Open Reduction Internal Fixation (ORIF) – Clavicle

Anesthesia Implications

Position: Sitting / Beach Chair, arms at side on armboards
Time: 1-2 hours (average)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Yes
Lead: Yes
Blocks: Superficial Cervical Plexus

Tape the ETT tube to the non-operative side.

After intubation, staff will help lift the patient and exchange the head rest. Once the head rest is secured, the patient will be lifted to the sitting position. Make sure the circuit is disconnected and the ETT is free when lifting – this could easily result in extubation if the ETT is not disconnected.

Patient will be in the sitting position. This means that blood pressure will be ~ 20 mm Hg BELOW what it is reading at the cuff.

Beach Chair/sitting position (general considerations): When putting the patient in this position, the staff will typically help lift the patient and exchange the head rest after intubation. Once the headrest is secured, the patient will be lifted to the sitting position. At this junction, make sure the circuit is disconnected and the ETT is free – this could easily extubate the patient if the ETT is still attached when lifting the patient. The degree of hemodynamic changes depends on the angle. If sitting at 45 degrees there will be minimal changes, whereas 90 degrees will reduce cardiac output by 20% (due to venous pooling in the legs). SVR will be 15-20 mm Hg lower at the circle of willis than at the cuff, which may compromise cerebral perfusion. Consider having ready ephedrine and phenylephrine to support blood pressures. For higher risk patients requiring an A-line, it is recommended to place the transducer at the level of the brain (level the transducer at the tragus). Make sure the head is in a neutral position (looking straight ahead and void of flexion/extension).

Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.