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66 Cards in this Set

  • Front
  • Back
cocaine (1st anesthetic)
Quinke performed a lumbar puncture
Bier block (Bier, IV regional anesthesia)
Einhorn - synthesized Procaine (1st)
toxic manifestations of lidocaine (4 mcg/ml)
1) tongue numbness
2) lightheadness
ester local anesthetic are derivatives of?
benzoic acid
What is a metabolic end product of ester local anesthetics?
PABA (para-aminobenzoic acid)
- cause allergic rxn
Dibucaine test
1) 80 (normal)
2) 40 (heterozygote) - 20-30 min block
3) 20 (homozygote) - up to 8 hrs
Prilocaine may induce?
a metabolite of liver metabolism of Prilocaine which may cause metHgemia
1) normal Hg has Fe 3+ (ferrous state)
2) met-Hb has Fe 2+ (ferric state) - O2 carrying capacity is poor
3) Tx: methylene blue 1-2 mg/kg over 5 min
1) are cytotoxic
2) do not use for spinal, epidural, or IV regional
3) need to say Methylparaben Free (MPF)
iliac crest
sacral hiatus
1) is felt just above ro between the gluteral cleft
2) diamond-shaped
the higherst point when lying flat
lowest point
spinal cord
1) extends from the foramen magnum
2) adult end at L1-2
3) newborn end at L3
conus medullaris
the terminal end of the SC
dura mater
1) dense and water tight
2) contains CSF
3) ends at S2 in adults, S3 in kids
Cauda equina
1) "horse's tail"
2) distal end of SC (below L1) where it branches off into terminal strands
3) bathed in CSF
4) enclosed w/i the dura
2 major blood supplies to SC
1) anterior spinal artery
2) posterior spinal arteries
1) posterior spinal arteries (2 vessels)
1) receive chief blood supply from cerebral arterial system and many collaterals
2) supply posterior portion of the cord
2) anterior blood supply
1) artery of Adamkiewicz or
2) arteria radicularis magna
- supply lower thoracic and lumbar seguments
total sympathectomy
1) increase in volume of the capacitance vessels
2) decrease in venous return to the heart
3) decrease in preload equals hypotension
partial sympathectomy
1) T8 block usually allows physiologic compensation with vasoconstriction
2) mediated by sympathetic fibers above block
cardiac accelerator fibers
1) T1-4
2) increase HR when stimulated
3) high central blockade, unopposed vagal activity leads to bradycardia
fibers that are involved in smooth muscle tone arise from?
regional anesthesia can block the sympathetic responses that cause?
1) HTN
2) myocardial stres
3) hyperglycemia
shoulder pain in TURP sx?
1) peritoneal stimulation or
2) bladder perforation
combined spinal and epidural (CSE)
Indications: C-sections and labor epidurals. This technique can be used in any surgery where completion time may be extended. It is also useful for dense surgical anesthesia via intrathecal route and post op pain control via epidural route.
CSE technique
Tuohy needle is positioned in epidural space and the spinal needle is advanced through it. Either the spinal needle follows the contour of the epidural needle and exits at a slight angle or the spinal needle exits the epidural needle through a hole in the tip of the epidural needle
Betadine can cause?
chemical meningitis
paramedian approach is used in pts with?
1) severe arthritis
2) kyphoscoliosis
3) little old crunchy people
paramedian approach technique
1) skin wheal 2 cm lateral to midline
2) needle is derected 10-15 degree toward the midline and advanced
3) only 2 pops are encountered (ligamentum flavum and dura)
Procaine (Novocaine)
1) ester
2) rapid onset
3) short duration (45-60 min)
4) rapid, dense block
1) ester
2) intermed. onset
3) long duration (90 min)
4) with Epi. (120-150 min)
1) amide
2) rapid onset
3) short duration
4) rapid, solid block (60 min)
1) amide
2) slow onset
3) long duration, unaffected by Epi. (120-150 min)
1) amide
2) less cardiotoxic than Bupivacaine
3) used freq. in OB as epidural drip
CSF s.g.
hyperbaric (most widely used)
1) Bupivacaine with 8.25% dextrose
2) Lidocaine with 7.5% dextrose
cephalad spread can increase with?
rising the pts legs or trendelenburg position
Tetracaine with sterile water - most frequently used
1) tetracaine
2) lidocaine
3) bupivacaine
- mix with CSF
lipid solubility
(more lipid soluble = higher the potency)
ex. Bupivacaine, Tetracaine
duration of action
protein binding
(long acting = highly protein bind)
onset time
degree of ionization, pKa
(unionized form cross lipid memb. into the nerve roots easier)
1) lower pKa = more unionized at pH 7.4
2) higher pKa = more ionized at pH 7.4
redistribution occures via?
vascular absorption into the epidural space
BIPCEPSS (highest absorbing to lowest)
1) blood
2) intercostal
3) paracervical
4) caudal
5) epidural
6) brachial plexus
7) subarachnoid
8) SQ
cauda equina syndrome
Cauda equina syndrome (CES) occurs when the nerve roots are compressed and paralyzed, cutting off sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage.
Cauda equina syndrome S&S
has been defined as low back pain, unilateral or usually bilateral sciatica, saddle sensory disturbances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss.
epidural venous plexus communicates with?
the intracranial venous sinuses superiorly
epidural venous plexus communicates inferiorly with the?
sacral plexus
epidural venous plexus communicates ventraly with?
the thoracic and abdominal venae caae and the azygos system
large spinal nerves -- and -- are the most difficult nerves to block in the epidural space
L5 and S1
segmental anesthesia
a band of anesthesia is produced, extending upward and downward form the injection point
test dose for epidural
3 ml 1.5% Lido with Epi
intravascular injection will cause?
HR to increase by 20% w/i 30-60 sec.
subarachnoid injection produces?
signs of spinal anesthesia w/i 3 min
5 ml of local anesthetic should be injected every?
3-5 min. until desired effect (always aspirate first!)
simple dosing rule of thumb
1-2 ml of anesthetic for each spinal segment
wet tap
1) compication of epidural
2) epidural needle punctures the dura
3) HA in 40-80 % of pts
1) pediatrics
2) lateral
3) sacral hiatus
4) 1 1/2 - 2", 22G Jelco needle
5) 0.75-1 cc/kg (0.25% Bupivacaine)