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exam 2 Flashcards

1
Q

eye procedures

NEVER insert more than ___ inch

use a ________ needle

A

1 inch

blunt needle

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2
Q

eye surgery
true or false

GA should always be available
Always have a clinician (eye surgeon) available when block is being performed!

it CAN be the sole anesthetic

A

true

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3
Q

topical is _______ only

NO akinesia

A

sensory

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4
Q

LA applied outside/adjacent/posterior vault of cone + around the sclera

Tenon capsule is fascial layer that encapsulates the sclera, it produces a “container” for the block
(similar to TAP) block

A

sub-tenon

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5
Q

eye
Sensory (analgesia) + akinesia (with LARGE doses)

A

sub-tenon

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6
Q

eye
sensory only

A

topical

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7
Q

eye
Sensory (analgesia) + akinesia (must be done on BOTH sides)

A

peri-bulbar

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8
Q

eye
Sensory (analgesia) + akinesia/motor

A

retro-bulbar

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9
Q

true or false

PERI-bulbar is SAFER and MORE common

A

true

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10
Q

what direction should needle go with PERIbulbar block
when advancing through CONJUNCTIVA

________, ________

A

inferior, lateral

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11
Q

peri-bulbar

R eye = ___-___ o clock
L eye = ___-___ o clock

A

R = 4-5
L = 7-8

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12
Q

what direction should needle go with PERIbulbar block
UNTIL THE MIDPOINT of eye (halfway)
_________ direction

A

caudal/posterior

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13
Q

eye
LA deposited directly posterior to the globe (muscle cone space)

A

retro-bulbar

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14
Q

what 5 nerves does RETRO-bulbar block*

A

CN 3-7

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15
Q

eye
have patient look at the ________

A

needle
or
straight ahead

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16
Q

retro-bulbar

1st: __________ approach
2nd: _________ approach
3rd: once halfway, ___________ approach

A

1st: inferior/caudal/downward

2nd: parallel

3rd: superior, once halfway

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17
Q

eye
which block do you use a smaller volume due to risk for compartment syndrome

A

retro-bulbar

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18
Q

4 complications of eye blocks

A

IV injection (seizure)
hemorhagic injury
globe injury
vagal (bradycardia)

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19
Q

true or false

airway block requires combo of 3 blocks

A

true

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20
Q

what are 4 adjunct drugs for airway blocks

A

antisialagogue

aspiration prophylaxis
(non-particulate + reglan)

anxiolysis

amnesia

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21
Q

indication for airway block

A

difficult airway

burn, contracture, spondylitis

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22
Q

most superficial airway nerve

A

glossopharyngeal (CN 9)

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23
Q

3 areas of sensation for glossopharyngeal (CN 9)

A

1) posterior tongue

2) pharynx

3) portions of soft palate + epiglottis

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24
Q

3 areas of innervation for SUPERIOR laryngeal nerve*

A

1) larynx

2) POSTERIOR epiglottis

3) cricothyroid muscle

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25
Q

3 areas of innervation for RECURRENT laryngeal nerve*

A

1) BELOW vocal cords

2) muscles of larynx (except cricothyroid)

3) deep to the trachea

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26
Q

SUPERIOR laryngeal nerve

identify _______ bone

inject ________ and __________ to the most lateral portion of bone

A

hyoid bone

lateral, inferior

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27
Q

RECURRENT laryngeal

use a _____________ injection through the _______________ membrane

A

trans-tracheal injection

through the cricothyroid membrane

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28
Q

best formulation for LA topical

A

paste

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29
Q

true or false

airway
giving ONLY topical LA for airway is NOT sufficient for scope down the throat

A

true

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30
Q

digital block

2 nerves lie to the _________/_________ side

A

ventral/forward side

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31
Q

2 types of approaches for digital block

A

bilateral injections

trans-thecal (single injection into callous/flexor sheath )

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32
Q

ligaments run ____________/________

A

longitudinal/vertical

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33
Q

connects
transverse process + spinous process*

A

lamina

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34
Q

connects transverse process + vertebral body*

A

pedicle

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35
Q

intrathecal/subdural =

A

spinal block

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36
Q

what type of approach should you use for THORACIC

A

paramedian

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37
Q

what type of ANGLE should you use for THORACIC

A

cephalad (toward the head)

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38
Q

true or false

termination of the spinal cord is NOT abrupt

A

true

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39
Q

epidural space is located where

A

posterior to the dura
anterior to the ligamentum flavum

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40
Q

epidural space is ___cm deep

for MIDLINE approach only

A

5cm deep
do not go deeper!

