Exam II: Specialty Flashcards
While topical anesthesia may be sufficient for certain eye procedures, the necessity of ___ of the extraocular muscles and eye lid may necessitate further anesthesia.
motionlessness (akinesia)
Avoiding general anesthesia may be valuable in certain scenarios therefore demonstrating the value of a regional technique to accomplish ___ and ___ ___ of the eye structures.
sensory, motor blockade
Knowledge of ___, surgeon preference, and ___ is important for deciding on the approach for ophthalmic anesthesia.
surgical field requirements, risk-benefit analysis
Toleration of the placement of the block and ability to tolerate the surgery using ___anesthesia should be considered.
regional
The use of sedation may result in satisfactory anxiolysis, but ___ ___should always be available, and caution is warranted when patients are at risk for airway support.
general anesthesia
The necessity of ___ ___may be affected by manipulation of the airway in the presence of sedation, such as patients with sleep apnea.
eye akinesia
One method of ___ is the application of local anesthetics to the surface of the eye.
analgesia
For many procedures, this (application of LA to eye surface) is adequate with or without ___.
sedation
Absence of ___ ___and speed of delivery make this very popular.
[Topical]
invasive injections
An application of ___ ___ is generally adequate for short procedures.
[Topical]
2% lidocaine
The ___or compartment ____ to the eye is the target of some blockades, but depositing local anesthetics outside of the cone adjacent to the cone and around the sclera can be a less invasive and adequate source of analgesia and in sufficient volumes, produce ____.
cone, posterior, akinesia
One example is the Sub-Tenon block where a specific cannula is introduced just ____ to the sclera and allowed to track ___.
external, posteriorly
The tenon capsule is a fascial layer that encapsulates the ___and produces the ____ for the Sub-Tenon block.
sclera, “container”
__-__ml is allowed to fill the space.
[Sub-Tenon]
3-5
As opposed to entry into the posterior vault/ cone, ___blocks deposit the LA into the tissue around the eye.
peri-bulbar
This decreases the chance that it fully covers all ___ muscles; owing to the partitions created ___ around the eye.
[Peri-bulbar]
extraocular, circumferentially
Larger volumes___ may be used or additional injections into the non-anesthetized quadrant can be completed to achieve akinesia.
[Peri-bulbar]
5-8ml
These blocks are achieved by similar approach to the retrobulbar in that an___ ___ 4-5 o’clock position for right eye or 7-8 o’clock for the left eye is used to advance through the conjunctiva
[Per-bulbar]
inferior lateral
A ___ direction is used until the mid-point of the globe is reached and then injection is given.
[Peri-bulbar]
caudal
This approach decreases the chance of ___ and ___compartment trauma, but increases the chance of failed akinesia on first injection.
[Peri-bulbar]
globe, posterior
A combination of ___ ___ and ___ ___ injections may produce desirable affect.
[Peri-bulbar]
superior lateral, inferior lateral
The retrobulbar block and several similar injection techniques, are accomplished through the injection of LA into the compartment directly ___ to the globe of the eye (muscle cone/ retrobulbar space).
posterior
Concurrent blockade of cranial nerves ___, ___, ___, ____, ___ accomplish the desired sensory and motor effects as the LA diffuses into the compartment nerves.
III, IV, V, VI, VII
The procedure is accomplished by injection of LA ___of ___% preservative free lidocaine after topical skin cleansing.
[Retrobulbar]
2-4ml , 1-2
___ may be administered prior to the block
[Retrobulbar]
Anxiolysis
___ may be administered prior to the block
[Retrobulbar]
Anxiolysis
Topical LA in the ___ is effective prior to injection
[Retrobulbar]
conjunctiva
The use of a ___ needle is ideal as this prevents over-insertion.
[Retrobulbar]
1”
Use of a block needle with ___ tip may also reduce traumatic effects.
[Retrobulbar]
blunted
Needle depth should be to a maximum of ___.
