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ANESTHESIA : Hall > CH10 ANATOMY, REGIONAL ANESTHESIA, and PAIN MANAGEMENT > Flashcards

CH10 ANATOMY, REGIONAL ANESTHESIA, and PAIN MANAGEMENT Flashcards

1
Q

phenomenom associated with repeated injection of LA leading to decreased effectiveness

A

TACHYPHYLAXIS

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2
Q

Tachyphylaxis is most closely related to

A

DOSING INTERVAL

dosing interval is short no tachyphylaxis

if the dosing interval is longer TACHYPHYLAXIS DEVELOPS

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3
Q

Treatment for pruritis from neuraxial opiates

A

Nalbuphine 5mg iv
diphenhydramine 50mg iv
propofol 10mg iv

dexmedetomidine 30mcg iv -
will dec narcotic dose but not treat pruritus

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4
Q

MAXIMUM dose of lidocaine containing 1:200,000 epinephrine is

A

5mg/kg withou epi

7mg/kg with epi

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5
Q

1:200,000

A

5mcg/ml

1:200,000 = 1g/200,000ml

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6
Q

DIGITALIS TOXICITY?

A 
loss of appetite
nausea and vomiting 
pain in trigeminal neuralgia 
pain anf discomfort in the feet 
pain and discomfort in the extremities
transient visual disturbance
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7
Q

earliest sign of lidocaine toxicity

A 
5-10
Light headedness 
 dizziness
numbness tomgue
perioral numbness
tinnitus

10-15
seizure
unconsciousness

15-25
rspi depression
coma

> 25
cardio

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8
Q

site of opiates in the spinal cord

A

SUBSTANTIA GELATINOSA of SC

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9
Q

epidural mg of morphine equivalent to intrathecal

A

5mg epidural Mso4= 0.1-0.3mg in intrathecal dose

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10
Q

AMINO ESTERS LA

A

one I only

procaine
chloroprocaine
tetracaine

plasma clearance by pseudocholinesterase
short half lives

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11
Q

AMINO AMIDE LA

A

2 i

bupivacaine
ropivacaine
lidocaine
mepicavaine
prilocaine

hepatic clearance
longer half lives

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12
Q

Interscalene Block

A

hand and forearm surgery
C8-T1

ULNAR NERVE SPARING
PHRENIC NERVE 100%
HORNER SYNDROME blockade of stellate ganglion. 70-90%

LOW RISK OF PNEUMOTHORAX

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13
Q

Structures thatare transversed bu a needle placed in the midline prior to the epidural space?

A 
skin
subq 
supraspinous lig
intserspinous lig 
LIGAMENTUM FLAVUM - snap
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14
Q

CAUDA EQUINA SYNDROME
symptoms?
secondary to?

A

Low back pain
bilateral lower extremity weakness
saddle anesthesia
loss of bowel and bladder control

POOLING of LA dependent area of the Subatachnoid space

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15
Q

CAUDA EQUINA SYNDROME

associated with

A

larger cathyer
lidocaine
tetracaine
lithotomy

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16
Q

DIFFERENTIAL NERVE BLOCK

A

Symphathetic berve block 2-5 higher than motor

sensory block 2-3 higher than motor block

in epidural :
sensory and symphatetic at the same area

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17
Q

pain persiating for more than 3 months after resolution of herpes zoster rash

A

PHN
POSTHERPETIC NEURALGIA

tx: 
TCA
anticonvulsant
opioids
topical LA 
CAPSAICIN
TENS
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18
Q

innervates the short extensors. of the toes and the skin of the web space between the great and second toes

A

deep peroneal nerve

block at the ankle by infiltration between the tensons of the ant tibial and extensor hallicis longus muscle

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19
Q

moat cardiotoxic LA

A

most to least

bupivacaine
ropivacaine
lidocaine

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20
Q 
define:
anesthesia dolorosa
neuropathic pain
dyaesthesia
hyperalgesia
allodynia
A

anesthesia dolorosa spontaneous pain in the are with anesthesia

neuropathic pain primary lesion or dysfunction in the nervous system

dyaesthesia unpleasant abnormal sensatiin

hyperalgesia increased response to normally painful stimulus

allodynia pain with stimulus that does not normally cause pain

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21
Q

most toxic ester LA

A

tetracaine

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22
Q

difference between CRPS TYPE 1 and 2

A

CPRS TYPE 1- trauma

CPRS TYPE 2 - nerve injury

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23
Q

the potency of local anesthetic is directly proportional to

A

LIPID SOLUBILITY

speed and onset is related to PKA

LOW PKA - inc about of non ionized and penetrate lipid portio fast

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24
Q

most important determinants of sensory level ?

