Regional Anesthesia Ii

Front 1

pt position for epi is ______
can enter from ______ to ______ but most common is lumbar b/c space is ______mm deep (vs. T area)

Back 1

sitting or lat decub
C6-7 to L5-S1 (T4-7 hardest)
5-6mm deep (thoracic=3-4mm)

Front 2

Insertion angle for epi inj is ______

Back 2

slightly cephalad in lumbar and low thor region

Front 3

best technique to ID epi space is ______

Back 3

loss of resistance - utilizes low sub-atm pressure in epi space

Front 4

once past the LF the glass syringe plunger should ______ and be able to inject ______

Back 4

collapse
3ml air or PF 0.9ns

Front 5

______ is the key to epidurals
______ cm deep to skin

Back 5

LF
3.5-5cm

Front 6

most common complication of epi inj is ______
will see ______

Back 6

dural puncture (esp. w/large needle)
gush of CSF

Front 7

inj test dose (______) once epi space is entered and watch for ______ w/in 1min

Back 7

3cc (1.5%Lido/15mcgEpi 1:200k)

20% incr in HR and mild sensory block

Front 8

once epi needle & cath are stabilized...
and NEVER ______ or ______!

Back 8

slowly w/d needle, admin incremental inj, repeated aspiration
pull cath back thru needle or advance thru broken sterile field

Front 9

to remove an epi cath the pt should...
and make sure that ______ is present on the cath before pulling

Back 9

flex the lumbar spine

black tip

Front 10

______ & ______ correlate to post-lumbar h/a
pts<40yrs use ______ g
______ g ok in elderly

Back 10

size and pt. age

25/26g
22g

Front 11

______ is a standard spinal needle that cuts the dural, so must arrange bevel ______.
i.e. ______

Back 11

beveled
parallel to fibers
Quincke

Front 12

______ is a rounded non-cutting needle that has decr incidence h/a
i.e. ______, ______

Back 12

pencil-point

Whitacre, Sprotte

Front 13

epi needles are ______ & ______
______ g achieve good sensation when in LF

Back 13

styletted & hollow

17-18g

Front 14

-std epi needle is called ______
-similar w/less angle is ______ has a gentle curve (______) and a dull tip to allow ______

Back 14

Tuohy
Hulstead (Huber tip)
cath advancement when stylet is removed

Front 15

______ needle is blunt and short-beveled used for ______

Back 15

Crawford
single inj epidural

Front 16

an epi is injected into ______ w/possible leakage out of ______
NOT inj into ______

Back 16

hollow space
intervert foramina
CSF (so baricity and position don't matter)

Front 17

segmental band of epi anes develops from ______

Back 17

site of injection

Front 18

S1 and sacral derm hard to block b/c ______ are site of action

Back 18

nerve roots (large in sacral area)

Front 19

with epi inj drug doses need to be ______ in order to achieve wide area of anes

Back 19

much larger, frequently close to toxic levels

Front 20

a test dose is req w/epi inj in order to ______

Back 20

avoid SAS and IV inj

Front 21

[bupivacaine] for epi inj=______
(vs. for spinal=______)
beneficial for ______

Back 21

0.25-0.125%
0.75%
labor (more sensory, less motor blockade)

Front 22

in epi inj ______ is primary determinant of block; ______ & ______ effect extent of block

Back 22

total mg
large mass & drug volume (incr conc=incr density motor block)

Front 23

in epi inj, LA mass determines ______, ______, & ______
slower than SAB b/c...

Back 23

onset, depth, & duration
fluid filling around roots, not just space

Front 24

epidural dosing is ______ml of LA per dermatomal level

Back 24

1-1.5ml

Front 25

1ml anes affects______ below and ______ above 1 spinal segment

Back 25

1/3 below & 2/3 above

Front 26

time to epi 2-level regression:
chloroprocaine=______
prilo=______ lido=______
mepiv=______ bupiv=______
ropiv=______

Back 26

45min
60min, 60min
60min, 120min,
120min

Front 27

an epidural req ______ volume for larger block and if more motor blockade is needed must use ______ sol'n

Back 27

more

more concentrated

Front 28

with epidurals must redose at ______ to ______ of expected LA duration of action

Back 28

2/3 to 3/4 top-off time

Front 29

smaller volumes=______ epi spread in old/young pts possibly d/t ______

Back 29

higher
narrowing of intervert foramina

Front 30

heavy pts have ______ LA requirement d/t...

Back 30

slightly less
fatty tissues engorge epi veins d/t abd compression

Front 31

taller pts may require slightly ______ epidural LA

Back 31

more

Front 32

short-acting epidural anes include______ & ______;
intermed include ______ & ______;
long-acting ______ & ______

Back 32

chloroprocaine & prilocaine
lidocaine & mepivacaine
bupivacaine & ropivacaine

Front 33

lidocaine (xylocaine):
______=good motor block
______=sensory analg
______=symp block
______min abd anes

Back 33

1-2%
1%
0.5%
60-90

Front 34

mepivacaine (carboaine):
1-2%=______min anes

Back 34

90-120

Front 35

2-chloroprocaine (nescaine):
______=motor block
______=analg
popular in OB b/c of ______ and outpt b/c ______

Back 35

3%
2%
low toxicity and short duration (45-60min sx anes)

Front 36

bupivacaine (marcaine, sensorcaine):
______=fair motor block
______=good for sx&motor blk
______ contraind for OB d/t...

Back 36

0.25-0.5%
0.75%
>0.5% d/t cardiotoxicity

Front 37

ropivacaine (naropin):
______% gives 2-5hr duration
______>______ blockade
<cardiotoxic than ______

Back 37

0.2-1%
sensory>motor
bupivacaine

Front 38

leobupivacaine:
______% gives 3-9hr duration

Back 38

0.5-0.75%

Front 39

physiological effects of SAB inlude ______, ______, & ______

Back 39

hypotension, bradycardia, and CV collapse

Front 40

SAB hypotension can be tx w/______ or ______

Back 40

ephedrine 5-10mg/dose (^CO via ^inotropy & ^HR but may get tachyphylaxis)
phenyleph 50-100ug/dose (^CO via ^SVR)