L&D is deeper

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41
Q

epidural space*

widest = __________
narrow = ___________

A

widest = posterior/midline

narrow = anterior/inward

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42
Q

INWARD curvature

A

lordosis

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43
Q

where is lordosis located

A

cervical
lumbar

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44
Q

OUTWARD curvature

A

kyphosis

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45
Q

where is kyphosis located

A

thoracic

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46
Q

kyphosis results in _________ leaning position

A

forward-leaning

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47
Q

lordosis results in __________-direct spine

A

posterior-directed

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48
Q

how should a person sit for lumbar placement

A

kyphosis (opposite of normal)

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49
Q

true or false
PALPATION of landmarks should occur PRIOR to site preparation/cleaning

A

true

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50
Q

CONTRAindications to central blocks

A

neuromuscular dx
(MS, MG, increased ICP)

cardiac frailty

unable to tolerate

aortic valve stenosis, HOCM, IHSS

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51
Q

3 types of patients that should NOT receive central block

this is due to dependence on SVR

A

aortic valve stenosis

hypertrophic obstructive cardiomyopathy (HOCM)

idiopathic hypertrophic subaortic stenosis (IHSS)

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52
Q

true or false

CPR will NOT be effective with patients with HOCM, IHSS, aortic valve stenosis

A

true

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53
Q

true or false

with coagulopathy, NO standard is recognized

54
Q

cause of total spinal

A

injected medications block nerves high into the thoracic or even cervical levels

55
Q

symptoms of total spinal

A

PNS symptoms

brady,
hypotension,
vascular collapse/dilation
apnea
loss of motor function
loss of consciousness
loss of airway

56
Q

3 symptoms of horner syndrome

A
  1. Ptosis
  2. Miosis
  3. Anhidrosis
57
Q

post dural “spinal” headache is a result of a _______ puncture

A

dural puncture

58
Q

___-___% of spinals cause post-dural headaches

59
Q

post-dural headache:

by laying supine, the CSF pressure _________, this relieves the stretching

A

CSF pressure increases

60
Q

2nd line treatment for postdural headache

injection into __________ space with blood

A

epidural space

61
Q

____ml blood patch, treatment is ___% successful

A

20 ml

90% successful

62
Q

dermatome
lateral portion of upper arm

63
Q

dermatome
prominent cervical spinous process

64
Q

dermatome
superior angle of the scapula and sternal notch

65
Q

dermatome
plane of Ludwig; carina; angle of Louis

66
Q

dermatome
base of the scapulae

67
Q

dermatome
xiphoid

68
Q

dermatome
umbilicus

69
Q

dermatome
lateral portion of UPPER leg

70
Q

dermatome
MIDDLE portion of leg

71
Q

dermatome
superior aspect of the iliac crests

72
Q

dermatome
lateral portion of LOWER leg

73
Q

motor blockade = ___ fiber

74
Q

sensory blockade = ___ fiber

75
Q

autonomic/sympathetic blockade = ___ fiber

76
Q

easiest to block

A

autonomic/sympathetic

B fiber

77
Q

hardest to block

A

motor blockade = A fiber

78
Q

which blockade goes the furthest out

A

autonomic/sympathetic (B fiber)

79
Q

Blocking ___ means it is a very dense block

80
Q

what is usually identified first

81
Q

device

ALLOWS for needle angle adjustment

and multi-directional adjustments

3D

slower

A

task-specific (Accuro)

