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AP I > Not General Anesthesia > Flashcards

Not General Anesthesia Flashcards

1
Q

T or F: According to the asa, MAC anesthesia is held to the same standards as general anesthetics?

A

TRUE

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2
Q

T or F: MAC cases do not require the same set up as for general anesthesia?

A

FALSE

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3
Q

What are the ASA guidelines for MAC cases for oxygenation:

A

100% O2 inspired gas
never use N2O b/c of no scavenging
must have pulse ox

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4
Q

What are the ASA guidelines for MAC cases for ventilation:

A

must use capnography

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5
Q

What are the ASA guidelines for MAC cases for circulation:

A

must monitor ECG and HR
must measure BP (NIBP, IBP)
should auscultate heart sounds
should palpate pulse

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6
Q

Define spinal neuraxial anesthesia:

A

injecting local anesthesia into the CSF within the subarachnoid space

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7
Q

Define epidural neuraxial anesthesia:

A

injecting local anesthesia into the space that lies within the vertebral canal but superficial to the dural sac

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8
Q

What are 3 neuraxial contraindications?

A

Absolute
Relative
Controversial

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9
Q

What are examples of absolute contraindications?

A 
injection site infection
patient refusal
hypovolemia
increased intracranial pressure
aortic/mitral stenosis
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10
Q

What are examples of relative contraindications?

A

sepsis
uncooperative patient
neurologic deficit
spinal deformity

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11
Q

What are examples of controversial contraindications?

A

prior back surgery
inability of the patient to communicate
surgeon preference
complicated surgery

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12
Q

What drug must be stopped before neuraxial anesthesia can be performed?

A

Coumadin

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13
Q

What drug needs to have been taken for at least 7 days for neuraxial anesthesia?

A

Plavix

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14
Q

The illiac crest crosses the spinal chord at what point?

A

L4

This is the principal landmark for spinal anesthesia

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15
Q

The inferior tip of the scapula is located at what point on spinal chord?

A

T7

This is the principal landmark for thoracic epidural

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16
Q

What is another name for where the illiac crest crosses spinal chord?

A

Tuffiers line

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17
Q

The spinal chord ends at what point in an adult ?

A

L1-L2

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18
Q

The order of ligaments from skin to vertebrae:

A 
Supraspinous ligament
Infraspinous ligament
Ligamentum flavum
Dura
Arachnoid membrane
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19
Q

The spinal chord ends at what point in a child?

A

L3-L4

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20
Q

What is the dermatome for belly button?

A

T10

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21
Q

What is the dermatome for nipple?

A

T4

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22
Q

What are indications for epidurals?

A

Primary anesthetic for belly or lower extremity
supplement to GA
postoperative pain control
can be continuous

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23
Q

What are indications for spinals?

A

Lower abdomen/perineum/lower extremities
One time shot
much faster

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24
Q

When doing a midline insertion, the needle:

A

comes straight on along same line as spinous process

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25
Q

When doing a paramedian insertion, the needle:

A

comes in at an angle

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26
Q

The block of the posterior nerve roots interrupts ?

A

somatic and visceral sensations

27
Q

The block of the anterior nerve roots prevents?

A

motor and autonomic outflow

28
Q

Somatic blockades are used for?

A

-Interruption of painful stimuli
-abolish skeletal muscle tone
is a differential blockade:
1) sympathetic: works 4 dermatomes away from block
2) sensory : work 2 dermatomes away from block
3) motor: works closest to injection site

29
Q

Cardiovascular manifestations following a blockade include:

A

Decrease BP
decrease HR
decrease contractility
PROFOUND bradycardia when blocking cardiac accelerators located T1-T4

30
Q

What pulmonary consideration must be accounted for when doing blocks?

A

Proximity to phrenic nerve from C3-C5 (diaphragm)

31
Q

What size needle to you use when doing epidurals?

A

17-20 gauge

32
Q

What size needle do you use when doing spinals?

A

22-24 gauge

33
Q

What is one way to minimize the cardiovascular effects of blocks?