A

BARICITY

AND POSITION of the pt

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25
LOWEST CONC in the fetus relative to maternal serum
CHLOROPROCAINE rapidly metabolized by paudocholinesterase t1/2 45 seconds
26
HIGH SPINAL ANESTHESIA
``` hypotension sympathetic blockade venodilation(dec preload) arterial dilation( dec afterload) brady ( cardioaccelerator fibers T1-T4 ) ```
27
PHANTOM LIMB
80% after amputation incidence increased with PROXIMAL few days after sx PNB decreased incidence treatment: opioids antidepressants gabapentin
28
IVRA | BIER BLOCK
upper extremety ``` raised arm bandage tourniquet 250-300mmHg (2.5 the pt systolic) inject 40-45 mins tourniquest time deflate for 5 sec ( look for toxicity signs) ``` lidocaine 0.5% 1.5 to 3mg/kg
29
Largest intervertebral space
L5-S1
30
SNS originated in the thoracic and lumbar spinal cord ?
T1-Lcan cause total sympathetic block
31
DURAL SAC ENDS
s1 upt to s2
32
spinal cord ends at
adult l1-L2 | infant L3
33
4 stages of epidural abscess
1st - localized back pain 2nd - nerve root or radicular pain 3rd- motor or sensory deficit 4th pareplegia
34
entrapment of lateral femoral cutaneous nerve as it courses below the inguinal ligaments
MERALGIA PAREsthesia associated burnjng pain over rhe lateral aspect of the thigh not a complication of epidura
35
COMPLEX REGIONAL PAIN SYNDROME
burning continous pain not anatomically distributes ``` cool red clammy skin HAIR LOSS associated atrophy and oateoporosis ```
36
NEUROLYTIC BLACKADE DIFFERENCE BETWEEN PHENOL AND ALCOHOL
phenol : painless dual action la and neurolytic agents
37
how luch LA SHOULD be administered by spinal segment
1-2mlsegment (20-40 years old elderly and preg 0.75-1.5ml/ segment
38
spread of LA ANESTHETICS PER EPIDURAL ___ secondary to___
2/3 spread cephalad 1/3 spread caudally until level of T4 secondary to INTRATHORACIC NEGATIVE PRESSURE
39
Artery of Adamkiewicz arises fromt he aorta at which spinal level
radicularis magna T9-T12 ASA( anterior spinal artery ) - anterior 2/3 SC posterior 1/3 SC - posterior Spinal artery
40
damage to this artery can lead to ischemia for the lower 2/3 SC. an cause paraplegia
artery of adamkiewicz
41
Sciatic nerve block landmarks
PSIS GREATER TROCHANTER OF FEMUR Sacral HIATUS
42
DEEP CERVICAL PLEXUS BLOCK
c234 | for carotid endarterectomy
43
complication of DEEP CERVICAL PLEXUS
``` injection vertebral artey subarachnoid space epidural space phrenic nerve hornera syndrome recurrent laryngeal nerve ```
44
retro ulbar block what nerve
346 | ciliqry ganglion and nerve
45
all of the muscle of the larynx is innervates by the _____ except
RLN | CRicothyroid muscle - external SLN
46
STELATE GANGLION
lies in fromt of the neck of the first rib vertebral artery lies andyerior to the ganglion
47
sharp pain during insertion of epidural catheter means
its in the nerve root pull out and reinset because if you push LA Caude compression of the nerve >> ischemia
48
five nerve that innervate the ankle and foot
``` post tibial superficial peroneal deep peroneal saphenous nerve sura ```
49
innervate the medial and ateral plantar nerve | plantar surface of the foot
post tibial nerve
50
CVS:CNS RATIO
lowest to highest ``` bupivacaine 2 levobupi 2 ropi 2 prilocaine 3 procaine chlorprocaine 3-7 etidocaine 4.4 lidocaine mepivavaine 7..2 ```
51
phantom limb pt acn received regional anesthesia
NO IT CAN CAUSE REACTIvation of the sendation GA
52
complete bilateral transection of the RLN
Vocal cords at the kntermediate position 2-3mm away
53
partial bilateral paralysis of the RLN
complete airway obstruction
54
PDPH
loss of CSF + posture component head is elevated - HA severe diplopia nausea and vomiting ha frontala nd occipial onset 12-24hrs
55
INTERcostal STRUCTURES | CEPHALAD TO CAUDAL
VAN
56
Greatest concentration absortion
ICE BFS intercostal caudal epodurala lumbar epidural brachial femoral subq
57
LA are base
WEAK BASE
58
supraclavicular block can cause
pneumothorax phrenic nerve ci: respiratory dse
59
FEMORAL NERVE
2nd to 4th lumbar anterior divisiin: motor : sartorius and cutaneous sensatiin ant and medial aspect of the thigh posterior division quafriceps muscle cutaneous ant medi and lateral knee
