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Anesthesia Techniques > regional > Flashcards

regional Flashcards

1
Q

what nerve layer encapsulates individual neurons

A

endoneurium

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2
Q

what nerve layer is tough and contains several neruons

A

perineum

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3
Q

what nerve layer is the toughest for local anesthetics to cross

A

perineurim

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4
Q

what is the nerve layer that is outermost and protects several groups of perineurium, essentially the sheath

A

epineurium

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5
Q

T/F a nerve will heal if you cut through it

A

F

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6
Q

are smaller or larger nerves blocked first

A

smaller

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7
Q

are myelinated or unmyelinated nerves blocked first

A

myelinated

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8
Q

why are C fibers resistant to LA

A

they are unmyelinated

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9
Q

where does LA pool

A

near axonal membrane/ nodes of ranvier

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10
Q

what nerve types are the aim for blocks

A

A delta- pain
A beta-muscle

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11
Q

what is the order of nerve block onset

A

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

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12
Q

what is the order of nerve recovery

A

C,
A delta,
A gamma,
A beta,
A alpha,

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13
Q

what do A-alpha nerves transmit

A

muscle length, force, propioception

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14
Q

what do A-beta nerves transmit

A

proprioception, touch, pressure

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15
Q

what do A-gamma nerves transmit

A

skeletal muscle tone

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16
Q

what do A-delta nerves transmit

A

pain, temp, touch

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17
Q

what do B nerves transmit

A

autonomic fxn

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18
Q

what do sC nerves transmit

A

autonomic fxn

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19
Q

what do dC nerves transmit

A

pain, temp, temp, touch, autonomic fxn

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20
Q

what is the action of local anesthetics

A

impair propagation of the AP along nerve axon
direct action on voltage-gated sodium channels to prevent sodium influx

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21
Q

the __________ form of the LA penetrates the libip bilayer of the nerve

A

non-ionized

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22
Q

the ________ form of the LA locks the sodium channel

A

ionized

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23
Q

what can you add to LA to increase onset

A

HCO3, makes in more non-ionized

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24
Q

what happens to the non-ionized LA that crosses over into the nerve

A

becomes ionized

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25
Q

what does pKa correlate with

A

onset

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26
Q

the ____________ the pKa the more non-ionized and the ________ the onset

A

lower (pH)
faster

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27
Q

local anesthetics are weak (acids/bases_

A

bases

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28
Q

pKa chart

A
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29
Q

tetracaine Pka onset and %nonionized @ ph 7.4

A

pka 8.6
% non ionized 14
slow onset

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30
Q

bupivicaine Pka onset and %nonionized @ ph 7.4

A

pka 8.1
non ionized 17
moderate onset

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31
Q

ropivicaine Pka onset and %nonionized @ ph 7.4

A

pka 8.1
% nonionized 17
moderate onset

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32
Q

chloroprocaine Pka onset and %nonionized @ ph 7.4

A

pka 9.1
% nonionized 2
fast onset

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33
Q

lidocaine Pka onset and %nonionized @ ph 7.4

A

pka 7.7
% nonionized 24
fast onset

34
Q

etidocaine Pka onset and %nonionized @ ph 7.4

A

pka 7.7
% nonionized 33
fast onset

35
Q

mepivicaine Pka onset and %nonionized @ ph 7.4

A

pka 7.6
%non ionized 99
fast onset

36
Q

lipid solubility is correlated with

A

potency

37
Q

the more lipid soluble the _________ the potency

A

greater

38
Q

non lipid soluble LA require a _________ concentration

A

higher

39
Q

protein binding is related to

A

duration of action

40
Q

what protein does LA bind to first

A

AAG (alpha1-acid glycoprotein)

41
Q

what protein does LA bind to second

A

albumin

42
Q

a decreased pH results in (higher/lower) protein binding

A

lower

43
Q

how does systemic acidosis affect local anesthetic

A

increased free local anesthetic, increased risk of toxicity

44
Q

the higher the protein binding the ________ the DOA

A

longer

45
Q

3% 2-chlorprocain (HCO3 +EPI) onset, anesthesia hrs, analgesia hours

A

onset 10-15 min
anesthesia hrs 1.5-2hrs
analgesia hrs 2-3 hrs

46
Q

1.5% mepivacaine (HCO3 + EPI) onset, anesthesia hrs, analgesia hrs

A

onset 10-20 min R: 5 min
anesthesia hrs 2-5 hrs
analgesia 3-5 hrs

47
Q

2% lidocaine (HCO3 + EPI) onset, anesthesia hrs, analgesia hrs

A

onset 10-20 min
anesthesia hrs 2-5 hrs
analgesia hrs 3-8 hrs

48
Q

ropivicaine 0.5% onset, anesthesia hrs, analgesia hrs

A

onset 15-30 min
anesthesia hrs 4-8 hrs
analgesia 5-12 hrs

49
Q

0.5% bupivicaine +EPI onset, anesthesia hrs, analgesia hrs

A

onset 15-30 min
anesthesia hrs 5-15
analgesia hrs 6-30 hrs

50
Q

for a motor block use a LA of (higher/lower) concentration

A

higher

51
Q

for a sensory block use a LA of (higher/lower) concentration

A

lower

52
Q

T/F local anesthetics are neurotoxic

A

true

53
Q

what happens if you inject LA directly into nerve

A

nerve injury

54
Q

what happens if you inject into peritoneum

A

increased hydrostatic pressure
ischemia

55
Q

T/F 99% of nerve injuries resolve in 6 months

A

TRUE

56
Q

when advancing needle under ultrasound, always keep __________ inview

A

the tip

57
Q

if injecting multipile nerves, inject the (most shallow, deepest) first

A

deepest

58
Q

what order to you inject a nerve in

A

underneath
side
top

59
Q

when you inset nerve stimulator what is the output setting

A

0.4 mA

60
Q

when you get a twitch with 0.4 mA what do you do next

A

dial back to 0.2 mA

61
Q

what is the goal of nerve stimulation

A

no twitch at 0.2 mA and twitch at 0.3 mA

62
Q

if you have a strong twitch at 0.2 mA where is the needle

A

intraneural

63
Q

what block do you do for anterior aspect of the knee

A

femoral nerve

64
Q

what block do you do for posterior part of the knee

A

sciatic

65
Q

what do you block for erector spinae

A

T6-T10

66
Q

what do you block for medial ankle

A

saphenous

67
Q

what do you block for lateral ankle

A

sural

68
Q

what volume do you use for a specific nerve

A

2-3cc

69
Q

what volume do you use for a large area

A

30-50 cc

70
Q

what is the max dosage of marcaine

A

2.5 mg/kg

71
Q

what is the max dose of lidocaine

A

4 mg/kg

72
Q

what is the max dose of lidocaine with epi

A

7 mg/kg

73
Q

brachial plexus

A
74
Q

what does the interscalene block block

A

C5 C6 C7 roots

75
Q

what do we use supraclavicular block for

A

anesthesia for upper arm below shoulder

76
Q

T/F in supraclavicular block the medial aspect of skin is no anesthetized

A

F, not blocked by any brachial plexus block (T2)

77
Q

what position do we do supraclavicular block for

A

supine or semi-sitting position

78
Q

how do you place transducer in SCB

A

transverse on neck, superior to clavicle at midpoint

79
Q

what does the supraclavicular block block

A

superior, middle, inferior trunks

80
Q

what is Cm

A

the unit of measure that quantifies the concentration of LA that is required to block conduction

81
Q
A

Anesthesia Techniques (11 decks)

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