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SRNA3Regional > Equipment for Regional > Flashcards

Equipment for Regional Flashcards

1
Q

Provision for proper

A

monitoring, oxygen, equipment for emergency airway management and positive-pressure ventilation, and

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2
Q

is of paramount importance

A

access to emergency drugs

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3
Q

The anesthesia cart

A

should also be well stocked with all equipment necessary to perform

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4
Q

PNBs effectively, safely, and efficiently. Supplies such as needles and catheters of

A

various sizes, local anesthetics, and emergency airway and resuscitation equipment should also be included

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5
Q

Local anesthetic toxicity due to intravascular injection or rapid absorption into systemic circulation is a

A

relatively uncommon but potentially life-threatening complication of regional anesthesia.

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6
Q

Premedication often necessary before many regional anesthesia procedures, may result in

A

respiratory depression, hypoventilation, and hypoxia

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7
Q

The risk of the local anesthetic

toxicity has a biphasic pattern and should be anticipated

A

(1) during and immediately after the injection and (2) 10 to 30 minutes after the injection.

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8
Q

Signs and symptoms of toxicity occurring during or shortly after the completion of the injection are due to an

A

intravascular injection or channeling of local anesthetics to the systemic circulation (1–2 minutes).

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9
Q

In the absence of an intravascular injection, the typical absorption rate of local anesthetics after injection peaks at approximately

A

10 to 30 minutes

after performance of a PNB;

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10
Q

local anesthetics after injection peaks at approximately 30 mns , therefore patients should be

A

continuously and closely monitored for at least 30 minutes for signs of local anesthetic toxicity

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11
Q

Routine monitoring during administration of nerve blocks:

A 
 Mental Status (Of the patient!)
 Pulse Oximetry
 Non-Invasive Blood Pressure
 Electrocardiogram
 Respiratory Rate
 Set-up should be clean and comfortable for all, including the anesthesia provider.
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12
Q

Choice of needle depends on

A

the block being performed, the size of the

patient, and preference of the clinician.

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13
Q

Long needles have a greater risk of causing injury

A

due to increased difficulty in their handling and possibility of being inserted too deeply.

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14
Q

Have greater risk of injury

A

Long needles

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15
Q

US and needle

A

needle length is often longer by 2 to 3 cm for ultrasound guided blocks because needles are inserted further from the target to visualize the course of the needle on the image.

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16
Q

Needles should have

A

depth markings on their shaft to allow monitoring for the depth of placement at all times.

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17
Q

Cervical plexus block needle size

A

2 in (50mm)

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18
Q

Interscalene brachial pl block needle size

A

1-2in (25-50mm)

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19
Q

Infraclavicular brachial plexus block needle size

A

100mm (4in)

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20
Q

Axillay nerve block needle size

A

1-2in (25-50mm)

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21
Q

Thoracic paravertebral block needle size

A

90mm (3.5-4in)

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22
Q

Lumbar paravertebral, and lumbar plxus block needle size

A

100mm (4in)

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23
Q

Sciatic block posterior approach needle size

A

100mm (4in)

24
Q

Sciatic block anterior approach needle size

A

150mm

25
Q

Femoral block needle size

A

50 (mm)

26
Q

Popliteal block posterior approach needle size

A

50 mm

27
Q

Popliteal block anterior approach needle size

A

150mm

28
Q

Atropine dose

A

0.2-0.4

29
Q

Ephedrine dose

A

5-10mg

30
Q

Phenylephedrine

A

50-200mcg

31
Q

Epinephrine

A

10-100mcg

32
Q

Midazolam

A

2.0-10mg

33
Q

Propofol

A

30-200mg

34
Q

Succ

A

20-80mg IV

35
Q

Intralipid Emulsion

A

105ml IV F/b 0.25ml/kg/min infusion at 400ml ovr 10min

36
Q

Studies have recently demonstrated the correlation between larger needle gauge and

A

increasing levels of nerve damage after intentional nerve perforation in a porcine model.

37
Q

The needles of smaller caliber however, may also be more likely

A

to penetrate the fascicles.

38
Q

In addition, needles of smaller gauges have more internal

resistance,

A

making it more difficult to gauge injection resistance and aspirate blood.

39
Q

Long vs Short needles injection internal resistance

A

smaller needles

40
Q

Needles of very small size (25 and 26 gauge) are most commonly used for

A

superficial and field blocks.

41
Q

Larger gauge needles (20–22 gauge) may be used in

A

deeper blocks to avoid bending of the shaft and to maintain better control over the needle path.

42
Q

17-19 gauge Toughy needles are most commonly used with

an 18- gauge catheter for

A

continuous catheters

43
Q

is one of the more challenging aspects of

performing an ultrasound-guided PNB.

A

Visualization of the needle tip

44
Q

Nerve stimulation has been a cornerstone of

A

peripheral nerve blocks for decades.

45
Q

Understanding how nerve stimulators and why it works will probably

A

increase your success rates and decrease complications.

46
Q

DUAL technique

A

Nerve stimulation should always be used in conjunction with ultrasoundfor best results!

47
Q

HYPERECHOIC NEEDLE

A

Dimples tip for visibility

48
Q

DUAL TECHNIQUE: Not simply from a nerve localization perspective, but as a means of

A

affording one medical legal protection, and more effectively describing the needle to nerve distance at the time of injection.

49
Q

The current intensity used is usually from

The duration of the current is usually

A 
0.2- 1 mA (milliam
100 msec (milliseconds)p).
50
Q

Normally, we try to elicit a nerve response at higher intensities, then dial-down to maintain the twitch. If we loose the twitch at higher amperage,

A

we are not in the correct place. Manipulation of the needle tip is needed to redirect to closer to the target.

51
Q

(c-fibers), and therefore require

A

less current to stimulate them.

52
Q

As a clear, accurate image of the target is acquired via ultrasound,

A

A stimulating needle is placed and viewed approaching the target. It is at this point we begin to see the benefits of the dual technique.

53
Q

If the current is too high, a

A

“muscle twitch” may be elicited. This is different

than a “nerve twitch”

54
Q

Dual technique summary

A

As a clear, accurate image of the target is acquired via ultrasound, a stimulating needle is placed and viewed approaching the target. It is at this point we begin to see the benefits of the dual technique. If the current is too high, a “muscle twitch” may be elicited. This is different than a “nerve twitch”.

Large alpha (motor) fibers have lower chronaxies than do sensory fibers
(c-fibers), and therefore require less current to stimulate them. This
means that a motor response can be elicited without the transmission of
pain. Also this means that its important to keep initial power intensities
low when performing stimulator techniques.

55
Q

Femoral block

A

Patellar twitch

56
Q

Interscalene block you look for

A

deltoid switch

SRNA3Regional (17 decks)

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