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Travis > IV Regional > Flashcards

IV Regional Flashcards

1
Q

IV regional anesthesia is done after injecting local where?

A

venous system of an extremity that has been exsanguinated by the compression and isolated from the central circulation via tourniquet.

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2
Q

True or false; IV regional blocks can be used as primary anesthesia?

A

True

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3
Q

What is the time limit for IV regional?

A

1 hour or less

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4
Q

Which has the greatest occurrence of complications, upper or lower extremity?

A

lower extremity

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5
Q

Upper extremity IV regional is best suited for which operations?

A

soft tissue operations such as ganglionectomies, CTR, Dupuytren’s contractures, reductions of fractures.

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6
Q

Manipulations of the ulnar, median, or radial nerves may require what in an addition to IV regional?

A

analgesics, sedation; usually a MAC or fentanyl/versed cases

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7
Q

Indications for lower extremity IV regional techniques

A

excision of masses, digital nerve repair, phalangeal fractures, navicular excisions, orthopedic procedures

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8
Q

Lower extremity IV regional techniques is associated with an increased risk of what?

A

compartment syndrome when treating tibial shaft fractures.

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9
Q

Relative contraindications to IV regional?

A

crush injuries, inability to locate PIV, local skin infections, cellulitis, compound fractures, allergy to LA, severe vascular injury, PVD, sickle cell disease

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10
Q

Only absolute contraindication to IV regional?

A

patient refusal

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11
Q

What is the equipment necessary to perform IV regional?

A

LA, 18-20g IV, standard monitoring, functioning IV access, two pneumatic tourniquets, esmarch bandage, syringe

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12
Q

First step in preparing patient for IV regional of upper extremity.

A

IV placement in hand or forearm (surgery on hand), Forearm or AC (if surgery on the elbow).

AC can be used if no access obtainable on hand (decreased effectiveness)

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13
Q

First step in preparing patient for IV regional of lower extremity.

A

IV in lower leg, foot or ankle for surgery on leg/foot

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14
Q

What could result in sickle cell disease?

A

acidosis, venous statis, sickle cell disease

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15
Q

Esmarch bandage is applied when?

A

prior to axillary artery occlusion

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16
Q

Which cuff is inflated first?

A

distal, then proximal

17
Q

Which cuff is deflated first?

A

distal; if pain inflate distal, deflate proximal

18
Q

If patient experiences tourniquet pain, waht should be the next action?

A

inflate distal, deflate proximal to cover TQ pain (will buy you 15-20 extra minutes)

19
Q

Axillary artery is occluded using what TQ pressure settings?

A

50-100mmHg above SBP (closer to 100 for LE)

20
Q

How many mLs of LA is infused in IV?

A

30-50mL

21
Q

LE requires how many mLs of LA?

A

100 mL

22
Q

What is the appropriate dosage for UE LA?

A

30-50 mL of 0.5% lidocaine (150-250mg);

12-15 mL of 2% lidocaine (24-30mg)

23
Q

What is appropriate dosages for LE LA?

A

50-100mL of 0.5% lidocaine (250-500mg)
15-30mL of 2% lidocaine (300-600mg)
MAX 300mg

24
Q

Other options for LA are available for IV regional?

A

Prilocaine 0.5% 40mL

25
Q

What are some additives of to IV regional LA?

A

Dexmedetomidine 0.5mcg/kg
muscle relaxants
Ketorolac 20-30mg (only drug that has showed any promise with blocks per Hadzic)

26
Q

What are some associated risks for IV regional?

A

excessive plasma concentrations, prilocaine = methemoglobin, ischemic pain from TQ

27
Q

Which block is associated with inadequate analgesia?

A

Lower; 100% incidence of local leakage under TQ

28
Q

TQ pain can result in what after 2 hours?

A

ischemic pain that results in HTN

29
Q

Use of procaine can result in what?

A

methemoglobinemia (occurs in about 4-8 hours after administration)

30
Q

Increased plasma concentrations of lidocaine are typically associated with what?

A

faulty tourniquet

31
Q

Increased plasma concentrations of lidocaine results in?

A

vasodilation, diminished cardiac contractility, hypotension

32
Q

There are typically no complications if TQ isn’t deflated for at least ____?

A

20 minutes

33
Q

TQ deflation is associated with what risk?

A

LAST; ranges from tinnitus to seizure and cardiovascular collapse

34
Q

It is not unusual for a patient to experience what symptoms?

A

tinnitus, light-headedness, metal taste in the mouth

35
Q

methods to decrease the risk of LAST?

A

transfer pt to PACU with clamped distal TQ if surgery is very short (shouldn’t be removed for 20 minutes) and deflate TQ in cyclic fashion, every 1-2 minutes, avoids one big LA washout

36
Q

Patients should be monitored for how long after deflation?

A

15 minutes

Travis (5 decks)

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