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SF quizzes > Regional Anaesthesia > Flashcards

Regional Anaesthesia Flashcards

1
Q

BMJ retrospective review showed what benefits with epidural/spinal anaesthesia?

A

Mortality reduced by 1/3, odds of DVT reduced by 44%
PE 55%, Transfusion 50%, less MI/Renal failure/pneumonia
-weakness, did not compare to GA

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2
Q

In hip fx surgery (regional vs general), findings?

A
  • Sympatholysis (vasodilation), blood thinning effect
  • Decreased post op DVT (30% vs 47%)
  • Decreased MI/pneumonia/Fatal PE/Hypoxemia
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3
Q

All of the following are true regarding major knee surgery and return to normal function EXCEPT?
A) better pain at rest and with movement with a block
B) better post op knee movement with a block at 3 mo
C) Faster return to sport at 6 mo with a block
D) Improved knee flexion at 1 mo post op with a block

A

FALSE statement is C: faster return to sport at 6 mo with a block

  • pt w/out block more likely to meet criteria to return to sport at 6 months
  • ? quad weakness from femoral nerve block (ACL surgery)
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4
Q

GI benefits of regional aana

A

Less post op ileus
improved bowel function
improved microcirculation and sympatholysis

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5
Q

All the following are true regarding the effect of regional anesthesia on cancer recurrence after oncology surgery EXCEPT:
A) Choice of anesthesia could affect cancer cell survival and mets
B) Morphine promotes angiogenesis
C) Local anesthetics stimulate NK cells
D) Epidural use improves 5 yr survival after colorectal resection for adenoCA

A

FALSE answer: D - epidural use improves 5 yrs survival after colorectal resections for adenocarcinoma

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6
Q

Which anesthetic drugs help cause cancer elimination via Th1 /CTL/NK cells?

A
  • Propofol
  • COX inhibits
  • B-blockers
  • Peripheral nerve blocks
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7
Q

Two concepts of cellular response in anesthesia in pts with cancer?

A

Elimination

Escape

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8
Q

What effect does morphine have on angiogenesis in cancer cells?

A

It increases angiogenesis

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9
Q

Can anaesthetic and analgesic technique affect cancer recurrence or mets?

A
  • Evidence is inconclusive in humans

- need RCTs

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10
Q

All of the following are benefits of regional anesthesia in children EXCEPT?

a) profound pain relief
b) reduced nursing workload
c) longer wake up time
d) rapid discharge from PACU

A

FALSE answer (C) - longer wake up time

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11
Q

Benefits of regional anesthesia in children?

A
  • faster wake up time, rapid PACU d/C, earlier return appetite
  • profound pain relief
  • reduced nursing workload, less like to remove dressings/catheters
  • no risk of congitive effects as GA does
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12
Q

What are the effect of neuraxial blocks on surgical blood loss and transfusion requirements?

A
  • Sympatholysis and vasodilation (decreased BP) leads to decreased blood loss
  • less transfusion
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13
Q

Study on OR Time consumption with interscalene block (ISB)

A
  • saved 170 euro per case
  • ready for surgical prep faster
  • faster emergence time (return of spontaneous breathing)
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14
Q

All of the following are true regarding Local anesthetics EXCEPT?
A) the work by blocking Na channels only
B) Slow rate of depolarization of nerve action potential
C) There are 2 types of local anesthetics (esters and amides)
D) Ropivacaine is less cardiotoxic than bupivicaine

A

EXCEPT A) work by blocking Na channels only

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15
Q

Benefits of regional anaesthesia?

A

Hight pt satisfaction
Shorter LOS
Decreased Morbidity/mortality

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16
Q

Two general categories of local anesthetics? Most commonly used?

A

Esters (dental procedures)

Amides (most common)

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17
Q

How are ESTER local anesthetics metabolized?

A

Hydrolysis by choinesterase

18
Q

How are AMIDE local anesthetics metabolised?

A

Liver microsomal enzymes

19
Q

Allergy risk of ester anesthetics?

A

Low, but produces PABA

20
Q

Allergy risk of AMIDE anesthetics?

A

Very low

21
Q

Mechanism of action of local anesthetic?

A

Blocks Na channel - Impedes cell from depolarizing (cannot reach action potential)
Blocks K+ channels, and even calcium channels

22
Q

True or false, local anesthetic works in an acidic environment (like an abscess)?

A

False, it will not work in an acidic environment (site of an infection), as they are Bases

23
Q

Half life of bupivicaine? Mechanism of action?

A

376 minutes

Prevents ATP from entering mitochondria

24
Q

Local anesthetic maximum recommended doses in mg/kg?

A

Lidocaine 5 plain… 7 (with epi)
Prilocaine 6 plain… 9 (with epi)
Bupivicaine 2.5 plain… 3 (with epi)
Ropivacaine 2.5 plain… 3 (with epi)

25
Q

Which drug has a better safety profile (less cardiotoxic), ropivacaine or bupivacaine?

A

Ropivacaine

26
Q

Rate of systemic absorption?

A

IV > tracheal > intercostal > caudal > epidural > brachial plexus > sciatic > subcutaneous > spinal

27
Q

Indications for regional anesthesia?

A
  • moderate to severe pain -pre-existing chronic pain
  • pain expected to last > 48hrs
  • to avoid opioids in: OSA,IBD,babies
  • extensive abdominal/thoracic Sx
28
Q

Other indication for regional anesthesia?

A

High anesthesia risk patient, amenable to regional

  • multiple comorbidities
  • difficult airway
29
Q

Contraindications to regional anesthesia

A
  • pt refusal
  • anticoagulation (to neuraxial, but not compressible peripheral)
  • infection at the site -unknown lesion/rash
  • peripheral nerve block specific (ex interscalene w diaphragm prob)
30
Q

The 3 different brachial plexus blocks?

A
  • Interscalene, supraclavicular
  • Infraclavicular, axillary
  • Branches
31
Q

Inerscalene and supraclavicular block for what kind of surgery?

A
  • Shoulder (bankart)

- upper Arm surgery

32
Q

Infraclavicular and axillary block for what kind of surgery?

A

Surgery below the elbow

33
Q

Branches of brachial plexus, typically for what surgery?

A

Surgery below the wrist

34
Q

Lower extremity blocks?

A

Femoral/fascia iliaca: ACL repair or knee Sx

Sciatic: Foot surgeries

35
Q

Truncal blocks? (3)

A
  • TAP
  • Ilioinguinal/iliohypogasric
  • paravertebral
36
Q

TAP block (transversus abdominal plane block), for ? (2)

A

Laparotomy, laparoscopy

37
Q

What kind of block would you use for inguinal hernia, orchidopexy?

A

Ilioinguinal/iliohypogastric

38
Q

Paravertebral block useful for what kind of procedures?

A

Thoracotomy, laparotomy, breast surgeries

39
Q

SVT Tachycardia to PVC then VTACH, intra-op after 0.5% injection 5ml of bupivicaine, what kind of systemic toxicity?

A

Torsade des Pointes, have mitochondrial toxicity
7.5-20/10000 peripheral
1/10000 epidural

40
Q

Why would local anesthetic toxicity more common in babies?

A

Less albumin available to bind free drug

41
Q

Treatment of anesthetic systemic toxicity, as per ASRA?

A

ACLS
Seizure control
Specific treatment with 20% lipid bolus infusion
Cardiopul bypass activation

42
Q

How does lipid rescue work ?

A

-Circulating free bupivicaine is bound by lipid, before it binds mitochondrial receptors

SF quizzes (9 decks)

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