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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
Q

LOWEST CONC in the fetus relative to maternal serum

A

CHLOROPROCAINE

rapidly metabolized by paudocholinesterase
t1/2 45 seconds

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26
Q

HIGH SPINAL ANESTHESIA

A 
hypotension
sympathetic blockade 
venodilation(dec preload)
arterial dilation( dec afterload) 
brady ( cardioaccelerator fibers T1-T4 )
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27
Q

PHANTOM LIMB

A

80% after amputation
incidence increased with PROXIMAL
few days after sx
PNB decreased incidence

treatment:
opioids
antidepressants
gabapentin

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28
Q

IVRA

BIER BLOCK

A

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

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29
Q

Largest intervertebral space

A

L5-S1

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30
Q

SNS originated in the thoracic and lumbar spinal cord ?

A

T1-Lcan cause total sympathetic block

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31
Q

DURAL SAC ENDS

A

s1 upt to s2

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32
Q

spinal cord ends at

A

adult l1-L2

infant L3

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33
Q

4 stages of epidural abscess

A

1st - localized back pain
2nd - nerve root or radicular pain
3rd- motor or sensory deficit
4th pareplegia

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34
Q

entrapment of lateral femoral cutaneous nerve as it courses below the inguinal ligaments

A

MERALGIA PAREsthesia

associated
burnjng pain over rhe lateral aspect of the thigh
not a complication of epidura

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35
Q

COMPLEX REGIONAL PAIN SYNDROME

A

burning continous pain
not anatomically distributes

cool
red
clammy skin
HAIR LOSS 
associated atrophy and oateoporosis
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36
Q

NEUROLYTIC BLACKADE DIFFERENCE BETWEEN PHENOL AND ALCOHOL

A

phenol :
painless
dual action la and neurolytic agents

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37
Q

how luch LA SHOULD be administered by spinal segment

A

1-2mlsegment
(20-40 years old

elderly and preg
0.75-1.5ml/ segment

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38
Q

spread of LA ANESTHETICS PER EPIDURAL ___ secondary to___

A

2/3 spread cephalad
1/3 spread caudally

until level of T4

secondary to
INTRATHORACIC NEGATIVE PRESSURE

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39
Q

Artery of Adamkiewicz arises fromt he aorta at which spinal level

A

radicularis magna

T9-T12

ASA( anterior spinal artery ) - anterior 2/3 SC

posterior 1/3 SC - posterior Spinal artery

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40
Q

damage to this artery can lead to ischemia for the lower 2/3 SC. an cause paraplegia

A

artery of adamkiewicz

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41
Q

Sciatic nerve block landmarks

A

PSIS
GREATER TROCHANTER OF FEMUR
Sacral HIATUS

42
Q

DEEP CERVICAL PLEXUS BLOCK

A

c234

for carotid endarterectomy

43
Q

complication of DEEP CERVICAL PLEXUS

A 
injection
vertebral artey
subarachnoid space
epidural space
phrenic nerve
hornera syndrome 
recurrent laryngeal nerve
44
Q

retro ulbar block what nerve

A

346

ciliqry ganglion and nerve

45
Q

all of the muscle of the larynx is innervates by the _____ except

A

RLN

CRicothyroid muscle - external SLN

46
Q

STELATE GANGLION

A

lies in fromt of the neck of the first rib

vertebral artery lies andyerior to the ganglion

47
Q

sharp pain during insertion of epidural catheter means

A

its in the nerve root

pull out and reinset

because if you push LA Caude compression of the nerve&raquo_space; ischemia

48
Q

five nerve that innervate the ankle and foot

A 
post tibial
superficial peroneal
deep peroneal
saphenous nerve 
sura
49
Q

innervate the medial and ateral plantar nerve

plantar surface of the foot

A

post tibial nerve

50
Q

CVS:CNS RATIO

A

lowest to highest

bupivacaine 2
levobupi 2
ropi 2 
prilocaine 3
procaine chlorprocaine 3-7 
etidocaine 4.4
lidocaine mepivavaine 7..2
51
Q

