• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/108

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

108 Cards in this Set

  • Front
  • Back
What is the golden rule for anesthesia
Always be ready to go to sleep!
What are the 2 types of local anesthestics used
Esters & Amides
Where are esters metabolized?
metabolized by plasma cholinesterases
Where are amides metabolized
in the liver
All Amides have what letter in their prefix?
"i"
Does Cocaine prevent/foster reuptake of catecholamines?
prevent
What are the two principal side effects of local anesthetics
allergic reaction
systemic toxicity
What causes the allergic reaction to esters?
PABA (metabolite para-aminobenzoic acid)
What are the toxicity levels for Bupivacaine, and Lidocaine?
Bupivacaine = 3mg/kg
Lidocaine = 4mg/kg
Lidocaine w/epi = 7mg/kg (because epi causes vasoconstriction it delays release of lidocaine systemically)
True allergic reactions are
a) rare, less than 1%
b) usually due to excess plasma levels
c) both of the above
both of the above
What are the two causes of systemic toxicity
accidental intravascular injection
too high local anesthetic dose
What are the symptoms of Systemic toxicity?
usually present as CNS effects
circumoral numbness
lightheadedness
tinitis
visual disturbance
slurring of speech
SEIZURES
What is treatment for seizure caused by systemic toxicity with LA's
Protect patient
supplemental O2
Na pentothal
BZD's
IA's
What are the seven sites of placement of LA's
topical/surface
local infiltration
peripheral nerve block (ie axillary block)
IV regional (bier block)
epidural
spinal
caudal
What does LTA stand for? And can it reduce inhaled anesth. need?
Local Tracheal Anesthesia
(usually use 4% lidocaine)
yes it can decrease inhalation agent requirements, safe in elderly
Describe how a Bier Block is performed
IV inserted for injection of LA, 2 tourniquets placed on extremity, LA injected into IV (LA stays in extremity until tourney released, do it SLOWLY)
pt may have PAIN from tourney
Where is a caudal block performed (which area of spine)
Sacral Hiatus
With local anesthesia, LA is injected SQ into area to be worked on. The surgeon is using a bovie at the site, for long periods of time. You see a rise in BP & HR what could be going on?
pt could be exhibiting signs of pain, although he isn't feeling it
What area of the spine is a spinal anesthesia usually placed?
around L4-L5
What area in the spinal column is LA injected for a spinal anesthesia?
subarachnoid space
Epidural or Spinal which one has a quicker onset? Why?
Spinal, because it is closer to the spinal cord ( about 5 minutes compared to Epidural about 15 - 20 minutes)
Would you expect to see more sympathectomy in a spinal or epidural?
Spinal
Which has a higher risk for a post injection headache, spinal or epidural?
Spinal
Where does the spinal cord end?
L1
what is the number one contraindication for not giving a regional anesthetic?
Pt Refusal
Regional anesthesia produces _________anesthesia for a specific site whereas general anesthesia produces ___________body anesthesia
selective
total
You have just performed your regional anesthetic without any problem, now how much muscle relaxant will you need to give your patient?
None! RELAXATION IS PROFOUND! there is little need for muscle relaxants after a regional anesthetic
What factors are taken into consideration when selecting a patient for a regional anesthetic?
cooperation
pt consent
fluid status (sympathectomy)
experience of provider
availability of emergency equipment
pt fear of permanent paralysis
The spinal cord extends form the foramen magnum to
a) L4-L5
b) L1 - L2 (sacral hiatus)
c) cauda equina
L1 - L2 (sacral hiatus)
The vertebral column consists of
________ cervical
________thoracic
________lumbar
7 cervical
12 thoracic
5 lumbar
Each vertebra consists of
a vertebral body
bony arch
Each vertebral body consists of
_____anterior pedicles
_____posterior laminae
2 pedicles
2 laminae
The laminae of the vertebra are connected by
a) ligament flavum
b) cauda equina
c) spinal cord
ligament flavum (dense & fibrous)
Which of the following is NOT contained in the spinal canal
a) pia mater
b) arachnoid mater
c) dura mater
d) equina mater
equina mater
True/False the sacral nerves extend in spinal canal as the cauda equina
True
Space between the arachnoid mater and pia mater is known as_____________
subarachnoid space
Is the epidural space considered a positive pressure space or negative pressure space?
negative pressure space
What is the epidural space normally filled with?
a) fluid
b) adipose tissue
c) connective tissue
d) b & c
d) adipose & connective tissue
Landmarks for insertion of a subarachnoid block include
a) midline (spinous process)
b) line across iliac crest (L4)
c) cauda equina
d) a & b
d)
midline (spinous process)
LINE ACROSS ILIAC CREST L4
The typical needle used for spinal (subarachnoid) injections is
a) 22/25 gauge beveled spinal needle
b) 22/25 gauge needle
c) what ever is handy
a) 22/25 gauge beveled spinal needle
True/False When performing a spinal anesthesia the best positions include lateral decubitus or sitting
True
Confirmation of correct placement of a spinal injection is identified by
a) no blood when drawing back
b) blood when drawing back
c) positive CSF when drawing back
c) positive CSF when drawing back
When you have flow of CSF what space are you in?
a) cauda equina
b) intrathecal
c) epidural space
d) you will get CSF in any of these places
b) intrathecal
What is the FIRST sign of a good spinal injection?
SYMPATHECTOMY
If a patient is unable to "flex" back what technique might you use?
Lateral (paramedian) approach which is 1-2 cm lateral to the midline
True/False The largest interspace is between L5 - S1
True
Distribution of local anesthetic is influenced by what factors
a) baricity of the solution
b) contour of the spinal canal
c) position of patient during injection
d) all of the above
d) all of the above
