Exam 1 Spinal & Epidural Neuraxial Anesthesia [6/03/24] Flashcards
What is the preservative found in Amide LA’s?
Methylparaben
True or False:
If someone has an ester allergy, they will most likely have an amide allergy?
False
There is no cross-sensitivity between esters and amides.
What two components of a LA determine its onset of action?
- pKa
- Concentration
What component of a LA determines its potency?
Lipid solubility
The protein binding % of a LA determines its ___.
Duration of Action
Factors Influencing Vascular Uptake and Plasma Concentration of Local Anesthetics include:
STAMP
Site of Injection
Tissue Blood Flow
Addition of Vasoconstrictor
Metabolism
Physiochemical Properties
Which LA do we NOT want to use in a Bier Block?
Bupivicaine
Which type of LA baracity is good for Hip Replacements per Dr. Tubog?
Isobaric
List examples of Hyperbaric LA solutions:
Bupivicaine 0.75% in 8.25% Dextrose
Lidocaine 5% in 7.5% Dextrose
Tetracaine 0.5% in 5% Dextrose
Procaine 10% in water
What is the baracity of Bupivicaine 0.3% in water?
Hypobaric
The 4 isobaric solutions listed in class are all mixed with what additive?
Saline
What is the only LA mixture (per the powerpoint slides) that is combined with water but is not a hypobaric solution?
Procaine 10% in water = Hyperbaric
High and Low (Peak and Trough) dermatome points in a SAB?
High: C3 and L3
Low: T6 and S2
SAB Dosing Table
In an epidural, while ensuring incremental dosing of 5 mls, we should be avoiding these 3 negative outcomes.
- Accidental “High Spinal”
- Hypotension from Rapid autonomic blockade
- LAST
Most common concentration of 2-Chloroprocaine for surgical anesthesia?
Why is this important?
3%
Higher concentration = faster onset
Adding NaHCO3 increases these 4 things:
- pH of LA
- Concentration of Non-ionized form
- Rate of diffusion
- Speed of the onset of the block
Alkalinization
The ___ of the LA is crucial for determining how high the anesthetic block reaches.
Volume
What is the initial dose of an epidural?
What about the top-up dose?
Initial: 1-2 ml/segment
Top-Up: 50-75% of initial dose
What aspect of a LA determines how strong/dense the block is?
Concentration
What are some positive outcomes to adding adjuncts to neuraxial anesthesia?
- Postoperative Analgesia
- Extends Duration
- Improves the density of the block
Which of the following drugs has been PROVEN to be the safest adjunct for neuraxial anesthesia?
A. Neostigmine
B. Ketamine
C. Versed
D. Clonidine
E. Magnesium
D. Clonidine
Rationale:
All of the other drugs are still listed as “Investigative agents” and need to be further studied in order to be validated.