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Advanced Anesthesia 2 > Oral Maxillofacial Trauma & Local Anesthetics - Quiz 5 > Flashcards

Oral Maxillofacial Trauma & Local Anesthetics - Quiz 5 Flashcards

1
Q

Which Facial Fracture is Triangular/Pyramidal in shape and affects the Nose and Palate?

A

Lefort II

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2
Q

Which type of Facial Fracture affects the entire face and completely separates the Midfacial Skeleton from the Cranial Base?

A

Lefort III

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3
Q

Which type of Facial Fracture affects just the Palate?

A

Lefort I

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4
Q

What is a concern while Intubating if a Lefort II or III is suspected?

A

Possible Intracranial Placement of ETT

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5
Q

Label the 7 Parts of the Mandible.

A
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6
Q

What are the Anesthetic Considerations regarding Facial Fractures?

A

Pretreat Edema w/ Steroids

Difficult/Bloody Airway

Awake Extubation

MUST have Wire Cutter/Scissors

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7
Q

What med can be given to help with Nasal Intubation?

A

Phenylephrine

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8
Q

A Left Enantiomer is denoted with an ___ for _______ and a Right Enantiomer is denoted with an __ for _______

A

A Left Enantiomer is denoted with an “s” for SINISTER and a Right Enantiomer is denoted with an “r” for RECTUS

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9
Q

Which Local Anesthetics are Pure Isomers?

A

Ropivacaine (s)

&

Levobupivacaine (s)

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10
Q

What are the advantages of using Local Anesthetics that are S Enantiomers?

A

S Enantiomers are LESS Neuro & Cardio-toxic

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11
Q

How do Local Anesthetics work?

A

Stops Na+ Ions from going through Sodium Channels

Slows Depolarization

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12
Q

Local Anesthetics do not alter _____ or _____ potentials

A

Local Anesthetics does not alter RESTING MEMBRANE or THRESHOLD potentials

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13
Q

How do Local Anesthetics affect nerves with more activity and firing?

A

Faster Blockade d/t more frequently activated-open state

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14
Q

Local Anesthetics have a much lower affinity for ________ than they do Sodium Channels

A

Local Anesthetics have a much lower affinity for POTASSIUM ION CHANNELS than they do Sodium Channels

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15
Q

What Increases the Minimum Local Anesthetic Concentration (Cm) to produce a conduction block?

A

Larger Nerve Diameter

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16
Q

What factors Decrease Minimum Local Anesthetic Concentration?

A

Higher Frequency Nerves

&

Higher pH

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17
Q

How does the Minimum Local Anesthetic Concentration compare between Motor & Sensory Nerves?

A

Minimum concentration is 2X more for Motor than Sensory Nerves - easier to block Sensory Nerves

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18
Q

How do Epidurals & Spinals affect Local Anesthetic Minimum Concentration?

A

No effect on Minimum Concentration, but requires less amount d/t direct nerve access

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19
Q

Local anesthetics must block at least ______ Nodes of Ranvier, preferably ____ Nodes

A

Local anesthetics must block at least TWO Nodes of Ranvier, preferably THREE Nodes

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20
Q

What is the Order of Blockade for Nerve Fibers

A
  1. B Fibers
  2. C & A-Delta Fibers
  3. A-Gamma Fibers
  4. A-Beta Fibers
  5. A-Alpha Fibers
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21
Q

What does the blocking of B Fibers affect?

A

Preganglionic Sympathetic Efferents

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22
Q

What does the blocking of C & A-Delta Fibers affect?

A

Pain

Temperature

Touch

Postganglionic Sympathetic Neurons

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23
Q

What are the function of A-Gamma fibers?

A

Efferent to Muscle Spindles

Muscle Tone

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24
Q

What is the function of A-Beta Fibers?

A

Afferent from Skin & Joints

Tactile

Propioception

Touch Pressure

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25
Q

What is the Function of A-Alpha Fibers?

A

Efferent to Muscles

Motor

&

Propioception

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26
Q

What is the Order of Blockade for Nerve Functions?

A

ATP - TP - MVP

Autonomic, Temperature, Pain

Touch & Pressure

Motor, Vibration, Proprioception

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27
Q

What happens if B, C, and small/medium A Fibers are blocked, but NOT Large A Fibers?

A

Sympathectomy

Loss of Temp & Pain Sensation

Preserved Motor & Proprioception

28
Q

What form is required to cross the Lipid Bilayer regarding pK?

A

Unionized, therefore Local Anesthetics closer to Physiologic pH have FASTER onset

29
Q

Which particular Local Anesthetic does NOT ionize based on pH and has an Unknown mechanism?

A

Benzocaine - Weak Acid - pKA 3.5

30
Q

A ________ pH Lessens sting of Local Infiltration

A

A HIGHER pH Lessens sting of Local Infiltration

31
Q

How is Local Anesthetics Distrubuted throughout the body?

A

Lungs 1st

High Perfused Tissues 2nd
<span>(Heart, Brain, Kidneys)</span>

Low Perfused Tissue 3rd
(Muscle & Fat)

32
Q

Which type of Local Anesthetics are more widely distributed throughout the body?