A hyperbaric solution will
a) stay where it's injected
b) sink
c) rise
b) sink
A hypobaric solution will
a) stay where it's injected
b) sink
c) rise
c) rise
A isobaric solution will
a) stay where it's injected
b) sink
c) rise
a) stay where it's injected
True/False migration of of the local anesthetic cephalad in CSF depends on its specific gravity in relation to CSF's specific gravity
True
To make a hyperbaric solution you would add
a) sterile water
b) dextrose
c) CSF
b) dextrose
To make a hyperbaric solution you would add
a) sterile water
b) dextrose
c) CSF
b) dextrose
To make a hypobaric solution you would add
a) sterile water
b) dextrose
c) CSF
a) sterile water
When using a hyperbaric solution where will the anesthetic settle when patient is in lateral position?
a) dependent side
b) non-dependent side
c) it will stay where you put it
a) dependent side
When using a hypobaric solution where will the anesthetic settle when patient is in lateral position?
a) dependent side
b) non-dependent side
c) it will stay where you put it
b) non-dependent side
Addition of a vasoconstrictor drug to a local anesthetic can prolong the spinal up to
a) 25%
b) 50%
c) 75%
d) vasonconstrictors don't influence duration of spinal
b) 50%
What are the two vasoconstrictors mixed with local anesthetics?
Epinephrine
Phenylephrine
At what level in the spinal column would you find the cardio-acceleratory
fibers
a) T-5 - T-7
b) T-1 - T-4
c) L-1 - S-1
b) T-1 - T-4 (may have profound hypotension, bradycardia, decreased contractility)
If your patient develops apnea after a spinal injection what is the most likely cause? ___________________
Hypotension
True/False It is appropriate to place patient in trendelenburg when using a hyperbaric solution
False!!!!
Why must you use caution when administering a neuraxial block to patients with severe COPD?
Because patients with severe COPD might rely on accessory muscles (intercostal and abdominal)
Correlate the following spinal levels with their anatomic position
C8
T1 - T4
T1 - T2
T3
T4-T5
T7
T10
C8 = 5th digit ( includes (T1-T4 cardio accelerator)
T1 - T2 inner aspect of arm
T3 apex of axilla
T4- T5 nipple line
T7 tip of xyphoid
T10 - umbilicus
What are the levels required to have adequate anesthesia for the following surgeries
c-section
vag delivery, hip, TURP
lower extremity
foot surgery
Hemorrhoidectomy
T4 c-section
T10 vag hip TURP
L1 lower extremity
L2 -L3 foot
S2 - S5 Hemorrhoid
A C8 level of anesthesia is considered
a) high spinal
b) total spinal
total spinal
A T4 level of anesthesia is considered
a) high spinal
b) total spinal
c) low spinal
high spinal
A T10 level of anesthesia is considered
a) high spinal
b) low spinal
c) saddle block
low spinal
True/False The sympathetic nerves are 1st to be blocked in a spinal anesthesia
True
Sympathetic block may exceed somatic (sensory) block by as much as ____levels (dermatomes) above and below injection site
2 dermatomes
Hypotension associated with a spinal anesthesia can be minimized by
a) decreasing amount of LA injected
b) increasing preload by hydrating pt with IVF's
c) changing the level at which you inject
increasing preload by hydrating pt with IVF's
What is the first sign that your patient is hypotensive after a spinal injection?
NAUSEA
If your patient starts complaining of "i can't breath what steps should you take
a) reassure pt
b) check dermatome
c) supplemental O2
d) convert to a general anesthesia
e) all of the above
e) all of the above
What needle is used for an epidural anesthesia?
a) 17 gauge beveled spinal needle
b) 17 gauge tuohy needle
c) any small gauge needle, as long as it is beveled will work
b) tuohy needle tuohy needle
When performing an epidural loss of resistance is evident when the needle passes through
a) dura
b) ligamentum flavum
c) subarachnoid septum
b) ligamentum flavum
It is important to remember not to withdraw epidural catheter through the needle because
a) you will lose the position of the catheter
b) the tip of catheter can be sheared off
c) the manufacturer says not to
b) the tip of catheter can be sheared off
After placing the needle/ epidural catheter the catheter is threaded how far and then secured for a continuous epidural infusion?
3-5 cm be sure to note the marks on catheter
True/False It is important to do a test dose with an epidural catheter placement
True
What are you looking for when you do a test dose after placing an epidural catheter?
a) accidental dural puncture
b) accidental intravascular injection
c) radicularopathy
d) both a & b
d) both a & b
If you did puncture the dura, how would you know?
a) symptoms would show up in about 2 minutes
b) pt would have numbness of buttocks and lower extremities
c) the patient is able to get up and walk about
d) both a & b
d) both a & b
Level and duration of an epidural depends on which factors
a) volume & concentration of LA
b) use of epi (1:200,000)
c) weight, height, age of pt
d) all of the above
d) all of the above
What is important to remember to do after placing an epidural catheter?
a) always, always aspirate
b) always, always aspirate
c) both a & b
c) both a & b
With a higher concentration will there be
a) more motor blockade
b) less motor blockade
c) blockade doesn't depend on concentration
a) more motor blockade
True/False Epidural spread has to do with volume of LA
True
What is one of the big risks of intravascular injection of Bupivacaine?
Cardiovascular collapse
In what order does an epidural spread
a) sensory, motor, sympathectomy
b) motor, sensory, sympathectomy
c) motor, sympathectomy, sensory
d) sympathectomy, sensory, motor
d) sympathectomy, sensory, motor
True/False Epidural will have slower onset of sympathectomy than spinal
True
An epidural may average how many segments above and below injection site?
a) 4 segments
b) 2 segments
c) 1 segment
d) it doesn't move from injection site
a) 4 segments
What are the types of peripheral nerve blocks?
Cervical plexus

