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ANESTHESIA > REGIONAL ANESTHESIA > Flashcards

REGIONAL ANESTHESIA Flashcards

1
Q

Membrane
• 90% of lipids
• 10% protein

A
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2
Q

Negative resting potential

A

-70 to -90 mV

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3
Q

Classification of
Regional Anesthesia:

I. _____ – skin or mucous membrane

II. _____ – incision site / tissue to be cut (e.g. sebaceous cyst)

III. _____ – around tissue to be cut (e.g. breast mass)

IV. _____ (Bier Block)

V. _____ BLOCK – along nerve or course of nerves
A. Peripheral Nerve Blocks
B. Central Blocks

A

I. TOPICAL – skin or mucous membrane

II. INFILTRATION – incision site / tissue to be cut (e.g. sebaceous cyst)

III. FIELD BLOCK – around tissue to be cut (e.g. breast mass)

IV. INTRAVENOUS REGIONAL (Bier Block)

V. CONDUCTION BLOCK – along nerve or course of nerves
A. Peripheral Nerve Blocks
B. Central Blocks

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4
Q

CONDUCTION BLOCK types

A

A. Peripheral Nerve Blocks
B. Central Blocks

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5
Q

Incision site like sebaceous cyst anesthesia used

A

Infiltration

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6
Q

around tissue to be cut like breast mass anesthesia used

A

Field block

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7
Q

INTRAVENOUS REGIONAL ANESTHESIA aka.

A

Bier Block

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8
Q

Branches of trigeminal nerve

A

(ophthalmic, maxillary, mandibular)

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9
Q

CERVICAL PLEXUS BLOCK
• Anterior rami of _____ spinal nerve roots

A

C1-C4

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10
Q

BRACHIAL PLEXUS BLOCK
• Anterior rami of ____ spinal nerve roots

A

C4-T2

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11
Q

Major Peripheral Branches a. Axiliary N – __
b. Musculocutaneous – __
c. Radial – __
d. Median – __
e. Ulnar – __

A

Major Peripheral Branches
a. Axiliary N – shoulder abduction
b. Musculocutaneous – elbow flexion
c. Radial – elbow, wrist, and finger extensions
d. Median – wrist and finger flexion
e. Ulnar – wrist and finger flexion

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12
Q

operations of upper extremity anesthesia used

A

BRACHIAL PLEXUS BLOCK

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13
Q

__ provides alternatives to general anesthesia

A

Neuraxial anesthesia

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14
Q

__ pass freely in and out
__ barred outside

A

Channels guarded by “gates”
• K+ pass freely in and out
• Na+ barred outside

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15
Q

Nerve stimulation

A

o Gates open
o Na+ rushing in
o Shifting of polarity
o Depolarization

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16
Q

INTERCOSTAL NERVE BLOCK
• Anterior rami of __ eleven spinal nerves • At inferior surface of ribs

A

1st

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17
Q

COMPLICATIONS OF INTERCOSTAL NERVE BLOCK

A

Pneumothorax

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18
Q

ANKLE BLOCK

• Blocks five nerves supplying foot
1-5

A

a. Deep peroneal
b. Superficial peroneal
c. Saphenous
d. Posterior tibial
e. Sural

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19
Q

ANKLE BLOCK
• Precaution
• Avoid __ to reduce risk of ischemia

A

epinephrine

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20
Q

PUDENDAL NERVE BLOCK
• sacral plexus __-__

A

(S2 – S3 – S4)

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21
Q

Fan-shaped injection at the base blocks dorsal and ventral branches

A

DORSAL PENILE BLOCK

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22
Q

Local anesthetic deposited at sub arachnoid space

A

SPINAL ANESTHESIA

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23
Q

Drugs Used in Spinal Anesthesia

A

• Tetracaine
• Lidocaine
• Bupivacaine
T L B

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24
Q

Factors Determining Level of Anesthesia (in spinal anesthesia)

A

• volume of solution
• concentration
• barbotage
• speed of injection
• patient position
• specific gravity of solution
• site of injection
• height of patient
• increasedintra-abdominalpressure

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25
Q

Position in spinal anesthesia

A

Lateral decubitus – knees flexed to chest chin put down on chest (nose-to-knee)

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26
Q

Puncture Sites in spinal anesthesia

A

• Interspaces between L2-L3, L3-:4, L4-L5
• Line joining highest points of iliac crests
• crosses either body of L4 or interspace
• between L4-L5

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27
Q

DELAYED COMPLICATIONS – leak of CSF

A

Headache

28
Q

Levels of Spinal Anesthesia – Dermatomes Involved

____ - sensory loss involves lowers lumbar and sacral segments.

A

Saddle Block

29
Q

Levels of Spinal Anesthesia – Dermatomes Involved

__ – level of umbilicus (T10) lower thoracic lumbars and sacrals

A

Low Spinal

30
Q

Levels of Spinal Anesthesia – Dermatomes Involved

__ – costal margin (T6) lower thoracic lumbars and sacrals

A

Mid-Spinal

31
Q

Levels of Spinal Anesthesia – Dermatomes Involved

__ – nipple line (T4) thoracic segments (T4 – T12) lumbars and sacrals

A

High Spinal

32
Q

Distance from skin to epidural space – __

A

4-5 cm

33
Q

Position of epidural anesthesia

A

Position
• Cervical epidural – sitting (C7)
• Thoracic epidural (T7)
• Lumbar epidural
(L1-L2, L2-L3, L3-L4, L4-L5)

