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70 Cards in this Set
- Front
- Back
- 3rd side (hint)
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How many roots, trunks, divisions and cords can be found in the brachial plexus?
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Roots = 5
Trunks = 3 Divisions 6 Cords =3 Branches = 5 |
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What is the definition of pKa?
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The pH at which the drug is spint between 50 being ionoized and 50 being unionized.
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Which nerve is at risk for accidental blocking when preforming an interscalene block?
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The phrenic nerve?
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Name the type of nerve fiber that controls motor function, its diameter and its conduction speed.
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Aalpha fibers
they are 12-20 mm in diameter Have a conduction speed of 70-120 m/s not very sensetive to local anesthetics they are myelinated. |
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What are Aalpha 1a fibers...explain in detail.
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They provide proprioception with a diameter of 12-20m/s and a conduction speed of 70-120m/s, are mildly sensetive to local anesthetics and are myelinated.
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What are Aalpha 1b nerve fibers, expain in detail....
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They sense propriocpetion and are 12-20 mm in diameter, a conduction speed of 70-120m/s, are mildly sensetive to local anesthetics and are myelinated.
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What are Abeta type II nerve fibers, explain in detail....
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They sense touch, pressure, and proprioception
They are 5-12mm in diameter They have a conduction speed of 30-70m/sec Are mildly sensetive to LAs Are myelinated |
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Alpha gamma nerve fibers, explain in detail....
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They provide motor control (muscle spindle),
Diameter is 3-6mm Speed is 15-30m/sec Mildly sensetivie to LAs are Myelinated |
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Alpha delta nerve fivers type III explain in detail....
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They sense pain, cold temperature, and touch
Diameter is 2-5mm Speed is 12-30m/sec Moderately sensetive to LAs THey are myelinated |
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B nerve fibers, explain in detail....
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They are preganglionic autonomic fibers
Diameter <3mm Speed 3-14m/s Highly sensetive to LAs Some are myelinated |
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C nerve fibers type IV, explain in details....
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They sense pain, warm and cold, temperature, and touch
Diameter 0.4-1.2mm 0.5-2m/s Highly sensetive to LAs THey are not myelinated |
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B nerve fibers, explain in detail....
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They are preganglionic autonomic fibers
Diameter <3mm Speed 3-14m/s Highly sensetive to LAs Some are myelinated |
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C sympathetic nerve fibers, explain in details....
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They are postganglionic sympathetic nerve fibers
Diameter 0.3-1.3 Speed 0.7.2.3m/s Highly sensetive to LAs They are not myelinated |
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What does ATPTPMVP stand for?
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Automonic
Temperature Pain Touch Pressure Motor Vibration Proprioception |
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Duration of action is highly correlated with ______ ______.
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Lipid Solubility
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How are ester anesthetics metabolized?
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They are metabolized by pseudocholinesterase. Ester hydrolysis is rapid and water soluble metabolites are excreted in the urine.
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Procaine and Benzocaine are metabolized to __________, which has been associated with allergic reactions?
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p-aminobenzoic acid (PABA)
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In order to examine how the rate of systemic absorption is porportionate to the vascularity of the site of injection, this mneumonic can be used.
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I think I can please everyone but susie smith
I = intravenous T = tracheal I = intraccostal C = caudal P = paracervical E = epidural B = brachial plexus S = sciatic S = subcutaneous |
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What three benefits occur as a result of adding vasoconstrictors to local anesthetics.
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1) Enhances the quality of analgesia
2) Prolongs the duration of action 3) Limits the toxic side effects |
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The addition of epinephrine to lidocaine will extend the duration of anesthesia by what percentage ?
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50%
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How are amide local anesthetics metabolized ?
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They are metabolized by the P-450 enzymes in the liver.
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Which local anesthetics have metabolites that can cause methemaglobinemia?
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Prilocaine
Benzocaine Remember (EMLA cream contains prilocaine) |
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What is the treatment for significant methemaglobinemia?
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Methylene blue 1-2mg/kg of a 1% soultion over five minutes.
Methemaglobin reduces methemaglobin Fe3+ to Hemaglobin Fe2+ |
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List the ester local anesthetics.
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Benzocaine
Chloroprocaine Cocaine Procaine Tetracaine |
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List the amide local anesthetics.
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Bupivicaine
Lidocaine Mepivicaine Prilocaine Ropivicaine |
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What is the max dose of chloroprocaine?
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12mg/kg
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Which local anesthetics have a max dose of 3mg/kg?
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Cocaine
Tetracaine Bupivicaine Ropivicaine |
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Which local anesthetics have a max dose of 4.5mg/kg
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Lidocaine
Mepivicaine |
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What is the max dose of prilocaine?
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8mg/kg
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what are the early symptoms of neuro toxicity with local anesthetics?
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Circumoral numbness
Tongue parasthesia Dizziness |
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IV lidocaine increases/decreases cerebral blood flow and attenuates the rise in intracranial pressure that accompanies intubation in patients with decreased intracranial compliance.
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decreases
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What factors influence the toxicity level of local anesthetics (4) ?
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Location of injection
Total dose Vasoconstrictor Pharmalogical profile of local anesthetic. |
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What are the symptoms of the excitment phase of CNS toxicity from LA's
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muscle twitching
tonic/clonic convulsions |
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What symptoms are seen during the depression phase of CNS toxicity from LA's?