phantom limb pt acn received regional anesthesia

A

NO IT CAN CAUSE REACTIvation of the sendation

GA

52
Q

complete bilateral transection of the RLN

A

Vocal cords at the kntermediate position 2-3mm away

53
Q

partial bilateral paralysis of the RLN

A

complete airway obstruction

54
Q

PDPH

A

loss of CSF + posture component

head is elevated - HA severe

diplopia
nausea and vomiting
ha frontala nd occipial

onset 12-24hrs

55
Q

INTERcostal STRUCTURES

CEPHALAD TO CAUDAL

A

VAN

56
Q

Greatest concentration absortion

A

ICE BFS

intercostal
caudal epodurala
lumbar epidural

brachial
femoral
subq

57
Q

LA are base

A

WEAK BASE

58
Q

supraclavicular block can cause

A

pneumothorax
phrenic nerve

ci: respiratory dse

59
Q

FEMORAL NERVE

A

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
Q

Obturator nerve block needle placement

A

1-2 cm lateral to and 1-2 cm below the pubic tubercle

61
Q

the most SERIOUS COMPLICATION OF SUPRCLAVICULAR BLOCK

A

pnuemothorax

62
Q

the most COMMON COMPLICATION OF SUPRCLAVICULAR BLOCK

A

phrenic nerve block

63
Q

ipsilateral ptosis
miosis
anhidrosis

A

HOTNERS SYNDROME

64
Q

brachial plexus innervates the sensory of the arm except

A

shoulder - supraclavicular nerve of the cervical plexus

posterior medial aspect of the arm - intercostobrachial nerve

65
Q

brachial plexus sections

A

roots trunk- interscalene

trunk-division- supreclabicular

cord- infraclavicular

braches - axillary

66
Q

CELIAC PLEXUS

A 
lower esophagus
stomach
small intestines
large intestine splenic flexure
pancreas
liver
biliary tract spleen kidneys 
adrenal glands 
omentum
67
Q

HYPOGASTRIC PLEXUS -

A 
pelvic organ
uterus
ovaries
prostate
distal colon
68
Q

GREAT TOE IS INNERVATED BY

A 
posterior tibial
deep peroneal
superficial peroneal
post tibial
saphenous
69
Q

TENS produec analgesia bu

A

releasing endogenous endorphins

inhibitory effect at the sc
augments the inhibitory pathways

70
Q

dermatome of the fingers?

A

c6- thumb
c7 - 2nd and middle
c8 - 4th and little

71
Q

neurolytic nerve block
duration of action
alcohol?
phenol?

A

alcohol 3-6 months
phenol 2-3 months

never permanent

72
Q

TNS is not affected by

A 
baricity
conc
addtion of epinephrine 
dextrose
hypotension
73
Q

ULTRASOUND :
high freq
lower freq

A

high - lower stucture

low for - deeper stucture

74
Q

PDPH INCREASED incidence

A

younger
women
pregnant
large needle

75
Q

VISCERAL PAIN

A

transmitted by sympathetic nervous system
unmyelinated c fibers

dull aching and burning

76
Q

PSOAS COMPARTMENT BLOCK

A

posterior lumbar plexus

for proximal aspect of the thigh and hips

+sciatic block = complete leg block

77
Q

sensory innervation of the MEDIAL ASPECT OF THE LOWER LEG

A

saphenous nerve

78
Q

most common complication of celiac plexus block

A

hypotensio

79
Q

occipit receive sensory innervation from

A

lesser and greater ocipinal nervce (c2-c3)

from the cervical plexus

80
Q

thoracic paravertebral blocks are used for

A

postoperative analgesia for breast, axillary or chest wall rigidity surgery

81
Q

thoracic paravertebral blocks

most common complication

A

pneumothorax

82
Q

intrathecal injection of large dose LA will cause

A

HYPOTENSION
symphathetic fiber
t1-L2

BRADYCARDIA
cardiac accelerator
T1-T4

RESPIRATORY ARREST
phrenic nerve
C3-C5

dilated pupils

83
Q

CENTRAL PAIN

A

encephalization
psychogenic pain
malingering

84
Q

metabolites of ester LA RESponsible for allergic reaction

A

PABA

85
Q

MYELINATEF NERVE

A

suscrptible to LA

86
Q

Complete anesthesia for shoulder arthroscopy

A

interscalene and SUPERFICIAL CERVICAL BLOCK

87
Q

when to stop LMWH prior ti PNB

A

low doses at 10-12 hrs

hig doses 24 hrs

88
Q

NA BICARBONATE + LA

A

hasten onset
decrease pain with infiltration
dec durationof PNB

89
Q

DURATION OF LA

A

SHORT
procain an dchloroprocaine

INTErMEDIATE
lidocaine
mepivacaine
prilocaine

LONG
etidocaine
bupivacaine
levo bupi
tetracaune 
rooivacaine
90
Q

TAP BLOCK

A

abdominal wall analgesia

subcostal T12
illioinguinal L1
hypogastruc L1

injection is between the internal oblique and TA MUSCLE

91
Q

POSTERIOR TIBIAL NERVE

A

flexion of the toes

sensory of the plantar foot

92
Q

S FORM OF ROPIVACAINE

A

reduced cardiac and nephro toxicity

93
Q

LUMBAR PLEXUS

A

L1-2 genitofemoral
L2-3 femoral cutaneous
L2-4 obturator, femoral

sciatic
L4 ( lumbar plexus)+ L4-s3 ( scral plexus)

94
Q

LAST AVOID THE USE OF

A

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
Q

Pain nerve fiber

A

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
Q

prilocaine causes formation of

A

Methemoglobin

97
Q

PDPH

ETIOLOGY

A

dec csf pressure&raquo_space; tension meningeal vessels and nerves

98
Q

treatment for neuropathic pain

selective inhibitionof serotonin and NE REUPTAKE

A

DULOXETINE

99
Q

pudendal nerve

A

s2-s4

100
Q

greater splanic

A

T5-T90

101
Q

lesser splanchnic

A

T10-T12

ANESTHESIA : Hall (6 decks)

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