Local Anesthetics and Regional Anesthesia

Question 1

Local anesthetics prevent depolarization of nerve by blocking _____

Answer 1

influx of NA, blocks fast NA channels

Question 2

Which fibers are blocked easier by local anesthetics?

Answer 2

small fibers

Question 3

Order of a Block:

Answer 3

B fibers
C
A-
delta, gamma, beta, alpha

Question 4

Two types of locals:

Answer 4

esters and amides

Question 5

Amides are cleared by reaction in ______

Answer 5

liver

Question 6

Esters are broken down by ______

Answer 6

plasma cholinesterase

Question 7

Types of esters for infiltration

Answer 7

procaine (novacaine)
cholorprocaine (Nesacaine)
tetracaine (pontocaine)

Question 8

Max plain dose of procaine (novacaine)

Answer 8

350-600 mg

Question 9

max with epinephrine dose of chloroprocaine (nescaine)

Answer 9

1000 mg

Question 9

Max with epinephrine dose of procaine (novacaine)

Answer 9

1000 mg

Question 9

Max plain dose of chloroprocaine (nesacaine)

Answer 9

800 mg

Question 9

other name for procaine

Answer 9

novacaine

Question 9

other name for lidocaine

Answer 9

xylocaine

Question 9

other name for tetracaine

Answer 9

pontocaine

Question 10

other name for chloroprocaine

Answer 10

nesacaine

Question 10

max plain dose of tetracaine

Answer 10

100 mg

Question 10

types of amides

Answer 10

lidocaine (xylocaine)
mepivacaine (carbocaine)
bupivicaine (marcaine)

Question 11

other name for mepivacaine

Answer 11

carbocaine

Question 12

other name for bupivicaine

Answer 12

marcaine

Question 13

Lidocaine 0.5-1% max plain dose

Answer 13

4.5 mg/kg or 300 mg

Question 14

max with epinephrine dose of lidocaine

Answer 14

7 mg/kg or 500 mg

Question 15

Mepivacaine 0.5-1% max plain dose

Answer 15

300 mg or 7mg/kg

Question 16

max with epinephrine dose for Mepivacaine

Answer 16

500 mg

Question 17

Bupivicaine 0.25% max plain dose

Answer 17

2.5mg/kg or 150 mg

Question 18

max with epinephrine dose of Bupivicaine

Answer 18

225mg or 3mg/kg

Question 19

four types of regional anesthesia

Answer 19

local infiltration bier block IV peripheral nerve blocks central block

Question 20

3 types of central nerve blocks

Answer 20

epidural caudal spinal

Question 21

Who can inject local infiltration?

Answer 21

surgeon podiatrist dentist

Question 22

indications for a bier block

Answer 22

brief procedure of hand or forearm ex: carpal tunnel repair

Question 23

explain technique for bier block

Answer 23

20g IV in operative arm with extension tubing with 10 ml syringe, double pneumatic tourniquet on operative upper arm. elevate arm, then esmarch wrap distal to proximal. inflate distal cuff, then proximal. inflate to 250-300mHG, esmarch off, distal cuff deflated

Question 24

what dose of lidocaine 0.5% is administered during a bier block

Answer 24

3mg/kg - 40-50 ml injected slowly into IV

Question 25

complications of a bier block

Answer 25

accidental tourniquet release/leak

Question 26

injection of local into the epidural space

Answer 26

epidural

Question 27

two techniques of a epidural

Answer 27

hanging drop and loss of resistance technique

Question 28

what is the test dose of 1.5% lidocaine with epinephrine

Answer 28

1:200,000 mcg 3-5 ml Total

Question 29

names of epidural anesthetics

Answer 29

chloroprocaine (nescaine) lidocaine bupivicaine (marcaine) ropivacaine

Question 30

plain dose of chloroprocaine 2-3%

Answer 30

200-750 mg

Question 31

dose of lidocaine 1-2% for epidural

Answer 31

150-300 mg

Question 32

dose of bupivicaine 0.25-0.5% for epidural

Answer 32

50-100 mg

Question 33

dose of ropivacaine 0.25-1% for epidural

Answer 33

75-250 mg

Question 34

caudals are typical in what patient population?

Answer 34

kids

Question 35

injection of local into the subarachnoid space at lower lumbar area?

Answer 35

spinal

Question 36

names of drugs given during spinal:

Answer 36

tetracaine (pontacaine) chloroprocaine lidocaine bupivicaine ropivacaine

Question 37

plain dose of tetracaine for a spinal

Answer 37

8-15 mg

Question 38

dose with epinephrine with tetracaine for a spinal

Answer 38

0.1-0.2 mg

Question 39

dose of chlorprocaine for a spinal

Answer 39

40-60 mg

Question 40

epinephrine is not recommended for which drugs

Answer 40

chlorprocaine, lidocaine, bupivicaine, ropivacaine

Question 41

dose of lidocaine 5% for a spinal

Answer 41

75-100 mg

Question 42

dose of bupivicaine 0.5-0.75% for a spinal

Answer 42

12-20 mg

Question 43

dose of ropivacaine 0.5-1% for a spinal

Answer 43

18-25 mg

Question 44

local mixed with sterile H20

Answer 44

hypobaric

Question 45

local mixed with spinal fluid/NSS

Answer 45

isobaric

Question 46

local mixed with D10

Answer 46

hyperbaric

Question 47

indications for a spinal/epidural

Answer 47

lower extremity/hip procedure lower abdomen, groin, perineum, urologic, rectal, ob procedure

Question 48

absolute contraindications for a spinal or epidural

Answer 48

refusal infection at site sepsis severe hypovolemia coagulation abnormaity increase ICP

Question 49

relative contraindications for a spinal/epidural

Answer 49

infection peripheral to site neurologic disorders heparin/aspirin back pain or prior lumbar surgery hypovolemia uncoperative patient or surgeon

Question 50

cardiovascular effects of a Spinal

Answer 50

decrease HR decrease venous return decrease BP

Question 51

respiratory effect of spinal

Answer 51

intercostal paralysis

Question 52

side effects of spinal block

Answer 52

sympathetic nervous system block hypothermia maintains peristalsis- contacted GI tract

Question 53

order of spinal blockade

Answer 53

sympathetic temperature pain touch pressure motor vibratory proprioception

Question 54

how to treat hypotension from a spinal

Answer 54

prehydrate with fluids- 500-1000ml ephedrine 5-10 mg/iv

Question 55

complications of a spinal

Answer 55

hypotension post dural puncture headache tinnitus diplopia

Question 56

how to treat a post dural puncture headache from a spinal

Answer 56

analgesics bedrest hydration caffeine infusion blood patch

Question 57

ways to decrease incidence of the post dural Headache

Answer 57

smaller needle turning bevel to side paramedian round/blunt tip hydration

Question 58

complications of a epidural

Answer 58

hypotension accidental spinal

Question 59

signs and symptoms of local drug toxicity

Answer 59

tinnitus light headed dizzy slurred speech confusion circumoral numbness metallic taste low HR and BP arrhythmias seizures death