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Unconciousness
Generalized CNS depression Respiratory arrest |
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What symptoms do you see during the initial phase of CV toxcity with LA's?
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Hypertension and Tachycardia
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What symptoms do you see during the intermediate phase of CV toxicity from LAs?
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Cardiac depresson
Decreased CO Mild-moderate hypotension |
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What symptoms would you see in the terminal phase of CV toxicity with LA's?
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Vasodilation with profound hypotension
Bradycardia/Dysrhythmias Circulatory collapse/arrest |
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What steps should you take to treat LA toxicity?
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Get control of Airway
Hyperventilate on 100% O2 Use benzos to treat seizures, amiodarone for CV dysrhythmias, epinephrine, PDE inhibitor for intropic support Anticipate prolonged CPR, pacing, or CPB |
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Why is bupivicaine the worst for CV toxcitiy?
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It binds to CV proteins and also blocks beta receptor sites which will cause a prolonged refractory arrest
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What is the purpose of intralipids and how are they used?
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Binds to local anesthetics
Intralipid 20% should be given 1.5ml/kg over 1 minute Start infusion at 0.25ml/kg/min continue chest compressions, and repeat every 3-5 min up to 3ml/kg total dose until circulation is restored. Continue infusion increase to 0.5ml/kg/min if BP declines A max dose of 8ml/kg is recommended |
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Opioids reduce anesthetic requirements by ___%
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30%
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Using epinephrine with LAs reduces the amount of LA needed by ___%
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30%
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Using opioids and epinephrine with neuraxial anesthesia reduces the amount of LA needed by ____%
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60%
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Ropivicaine is the chiral enatomer of which drug?
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Bupivicaine
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Ropivicaine is __to__ times less lipid soluble than Bupivicaine?
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2 to 3
Has a smaller volume of distribution. |
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What determines onset for epidrual placement of LA?
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pH/pKa
Lipid solubility The use of epi |
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Where do the five roots of the brachial plexus start from?
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C5,6,7,8, T1
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The cords of the brachial plexus are named after their location to what artery?
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Axillary Artery
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The posterior cord of the brachial plexus branches into
the |
axillary and radial nerve
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The lateral cord of the brachial plexus branches into the _____ and _______
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musculocutaneous and 1/2 of the medial nerve
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The medial cord branches into the ______ and _______.
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1/2 medial nerve and the ulnar nerve
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Which nerve in the arm must be blocked separately in orde to prevent tourniquet pain?
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The intercostal brachial
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What type of surgery would the interscalene block be a poor choice for and why?
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It would be a bad choice for hand surgery because often the ulnar nerve is not saturated with LA
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What nerves must be blocked through infiltration in order to have a complete ankle block?
(Please Sit Down Scanky Susie) |
Posterior tibial
Sural Nerve Deep Peroneal Superficial Peroneal Saphenous Nerve |
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Is epi a good adjunct for an ankle or penis block?
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No way.....all around vasoconstriction means no blood flow!!!!
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Which type of block provides the greatest risk of pneumothorax?
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The Supraclavicular block carries a risk of pneumothorax of 0.5-5% because immediately medial to the first rib is the cupola of the lung.
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Which type of upper extremity block carries a high risk of LA toxicity?
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The axillary block carries a high risk for systemic toxicity because of the large amount of LA required to get a quality block.
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Which block is most effective for surgery distal to the elbow such as hand and forearm surgery?
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Axillary block
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Why should an interscalene block be avoided in patients with compromised respiratory function?
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The interscalene block very often will also saturate the phrenic nerve at C4 and will cause respiratory distress.
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What does the phrase push pull pinch pinch refer to?
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It refers to the way in which an upper extremity block can be assessed since motor weakness will appear prior to loss of sensation.
Push - tricep innervation - radial nerve Pull - bicep innervation - musculcutaneous nerve Pinch - on side of pinky notes changes to ulnar nerve Pinch - on side of index finger notes changes to medial nerve. |
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What are some of the complications associated with interscalene blocks?
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Subarachnoid injection
Epidural block IV injection into vertebral artery Pneumothorax Phrenic block |
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If a patient is c/o tourniquet pain on the upper extremity following a block, what nerve has most likely been missed?
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The intercostal brachial?
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How do LA's block the Na channels and what part of the LA structure is resonsible for activity.
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The benzene ring from LA's is responsible for its activity.
It attaches to sodium in the inactive closed channel? |
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I Think I can please everyone but susie smith
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IV
Tracheal Intercostal Caudal Paracervical Epidural Brachial Plexus Sciatic Subcutaneous |
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What is the Max dose of lidocaine mg/kg with epi?
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5mg/kg without
7mg/kg with |
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What type of brachial plexus block might produce symptoms of horner's syndrome?
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Interscalene
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How much bicarb should be added to LA solution to speed onset of block?
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1ml for very 10ml of local solution.
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Which upper extremity block is best suited for shoulder surgey?
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Interscalene block
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When placing an interscalne block the patinets voice becomes hoarse, which nerve are you concerned that you may have blocked?
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The Recurrent laryngeal nerve can be blocked in these patients - can be a possible airway emergency in patient's with partial vocal cord palsy.
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Which nerve is missed most often when performing a 3 part leg block?
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The lateral femoral cutaneous
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