34
Q

Method of Identifying Epidural Space

A

Principle: negative pressure in space

35
Q

Drop of saline at hub of epidural needle is sucked in once it enters space

A

Hanging Drop

36
Q

Central neuraxial block

A

Epidural anesthesia

37
Q

LA injected into the epidural space in the sacral canal through sacral hiatus

A

CAUDAL ANESTHESIA

38
Q

Caudal anesthesia blocks lumbosacral plexus ____ and
coccygeal plexus ___

A

lumbosacral plexus (T12, L1-5, S1-3) and
coccygeal plexus (S4-5, coccygeal nerves)

39
Q

In caudal anesthesia __mL of lidocaine is used in the technique

A

15-20 mL

40
Q

Reversible inhibition of sensory nerve impulse conduction

A

Local Anesthetics

41
Q

• Prevent transmission of information to the CNS
• No loss of consciousness

A

Local Anesthetics

42
Q

NON PHARMACOLOGIC FACTORS INFLUENCING ACTIVITY OF LOCAL ANESTHETICS
1-5

A
  1. Dosage
  2. Addition of vasoconstrictor
  3. Site of injection
  4. Additives
  5. Mixture of LA
43
Q

In Spinal anesthesia, lack of _____ around spinal cord are responsible for the rapid onset

A

nerve sheath

44
Q

Local anesthetic additive that increase pH near pKA more ionized faster entry faster onset

A

NaHCO3

45
Q

Clinically Useful Local Anesthesia

A

AMINO-ESTERS
Ester link between aromatic and main portion of the molecule

AMINO-AMIDES
Amide linkages

46
Q

Local Anesthetics Classification

Amides

A

Lidocaine, Bupivacaine,
Ropivacaine, Levobupivacaine

47
Q

Local Anesthetics Classification

Esters

A

Procaine, Chloroprocaine, Cocaine, Tetracaine

48
Q

Local Anesthetics Mechanism of Action

A

blocks voltage-sensitive Na+ ion channels in neuronal membrane

\/

prevent Na+ influx (Depolarization)

\/

prevent transmission of nerve impulses

49
Q

Low anesthetic potency & short duration of action

A

procaine & chloroprocaine

50
Q

Intermediate anesthetic potency & duration of action

A

lidocaine, mepivacaine &
prilocaine

51
Q

High anesthetic potency and prolonged duration of action

A

tetracaine, bupivacaine : racemic and levobupivacaine, ropivacaine, ethidocaine

52
Q

decreases max rate of depolarization w/o altering RMP

A

LIDOCAINE

53
Q

local anesthetic used in regional anesthesia for over 3 decades

A

BUPIVACAINE

54
Q
  • good motor/sensory block
A

BUPIVACAINE

55
Q

Mechanism: depresses the rapid phase of Depolarization (V max)

A

BUPIVACAINE

56
Q

compounds made up of same atoms connected by the same sequence of bonds with different 3D structure

A

Stereoisomers

57
Q

pairs of stereoisomers that, in their 3D projection, are related to each other as an object to its mirror image, and thus are not superimposable

A

Enantiomers

58
Q

(+)
enantiomer that rotates polarized light to the right

A

Dextrorotation

59
Q

(-) enantiomer that rotates
polarized light to the left

A

Levorotation

60
Q

equal amounts of enantiomers in a chiral compound

A

RACEMIC MIXTURES

61
Q

Comparative effect of racemic bupivacaine, levobupivacaine & ropivacaine on isolated rabbit heart.

A

D-Bupivacaine

62
Q

Methemoglobinemia

A

PRILOCAINE

63
Q

requires __mg Prilocaine to produce clinical level of Methemoglobenemia

A

600

64
Q

requires 600mg Prilocaine to produce clinical level of Methemoglobenemia

Reversed with _____

A

Methylene blue

65
Q

EXTRAVASCULAR INJECTION BLOOD CONCENTRATION
Depends on:

A

• Absorption
• Tissue Redistribution
• Metabolism
• Excretion

66
Q

Factors Affecting Absorption

A

• Site of injection – more blood supply > absorption
• Choice of Drugs – characteristics of the drug may affect
absorption • Dosage
• Addition of Epinephrine – depends on the sensitivity of the vessels at the site of injection and local anesthesia itself

67
Q

Central nerve blocks

A

A. Spinal anesthesia
B. Epidural anesthesia
C. Caudal anesthesia

ANESTHESIA (2 decks)

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