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My APA Anesthesia 1 > quiz 6 > Flashcards

quiz 6 Flashcards

1
Q

Labs need to be what for regional block?

A

Platelets >100k

PT/INR, aPTT < 2x normal value

PT: 11 - 13.5
INR: 0.8 - 1.1
PTT: 25 - 35

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2
Q

issue with pts who have preexisting nerve injuries?

A

can have prolonged or permanent block

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3
Q

intrallipid dosing

A

1.5ml/kg/min bolus, max 8ml/kg

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4
Q

which drug not a good motor blocker?

A

bupivicaine

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5
Q

DOA of ropiv, bupiv, lido? with Epi?

A

Ropiv: 2-6h, N/A w/epi

Bupiv: 2-4, 3-4 w/epi

Lido: 30min-2h, up to 3h w/epi

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6
Q

2% lido has how much per ml?

A

20mg per mL

just move decimal of percentage over 1 to get answer

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7
Q

1:200,000 solution to Epi ratio?

A

take second number and divide 1 million into it so – 5 mcg/ml

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8
Q

spraying local in an area to get the nerve, what technique?

A

field block technique

used for incision

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9
Q

parasthesia technique?

A

Block needle is inserted in proximity of the target nerve or nerve plexus

When needle makes direct contact with a sensory nerve, a paresthesia is elicited and the LA is injected

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10
Q

current and interval of nerve stimulator technique?

A

0-5 mA

1-2 Hz

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11
Q

what implies intraneural needle placement?

what about close to nerve?

A

muscle contraction elicited at < 0.2 mA

less than 0.5 mA – close to nerve

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12
Q

how much injected via nerve stimulator placement dose?

A

30-40 mL in divided doses with gentle aspiration

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13
Q

Ultrasound uses high-frequency sound waves emitted from _____________ that travel at different rates through tissues of different densities, returning a signal to the transducer. Range?

A

piezoelectric crystals

1-20 MHz

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14
Q

solid organs, deep structures have what echogenicity?

A

hypoechoic

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15
Q

diaphragm, gallstones, bone, pericardium have what echogenicity?

A

hyperechoic

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16
Q

fluid and blood filled structures have what echogenicity?

A

anechoic

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17
Q

look at slide 18

A

.

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18
Q

Nerves are best imaged in________ (_______)

A

cross-section

short axis

(seen as honeycomb appearance)

19
Q

The nerve appears as a single circular ________ structure with internal _________ circles

A

hyperechoic

hypoechoic

20
Q

preferred plane view?

A

longitudinal/in-plane alignment

21
Q

Advantages of Continuous PNB

A 
Reduction in resting and dynamic pain
Reduction in supplemental analgesia requirements
Reduction in opioid related side effects
Reduction in sleep disturbance
Improved patient satisfaction
Improved patient ambulation
Accelerated resumption of passive joint range-of-motion
Reduced time to discharge
22
Q

Complications of Continuous PNB

A 
Systemic local anesthetic toxicity
Catheter retention
Retroperitoneal hematoma
Infection
Increased risk of falling (femoral nerve catheter)
Nerve injury
23
Q

which LAs preferred for continuous and why?

A

Long acting

better effect on sensory and less effect on motor

24
Q

Brachial Plexus Blocks

A

Supraclavicular block
Interscalene block
Infraclavicular block
Axillary block

25
Q

Terminal Nerve Blocks

A 
Digital nerve blocks
Intercostobrachial nerve block
Median nerve block
Musculocutaneous nerve block
Ulnar nerve block
Radial nerve block
26
Q

intravenous regional anesthesia

A

Bier block

27
Q

interscalene block blocks what the most? good for what surgery? What area does injection happen?

A

c5-c7

involving the shoulder and the upper arm
(not appropriate for surgery at or distal to the elbow)

Roots

28
Q

what needs to be considered when doing a total shoulder and an interscalene block?

A

For complete surgical anesthesia of the shoulder, the C3-C4 cutaneous branches may need to be supplemented with a superficial cervical plexus block or local infiltration

29
Q

A properly performed interscalene block will invariably block the _______ ________ nerve – will block one side of diaphragm so don’t do double block

A

ipsilateral (same side)

phrenic

30
Q

a condition marked by a contracted pupil, drooping upper eyelid, and local inability to sweat on one side of the face, caused by damage to sympathetic nerves on that side of the neck.

A

Horner’s syndrome

myosis, ptosis, anhidrosis

31
Q

Other considerations with Interscalene block

A
  • Horner’s syndrome
  • RLN involvement
  • Vertebral artery involvment (immediate seizure)
  • Spinal or epidural injection (could get full spinal)
  • Pneumothorax
32
Q

where does brachial plexus come out b/w in neck?

A

B/w anterior and middle scalene muscle

interscalene triangle

33
Q

Supraclavicular block: Good for what surgeries? What is biggest risk? What area injected?

A

surgical procedures at or distal to the elbow

Pneumothorax

Divisions

34
Q

Complications of Supraclavicular block

A
  • Horner’s syndrome
  • Ipsilateral phrenic nerve palsy in ~50% of patients
  • Pneumothorax
  • Subclavian artery puncture
  • Recurrent laryngeal nerve palsy
35
Q

Infraclavicular Block: What level blocked? What spared? What surgery?

A

Cords

surgical procedures at or distal to the elbow

The intercostobrachial nerve is spared (T2 dermatome)

36
Q

Axillary block: What nerves? What does it block? What level?

A

Median and Ulner

entire arm distal to elbow

distal portion of cords

37
Q

favored sites for terminal nerve blocks?

A

the elbow and the wrist

38
Q

Bier block: duration? Common surgery?

A

45-60 mins

Carpel tunnel release

39
Q

look at slide 48

A

.

40
Q

Peripheral Nerve Blocks of the Trunk

A

Superficial Cervical Plexus Block
Paravertebral Block
Intercostal Block
Transverse Abdominis Plane Block

41
Q

highest risk of toxicity?

A

Bier block d/t IV

42
Q

Horner’s syndrome - may result from proximal tracking of local anesthetic and blockade of sympathetic fibers to the ____________.

A

cervicothoracic ganglion

43
Q

For Axillary block: At the _______ border of the _________ muscle, the cords of the brachial plexus form large terminal branches

A

lateral

pectoralis minor

My APA Anesthesia 1 (8 decks)

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