Brachial plexus-interscalene-supraclavicular-axillary

medial-ulna-radial nerves

sciatic, femoral, ankle,Bier block
How many nerve(s) must be blocked for an ankle block?
a) 1
b) 2
c) 5
d) 7
c) 5
What must you always be prepared to do when administering ANY type of anesthesia?
BE READY TO GO TO SLEEP!
Which of the following factors affect the level of anesthesia
a) Baricity of LA
b) position of pt (during & after injection)
c) drug dosage
d) site of injection
e) all of the above
e) all of the above
In adults, what is the generally accepted amount of LA required to achieve a block of ONE segment when administering an epidural?
a) 5-6 ml
b) 1-2 ml
c) 7-8 ml
d) there is no generally accepted guideline
b) 1-2 ml
What are the contraindications to peripheral nerve blocks
a) uncooperative pt
b) bleeding tendencies
c) infection
d) all of the above
d) all of the above
Potency of LA's correlates with
a) water solubility
b) lipid solubility
c) both of these
d) neither of these
b) lipid solubility
Onset of action depends on
a) Pka
b) physiological pH
c) both of these
c) both of these
What Local anesthetics are used for spinal anesthesia
Procaine, Tetracaine
Bupivacaine, Dibucaine, Lidocaine
What local anesthetics are used for epidural anesthesia
Chloroprocaine, Bupivacaine, Lidocaine, Mepivacaine, Prilocaine
Which local anesthetics are used for both spinal and epidural anesthetics
Bupivacaine, Lidocaine
the space between the arachnoid mater and pia mater is known as
a) epidural space
b) subarachnoid space
c) ligamen flavum
d) none of these
b) subarachnoid space
Sacrum & coccyx are distal estensions of _________________
vertebral column
Each vertebra consists of
______________ & _____________
vertebral body
bony arch
With an epidural where will the most intense block be?
dependent portion
With an epidural where will the most intense block be?
dependent portion
Procaine
a) long acting
b) short acting
c) intermediate acting
a) long acting
Tetracaine
a) long acting
b) short acting
c) intermediate acting
a) long acting
Chloroprocaine
a) long acting
b) short acting
c) intermediate acting
c) intermediate acting
Lidocaine 5% w/ 7.5% dextrose would have what baracity
a) hyperbaric
b) hypobaric
c) isobaric
a) hyperbaric
Which local anesthetic has vasoconstrictor properties
a) lidocaine
b) mepivacaine
c) Chloroprocaine
d) bupivacaine
b) mepivacaine