60
Obturator nerve block needle placement
1-2 cm lateral to and 1-2 cm below the pubic tubercle
61
the most SERIOUS COMPLICATION OF SUPRCLAVICULAR BLOCK
pnuemothorax
62
the most COMMON COMPLICATION OF SUPRCLAVICULAR BLOCK
phrenic nerve block
63
ipsilateral ptosis miosis anhidrosis
HOTNERS SYNDROME
64
brachial plexus innervates the sensory of the arm except
shoulder - supraclavicular nerve of the cervical plexus posterior medial aspect of the arm - intercostobrachial nerve
65
brachial plexus sections
roots trunk- interscalene trunk-division- supreclabicular cord- infraclavicular braches - axillary
66
CELIAC PLEXUS
``` lower esophagus stomach small intestines large intestine splenic flexure pancreas liver biliary tract spleen kidneys adrenal glands omentum ```
67
HYPOGASTRIC PLEXUS -
``` pelvic organ uterus ovaries prostate distal colon ```
68
GREAT TOE IS INNERVATED BY
``` posterior tibial deep peroneal superficial peroneal post tibial saphenous ```
69
TENS produec analgesia bu
releasing endogenous endorphins inhibitory effect at the sc augments the inhibitory pathways
70
dermatome of the fingers?
c6- thumb c7 - 2nd and middle c8 - 4th and little
71
neurolytic nerve block duration of action alcohol? phenol?
alcohol 3-6 months phenol 2-3 months never permanent
72
TNS is not affected by
``` baricity conc addtion of epinephrine dextrose hypotension ```
73
ULTRASOUND : high freq lower freq
high - lower stucture | low for - deeper stucture
74
PDPH INCREASED incidence
younger women pregnant large needle
75
VISCERAL PAIN
transmitted by sympathetic nervous system unmyelinated c fibers dull aching and burning
76
PSOAS COMPARTMENT BLOCK
posterior lumbar plexus for proximal aspect of the thigh and hips +sciatic block = complete leg block
77
sensory innervation of the MEDIAL ASPECT OF THE LOWER LEG
saphenous nerve
78
most common complication of celiac plexus block
hypotensio
79
occipit receive sensory innervation from
lesser and greater ocipinal nervce (c2-c3) from the cervical plexus
80
thoracic paravertebral blocks are used for
postoperative analgesia for breast, axillary or chest wall rigidity surgery
81
thoracic paravertebral blocks | most common complication
pneumothorax
82
intrathecal injection of large dose LA will cause
HYPOTENSION symphathetic fiber t1-L2 BRADYCARDIA cardiac accelerator T1-T4 RESPIRATORY ARREST phrenic nerve C3-C5 dilated pupils
83
CENTRAL PAIN
encephalization psychogenic pain malingering
84
metabolites of ester LA RESponsible for allergic reaction
PABA
85
MYELINATEF NERVE
suscrptible to LA
86
Complete anesthesia for shoulder arthroscopy
interscalene and SUPERFICIAL CERVICAL BLOCK
87
when to stop LMWH prior ti PNB
low doses at 10-12 hrs | hig doses 24 hrs
88
NA BICARBONATE + LA
hasten onset decrease pain with infiltration dec durationof PNB
89
DURATION OF LA
SHORT procain an dchloroprocaine INTErMEDIATE lidocaine mepivacaine prilocaine ``` LONG etidocaine bupivacaine levo bupi tetracaune rooivacaine ```
90
TAP BLOCK
abdominal wall analgesia subcostal T12 illioinguinal L1 hypogastruc L1 injection is between the internal oblique and TA MUSCLE
91
POSTERIOR TIBIAL NERVE
flexion of the toes | sensory of the plantar foot
92
S FORM OF ROPIVACAINE
reduced cardiac and nephro toxicity
93
LUMBAR PLEXUS
L1-2 genitofemoral L2-3 femoral cutaneous L2-4 obturator, femoral sciatic L4 ( lumbar plexus)+ L4-s3 ( scral plexus)
94
LAST AVOID THE USE OF
vasopressin Cachannel blocker b blocker LA EPI REDUCED TO < 1mcg/kg LIPID EMULSION 1.5mg/kg c 1 min 0.25ml/kg/min continue until 10 mins after CV STABILITY upper limit 12ml/kg
95
Pain nerve fiber
Aa skeletal muscle Ab touch and proprioceptio Ay muscle tone Ad sharp pain temp and touc B sympathetic C nolocalized pain touch and tem
96
prilocaine causes formation of
Methemoglobin
97
PDPH | ETIOLOGY
dec csf pressure >> tension meningeal vessels and nerves
98
treatment for neuropathic pain | selective inhibitionof serotonin and NE REUPTAKE
DULOXETINE
99
pudendal nerve
s2-s4
100
greater splanic
T5-T90
101
lesser splanchnic
T10-T12

ANESTHESIA : Hall (6 decks)

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