A

Amides

33
Q

Which Local Anesthetic has a higher chance to Crossing Placenta: Lidocaine, Bupivacaine, or Ropivacaine?

A

Lidocaine since it’s NOT as protein-bound

34
Q

What happens when Local Anesthetics cross the placenta?

A

Local becomes more Ionized & cant get back out = Fetal Local Toxicity from Ion Trapping

35
Q

The Potency of Local Anesthetics is related to ________, while the Onset is more related to ______

A

The Potency of Local Anesthetics is related to LIPID SOLUBILITY, while the Onset is more related to IONIZATION

36
Q

How does Protein-Binding of Local Anesthetics affect Duration of Action?

A

More Protein-Binding = Stronger Attachment & Longer Duration

37
Q

Which Amide is the fastest to be Metabolized?

A

Prilocaine

38
Q

Which Amides are the slowest to be Metabolized?

A

Etidocaine

Bupivacaine

Ropivacaine

39
Q

How are Amides metabolized versus Esters?

A

Amides = Hepatic Clearance

Esters = Plasma Cholinesterase

40
Q

Which Ester is the fastest to be metabolized?

A

Chloroprocaine

41
Q

Which Ester is the slowest to be metabolized?

A

Tetracaine

42
Q

What Ester metabolite can cause allergic reactions?

A

Paraaminobenzoic Acid (PABA)

43
Q

Which local injection site has little to no cholinesterase?

A

CSF - must wait for systemic absorption for hydrolysis

44
Q

What can Inhibit the activity of Plasma Cholinesterase?

A

Liver Disease

Increased BUN

Parturients

Chemotherapy

45
Q

What is the function of Epinephrine with Local Anesthetics?

A

Test Dose

Limits Systemic Absorption

Prolongs Lidocaine by 1/3

No effect on Onset

46
Q

Which two Local Anesthetics have ZERO Vasodilator Activity?

A

Cocaine & Ropivacaine

47
Q

How does Clonidine affect Local Anesthetics?

A

Enhance Neuraxial Anesthesia & Increase Duration

48
Q

The Effects of Mixing Local Anesthetics are _______ and NOT _______

A

The Effects of Mixing Local Anesthetics are ADDITIVE and NOT SYNERGISTIC

49
Q

What is the Max Dose of Lidocaine?

A

300 mg

50
Q

What is the Max dose of Ropivacaine?

A

200 mg

51
Q

What is the Max dose of Bupivacaine?

A

175 mg

52
Q

What are symptoms of Systemic Local Anesthetic Toxicity w/ Plasma Lidocaine levels of 5-10 mcg/mL?

A

Circumoral Numbness

Tinnitus

Twitching

Hypotension

Myocardial Depression

53
Q

What are symptoms of Systemic Local Anesthetic Toxicity w/ Plasma Lidocaine levels of 10-15 mcg/mL?

A

Seizures & Loss of Consciousness

54
Q

What are symptoms of Systemic Local Anesthetic Toxicity w/ Plasma Lidocaine levels of 15 - 25 mcg/mL?

A

Apnea & Coma

55
Q

What are symptoms of Systemic Local Anesthetic Toxicity w/ Plasma Lidocaine levels > 25 mcg/mL?

A

CV Collapse

56
Q

What are the systemic levels related to blood flow of tissue from fastest to slowest for Local Anesthetics?

A

In Time I Can Please Everyone But Suzi and Sally

IV
Tracheal
Intercostal
Caudal
Paracervical
Epidural
Brachial Plexus
Subarachnoid
Subq

57
Q

What is the risk involved with Intrathecal Lidocaine?

A

Transient Neuro Symptoms (Back, Butt & Thigh Pain)

Cauda Equina Syndrome

Anterior Spinal Artery Syndrome

58
Q

What is Cauda Equina Syndrome?

A

Neurotoxicity r/t Lidocaine

Lumbosacral Plexus Injury

Bowel & Bladder Dysfunction

Paraplegia

59
Q

What happens with Anterior Spinal Artery Syndrome?

A

Lower Extremity Paresis

&

Sensory Deficit

60
Q

It takes 3x more in Plasma Local Anesthetic Concentration to see Cardiotoxicty versus CNS, except when using which Local Anesthetic?

A

Bupivacaine 8-10 mcg/mL - will see CV symptoms before CNS

61
Q

What happens with Cardiotoxicity r/t to Local Anesthetics?

A

Profound Hypotension

&

Myocardial Depression

62
Q

What should be done first for treating Local Anesthetic Toxicity?

A

Manage Airway & Supress Seizures

63
Q

Regarding Local Anesthetic Toxicity, which meds should be avoided when managing Arrhythmias?

A

Vasopressin

B-Blockers

CC-Blockers

Reduce Epi to < 1mcg/kg

64
Q

What can be given for CV Collapse related to Local Anesthetics?

A

20% Lipid Emulsion

65
Q

Which Local Anesthetics is Methemoglobinemia associated with?

A

Prilocaine > 8mg/kg

Lidocaine

Benzocaine

Cetacaine

Advanced Anesthesia 2 (8 decks)

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