients undergoing balanced anesthesia that does not include a
potent anesthetic vapor.
Box 40-2: Systemic Effects of Tourniquet *Release* (6) - CORRECT ANSWER -•
Transient fall in core temperature occurs.
• Transient metabolic acidosis occurs.
• Transient fall in central venous oxygen tension occurs, but systemic hypoxemia is unusual.
• Acid metabolites (e.g., thromboxane) are released into the central circulation.
• Transient fall in pulmonary and systemic arterial pressures occurs.
• Transient increase in end-tidal carbon dioxide occurs.
and Podiatry ACTUAL Questions and
CORRECT Answers
Cefazoline should be given within how long before incision - CORRECT ANSWER -1
hour
Vancomycin should be given within how long before incision - CORRECT ANSWER -2
hours
Pneumatic Tourniquet:
The degree of hypoxia & acidosis is partially influenced by _________ - CORRECT
ANSWER - Duration of insufflation
- For this reason, the inflation device also comes w/ a built-in timer, generally set for 60-minute
increments, w/ an alarm that will sound as a warning when the allotted time has been exhausted.
Maximum tourniquet time considered safe - CORRECT ANSWER - 2 hours
The pressure to which the tourniquet should be inflated depends on the _______ & _________ -
CORRECT ANSWER - BP & the shape & size of the extremity
Deflation of the tourniquet results in the release of _________ into the systemic circulation. -
CORRECT ANSWER - Metabolic Waste
Release of metabolic wastes after the tourniquet deflates can result in ________ (5) - CORRECT
ANSWER - - Metabolic acidosis
- Hyperkalemia
,- Myoglobinemia
- Myoglobinuria
- Renal failure
The deflation may be marked by transient changes in the hemodynamics or pulse ox.
Most of these resolve quickly, except in those patients w/ extreme conditions r/t their cardiac or
vascular status.
Box 40-2: Tourniquets
Application of a tourniquet for more than ______ causes tourniquet pain & HTN - CORRECT
ANSWER - 60 mins
Box 40-2: Tourniquets
Application for >____ may result in postop neuropraxia - CORRECT ANSWER ->2
hours
Box 40-2: Tourniquets
Abolition of somatosensory evoked potentials & nerve conduction occurs w/in _____ (time) -
CORRECT ANSWER - 30 min
Box 40-2: Tourniquets - Muscle changes (4) - CORRECT ANSWER - • Cellular hypoxia
develops within 2 minutes.
, • Cellular creatinine value declines.
• Progressive cellular acidosis occurs.
• Endothelial capillary leak develops after 2 hours.
Box 40-2: Systemic effects of Tourniquet *Inflation* - CORRECT ANSWER - Elevation
in arterial & pulmonary artery pressures develops.
Usually slight to moderate if only one limb is occluded.
The response is more severe in patients undergoing balanced anesthesia that does not include a
potent anesthetic vapor.
Box 40-2: Systemic Effects of Tourniquet *Release* (6) - CORRECT ANSWER -•
Transient fall in core temperature occurs.
• Transient metabolic acidosis occurs.
• Transient fall in central venous oxygen tension occurs, but systemic hypoxemia is unusual.
• Acid metabolites (e.g., thromboxane) are released into the central circulation.
• Transient fall in pulmonary and systemic arterial pressures occurs.
• Transient increase in end-tidal carbon dioxide occurs.