82
Q

device

does NOT allow for needle angle adjustment

DOES allow for depth of needle evaluation

A

standard ultrasound

83
Q

true or false

NEITHER device is set up for real time/live needle manipulation under ultrasound

84
Q

type of needle for SPINAL

A

non-cutting needles

“pencil point tips”
cone-shaped tips

85
Q

gauge for SPINAL needles

86
Q

common length SPINAL needle

A

3.5in or 9cm

87
Q

true or false

baricity is ONLY applicable to SPINAL**

88
Q

hyperbaric =

A

downward

dextrose

89
Q

hypobaric =

A

upward

sterile water

90
Q

4 biggest factors for affecting spread of SPINAL anesthesia

A

baricity

gravity/positioning

drug DOSE**

site of injection

91
Q

NARROW spine = _____ effect

A

narrow = LESS effect

92
Q

topical lidocaine for spinal

93
Q

spinal

needle should be _________ or ____________

A

cephalad
or
horizontal

94
Q

treatment for sympathectomy

A

volume challenge PRE-treatment

pressors

95
Q

cardioaccelerator blockade

T__-T___

96
Q

cardioaccelerator blockade
treatment

A

volume loading BEFOREhand (1-2 L)

97
Q

spinal is ___% of epidural dose

98
Q

bupivacaine dose

___% in _____% dextrose

A

.75% in 8.25% dextrose

99
Q

bupivacaine
___-___ mg for
perineum, lower limbs

100
Q

bupivacaine
___-___ mg for
lower abdomen

101
Q

bupivacaine
___-___ mg for
upper abdomen

102
Q

bupivacaine ALONE duration

A

1.5-2 hours

103
Q

bupivacaine + epi duration

A

1.5-2.5 hours

104
Q

fentanyl dose

A

10-25 mcg TOTAL

1-2 hour duration

105
Q

epi dose

A

100-200 mcg TOTAL

106
Q

true or false

you CAN create a motor blockade with epidural

107
Q

what type of needle is used for EPIDURAL

A

touhy
“blunted AND curved”

108
Q

true or false

epidural: needle should remain shallow/PROXIMAL to the dura

109
Q

needle GAUGE for epidural

110
Q

epidural
catheter advancement through needle should be ___-___cm

111
Q

how do you know you are in the epidural space

A

loss of resistance

hanging drop

112
Q

hanging drop uses _______

113
Q

what is a risk with hanging drop with epidurals

A

dural puncture

114
Q

true or false

the NEEDLE must be removed 1st,
then the catheter

115
Q

test dosing occurs with epidural

this is
___ml lidocaine,
__% lidocaine,
1:_________ epi or ___mcg epi

A

3ml lidocaine
1.5%

1:200,000 or 15 mcg epi

116
Q

what effects SPREAD**

117
Q

what effects DENSITY/FIBER TYPES**

A

concentration

118
Q

1 ml per dermatome

how many MLs would you need for T10-S5

119
Q

true or false

Re-dosing of a catheter does NOT require an additional test dose, but should always be aspirated first

120
Q

true or false

gravity effects density

121
Q

if catheter is stuck upon removal, what should you do

A

reposition the patient

122
Q

true or false

anticoagulation rules apply to catheter removal just as they do to catheter reinsertion

123
Q

what is more dangerous, spinal or epidural

124
Q

true or false

caudal blocks are for peds and are NOT the sole anesthetic

125
Q

caudal block is functionally the same as the __________ block

A

epidural block

126
Q

caudal block

approach the space through the ________ ________

A

sacral hiatus

127
Q

caudal block

sacral _______ = lateral
sacral _______ = center

A

cornua = lateral

hiatus = center

128
Q

caudal block

____ gauge
____ degree angle CEPHALAD

A

22 gauge
45 degree angle

129
Q

caudal block
dose per kg

____-___ml/kg

A

0.5-1 ml/kg

130
Q

what needle length for retrobulbar block

131
Q

toughy needle should be pointed ____

regional/OB (4 decks)

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