[Retrobulbar]
1”
Use of a blunt needle is preferred to a ___ needle
[Retrobulbar]
sharp
Finally needle angle should be initially ___, then ___ to the globe and only directed superiorly after passing the midpoint of the globe (~1/2”).
[Retrobulbar]
downward, parallel
Further, the patient should be directed to maintain gaze straight ahead or ideally toward the ___ such that the posterior structures of the eye are moved away from the needle’s path.
[Retrobulbar]
needle
Complications that can arise from these blocks include the following: ___causing seizures, ___ injury to posterior vasculature, ___injury, and significant ___ simulation.
[Retrobulbar]
Intravascular injection, hemorrhagic, globe, vagal
Particularly___ mediated bradycardia after the block should be anticipated and prepared for.
[Retrobulbar]
vagal
A clinician competent in ___ of the eye should be available when blocks are being performed.
[Retrobulbar]
decompression
Monitoring should be ___ to all other anesthetics.
[Retrobulbar]
equivalent
Primarily used to facilitate an ___ ___without sedation, regional techniques of the airway often require a ___ of blocks to sufficiently anesthetize the structures necessary to tolerate an intubation, classically by fiberoptic scope.
[Airway blocks]
awake intubation, combination
Regardless of the airway tool(s) used, the ___, upper airway, and ___must be considered.
[Airway blocks]
tongue, vocal cords
Glossopharyngeal nerve- (CN 9) controls sensation to the ___, ___, ___, ___.
posterior tongue, pharynx, portions of the soft palate and the epiglottis.
This nerve is blocked through bilateral injection of LA (2ml of plain 1-2% lidocaine at the ____).
[CN-IX]
base of each tonsillar pillar
Alternatively, various forms of sprayed LA (topical benzocaine “Hurricane/ Cetacaine” Spray or atomized/ nebulized lidocaine) can be aerosolized into the ___ and ___.
oral cavity, posterior pharynx
Superior laryngeal nerve- Derived from the Vagus (CN-10) innervates the ___ and ___ and controls the ____.
larynx and posterior epiglottis, cricothyroid muscle
The SLN can be blocked by identifying the ___ bone and inject 2ml of lidocaine laterally and inferiorly to the most lateral portion.
hyoid
Recurrent laryngeal nerve- controls sensation below the ___ and ___except the ___ muscle.
vocal cords and muscles of the larynx, cricothyroid
This nerve can be blocked by using a ___-___injection through the cricothyroid membrane.
[RLN]
trans-tracheal
An IV catheter is placed into the space, aspirating to confirm air, then ___ml of ___% lidocaine is injected to produce a cough and aerosolization of the LA onto the cords and adjacent structures.
[RLN]
2-3, 4
Topical anesthesia can be provided through: (3).
nebulized LA, sprayed, or atomized formulations
Typically, ___ is used.
[Airway]
lidocaine
Caution in toxic doses should be considered in relation to ___.
volume
Because of the ease of nebulizing 4% lidocaine, it is often used to achieve a ___block, but ___ in the tracheal sites warrants careful attention to subsequent dosing respect to maximums.
fast, speed of uptake
A key concept is ensuring all structures to be ___are addressed.
manipulated
For example, if a nasal approach is used, additional topical should be applied by ___, ___ or ___supplement the oral cavity.
cotton swab, nebulizer, or atomizer to
___ drugs for antisialagogue, aspiration prophylaxis, anxiolysis, and amnesia are usually helpful.
Adjunct
Two nerves lie on either side of the finger, more to the ___side.
ventral
Bilateral injections of ___ml is sufficient to provide blockage. [Digital Block]
2
Lidocaine will function for ___hours while bupivacaine will last for as long as ___hours.
1-3, 12
___ should not be added to digital blocks to reduce the risk of vascular ischemia.
Epinephrine
A single injection along the ___ sheath identified by the “callous” in the palm of the hand.
flexor
___ml injected here is possible for a bilateral block.
[Digital Block]
2
