Anesthesia 2nd Semester: Manipulation Under Anesthesia (MUA)

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Questions and Answers

Where is the genitofemoral nerve blocked?

2 cm above the midpoint of the inguinal ligament

What type of analgesia is recommended for day case patients?

NSAID, Paracetamol, Tramadol 50-100 mg

What is the technique of choice for repairing inguinal hernia defects in high-risk patients?

Inguinal hernia field block

What is local infiltration anesthesia?

Loss of sensation restricted to a superficial, localized area in the body Signup and view all the answers

What is Tramadol, and what is it used for?

An opioid pain killer used to treat moderate to severe pain Signup and view all the answers

What are the available doses of Tramadol?

50 mg, 100 mg, 150 mg, 200 mg, 300 mg Signup and view all the answers

What is the goal of Manipulation Under Anesthesia (MUA) in patients with fractures?

To correct deformity of limb Signup and view all the answers

What is another indication for Manipulation Under Anesthesia (MUA)?

To overcome stiffness in total joint replacement Signup and view all the answers

What is the age range of patients who typically require MUA?

Any age, but generally young and active people for fractures, and elderly for joint replacement and patellectomy Signup and view all the answers

Why is MUA considered a semi-urgent procedure for fractures?

To reduce pain Signup and view all the answers

What is a critical consideration for patients requiring MUA for fractures?

Vascular impairment Signup and view all the answers

What is necessary for patients undergoing elective MUA procedures?

Fasting Signup and view all the answers

What type of anesthesia can be used for MUA?

Regional anesthesia with sedation or general anesthesia Signup and view all the answers

What type of surgery is typically used for MUA?

Day-case surgery Signup and view all the answers

What is the purpose of the inguinal canal?

A passageway between the intra and extra abdominal structures. Signup and view all the answers

What are the contents of the inguinal canal in males?

The spermatic cord, the genitofemoral nerve, and the ilioinguinal nerve, gonadal vessels and lymphatics. Signup and view all the answers

What is an inguinal hernia?

When tissue, such as part of the intestine, protrudes through a weak area in the abdominal muscles. Signup and view all the answers

What is strangulation in the context of an inguinal hernia?

The condition in which the blood supply to a part of the body such as hernia is reduced or cut as a result of compression of blood vessel. Signup and view all the answers

What is the inguinal ligament?

A fibrous band extending from the anterior superior iliac spine to the pubic tubercle. Signup and view all the answers

What is the typical age group for patients undergoing inguinal hernia repair?

Adult males or young children. Signup and view all the answers

What is the purpose of an inguinal field block in anesthesia?

To block the iliohypogastric and ilioinguinal nerves. Signup and view all the answers

Where are the iliohypogastric and ilioinguinal nerves blocked in an inguinal field block?

2 cm medial to the anterior superior iliac spine. Signup and view all the answers

Study Notes

Manipulation Under Anesthesia (MUA)

Performed to correct deformity of limb due to fracture (humerus, ulna, radius, femur, tibia, fibula)
Used to overcome stiffness in total joint replacement (hip joint) caused by postoperative adhesions
Improves movement after patellectomy (kneecap joint operation)
Improves position of the limb after osteotomy (surgical cutting of bone or removal of piece of bone)

Orthopedic Operations

Patients may be any age, but fractures occur more often in young and active people
MUA is required after joint replacement (hip joint) and patellectomy in elderly patients
MUA is semi-urgent procedure to reduce pain, but it is urgent if there is any vascular impairment
Urgent patients may be unprepared (emergency condition, non-fasted)

Preoperative Preparation

Take medical history (diseases)
Perform physical exam and investigations according to the patient's condition
Ask about drug intake and allergy (drug history)
Patients should be fasted (prepared for operation) for elective procedures

Anesthesia

Regional anesthesia (Bupivacaine or Xylocaine) with sedation (Midazolam) or general anesthesia (I.V. anesthetic agent with muscle relaxant) are both suitable
The operation is done as day-case surgery
Monitoring: SPO2, ECG, Noninvasive BP

Pain Control after MUA

Patient controlled analgesia (epidural anesthesia with catheter)
Other analgesics (NSAID, Paracetamol)

Anesthesia for Inguinal Hernia Repair

The inguinal canal is a passage in the lower anterior abdominal wall located just above the inguinal ligament
Contents of the inguinal canal in males: spermatic cord, genitofemoral nerve, ilioinguinal nerve, gonadal vessels, and lymphatics
Contents of the inguinal canal in females: round ligament of the uterus, genitofemoral nerve, ilioinguinal nerve, gonadal vessels, and lymphatics
An inguinal hernia occurs when tissue protrudes through a weak area in the abdominal muscles
Small hernias that are not strangulated, not blocking blood supply to the intestine, and are not causing bowel obstruction or significant pain do not necessarily require surgery or emergency surgical repair

Anesthesia Techniques

Inguinal field block may be used as the only technique for surgery or to complement with GA
The iliohypogastric and ilioinguinal nerves are blocked 2 cm medial to the anterior superior iliac spine
The genitofemoral nerve is blocked 2 cm above the midpoint of the inguinal ligament
Local infiltration anesthesia is the technique of loss of sensation restricted to a superficial, localized area in the body

Postoperative Care

Give adequate analgesia to the patient to take home (NSAID, Paracetamol, Tramadol 50–100 mg)
Low dose Propofol infusion may be useful additive in case performed only under LA

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Description

Learn about Manipulation Under Anesthesia (MUA) in Anesthesia Management, a 2nd semester lecture for Anesthesia Theory students at Kurdistan Technical Institute. Quiz covers key concepts and techniques in MUA.