A

Make sure at least 1 L of fluid has been given prior to starting procedure

34
Q

All about epidurals:

A

greater control over intensity of sensory block
motor block achieved by local concentration
provides means of long term drug administration

35
Q

Disadvantages of epidurals:

A

Covers larger area, but far less intense
slower onset time (10-20 min)
block is less dense

36
Q

What is the test dose give before epidurals and why do you give it?

A

3 ml of 1.5% lidocaine with epi
Makes sure you are in epidural space and not through dura into CSF: if in CSF legs will go numb
Epi in test dose makes sure your not in blood vessel : epi would make HR go up

37
Q

When placing epidurals:

A

Volume and concentration much greater than spinal
1-2ml of local per segment
Drug must be preservative free

38
Q

Advantages of spinal anesthesia:

A

Less time to perform
less local required
more intense sensory and motor block
needle placement confirmed by CSF dripping out of needle (instead of waiting on test dose with epidural)

39
Q

What is baricity?

A

How heavy(density) is the drug compared to the CSF fluid

40
Q

What is the CSF specific gravity?

A

1.003 - 1.008

41
Q

What is the name if a drug is greater density than CSF (heavier) ?
What will it do in the CSF Fluid?

A

Hyperbaric

Sinks

42
Q

What is the name if a drug is lesser density than CSF (lighter) ?
What will it do in the CSF Fluid?

A

Hypobaric

Floats

43
Q

Adding glucose to the drug will do what?

A

makes drug heavier or more hyperbaric

44
Q

Adding sterile water to the drug will do what?

A

makes drug lighter or more hypobaric

45
Q

What is the most common side effect of neuraxial anesthesia?

A

Postdural puncture headache

46
Q

If you were to use a drug that contained preservatives, what would happen?

A

Preservatives cause inflammation of the chord

47
Q

Postduraal headaches are caused by what?

A

CSF leak that causes ICP to decrease

48
Q

What are the remedies of postdural puncture headache?

A 
Laying down
turning off lights/being in the dark
take NSAID's
increase fluid intake
get caffeine
Epidural blood patch
49
Q

What effect does caffeine do to the body?

A

stimulates an increase in CSF fluid production

50
Q

What is an epidural blood patch?

A

Where the patients own blood is used to form a patch in the epidural space where the needle punctured the dura

51
Q

What is the onset and duration of a post dural puncture headache?

A

Onset: 12 hours to 3 days later
Duration: can last several days

52
Q

What is the most common regional anesthesia technique in pediatrics?

A

caudal anesthesia

53
Q

Locations for a brachial plexus nerve block?

A

Interscalene
supraclavicular
infraclavicular
axillary

54
Q

optimal for procedures of shoulder, arm and forearm
Most intense at C5-C7
Least intense at C8-T1

A

interscalene block

55
Q

All about supraclavicular block:

A

anesthesia of entire arm including hand
high incidence of pneumothroax
High incidence of phrenic nerve block

56
Q

All about infraclavicular block:

A

anesthesia of hand, forearm, elbow and upper arm

high incidence of pneumothorax

57
Q

All about axillary block:

A

most common approach to brachial plexus

procedures distal to elbow

58
Q

Femoral nerve block:

A

block of anterior thigh, knee, medial foot
used in combo with other blocks
post op pain for knee surgery
When visualizing, use NAVY (nerve, artery, vein, y made by legs)

59
Q

Obturator nerve block:

A

anesthesia to medial thigh and muscle relaxation of adductor hip muscles
Part of 3 in 1 block with femoral and lateral femoral cutaneous

60
Q

Sciatic nerve block:

A

L4-L5 and S1-S3 nerve roots
sensory block to posterior hip and knee and lower extremity
motor block to hamstrings and lower muscles

61
Q

Lumbar plexus (psoas) block:

A

used for total hip and total knee analgesia

62
Q

Popliteal block:

A

used for foot and ankle surgery

63
Q

Saphenous nerve block:

A

used for sensory innervation along medial aspect of lower leg

AP I (8 decks)

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