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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
what does pKa correlate with
onset
26
the ____________ the pKa the more non-ionized and the ________ the onset
lower (pH) faster
27
local anesthetics are weak (acids/bases_
bases
28
pKa chart
29
tetracaine Pka onset and %nonionized @ ph 7.4
pka 8.6 % non ionized 14 slow onset
30
bupivicaine Pka onset and %nonionized @ ph 7.4
pka 8.1 non ionized 17 moderate onset
31
ropivicaine Pka onset and %nonionized @ ph 7.4
pka 8.1 % nonionized 17 moderate onset
32
chloroprocaine Pka onset and %nonionized @ ph 7.4
pka 9.1 % nonionized 2 fast onset
33
lidocaine Pka onset and %nonionized @ ph 7.4
pka 7.7 % nonionized 24 fast onset
34
etidocaine Pka onset and %nonionized @ ph 7.4
pka 7.7 % nonionized 33 fast onset
35
mepivicaine Pka onset and %nonionized @ ph 7.4
pka 7.6 %non ionized 99 fast onset
36
lipid solubility is correlated with
potency
37
the more lipid soluble the _________ the potency
greater
38
non lipid soluble LA require a _________ concentration
higher
39
protein binding is related to
duration of action
40
what protein does LA bind to first
AAG (alpha1-acid glycoprotein)
41
what protein does LA bind to second
albumin
42
a decreased pH results in (higher/lower) protein binding
lower
43
how does systemic acidosis affect local anesthetic
increased free local anesthetic, increased risk of toxicity
44
the higher the protein binding the ________ the DOA
longer
45
3% 2-chlorprocain (HCO3 +EPI) onset, anesthesia hrs, analgesia hours
onset 10-15 min anesthesia hrs 1.5-2hrs analgesia hrs 2-3 hrs
46
1.5% mepivacaine (HCO3 + EPI) onset, anesthesia hrs, analgesia hrs
onset 10-20 min R: 5 min anesthesia hrs 2-5 hrs analgesia 3-5 hrs
47
2% lidocaine (HCO3 + EPI) onset, anesthesia hrs, analgesia hrs
onset 10-20 min anesthesia hrs 2-5 hrs analgesia hrs 3-8 hrs
48
ropivicaine 0.5% onset, anesthesia hrs, analgesia hrs
onset 15-30 min anesthesia hrs 4-8 hrs analgesia 5-12 hrs
49
0.5% bupivicaine +EPI onset, anesthesia hrs, analgesia hrs
onset 15-30 min anesthesia hrs 5-15 analgesia hrs 6-30 hrs
50
for a motor block use a LA of (higher/lower) concentration
higher
51
for a sensory block use a LA of (higher/lower) concentration
lower
52
T/F local anesthetics are neurotoxic
true
53
what happens if you inject LA directly into nerve
nerve injury
54
what happens if you inject into peritoneum
increased hydrostatic pressure ischemia
55
T/F 99% of nerve injuries resolve in 6 months
TRUE
56
when advancing needle under ultrasound, always keep __________ inview
the tip
57
if injecting multipile nerves, inject the (most shallow, deepest) first
deepest
58
what order to you inject a nerve in
underneath side top
59
when you inset nerve stimulator what is the output setting
0.4 mA
60
when you get a twitch with 0.4 mA what do you do next
dial back to 0.2 mA
61
what is the goal of nerve stimulation
no twitch at 0.2 mA and twitch at 0.3 mA
62
if you have a strong twitch at 0.2 mA where is the needle
intraneural
63
what block do you do for anterior aspect of the knee
femoral nerve
64
what block do you do for posterior part of the knee
sciatic
65
what do you block for erector spinae
T6-T10
66
what do you block for medial ankle
saphenous
67
what do you block for lateral ankle
sural
68
what volume do you use for a specific nerve
2-3cc
69
what volume do you use for a large area
30-50 cc
70
what is the max dosage of marcaine
2.5 mg/kg
71
what is the max dose of lidocaine
4 mg/kg
72
what is the max dose of lidocaine with epi
7 mg/kg
73
brachial plexus
74
what does the interscalene block block
C5 C6 C7 roots
75
what do we use supraclavicular block for
anesthesia for upper arm below shoulder
76
T/F in supraclavicular block the medial aspect of skin is no anesthetized
F, not blocked by any brachial plexus block (T2)
77
what position do we do supraclavicular block for
supine or semi-sitting position
78
how do you place transducer in SCB
transverse on neck, superior to clavicle at midpoint
79
what does the supraclavicular block block
superior, middle, inferior trunks
80
what is Cm
the unit of measure that quantifies the concentration of LA that is required to block conduction
81

Anesthesia Techniques (11 decks)

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