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Anesthesiology > Regional Anesthesia > Flashcards

Regional Anesthesia Flashcards

1
Q

4 examples of aminoamide local anesthetics

A
  • lidocaine
  • bupivicaine
  • ropivicaine
  • mepivacaine

(the “i-caine”s)

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2
Q

4 applications for topical anesthesia

A
  • larynx (during intubation)
  • splash block prior to wound closure
  • corneal (eye exam)
  • EMLA cream for skin desensitization (for venipuncture or small mass removal)
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3
Q

potential CNS toxicity signs (5)

A
  • Depression of cortical inhibitory pathways
  • Impaired vision
  • Tremors/seizures
  • CNS depression
  • Coma
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4
Q

Describe the MOA of local anesthetics (3 parts)

A 
- Local anesthetic needs to penetrate
into the cell to produce the its effects
- Blockade of the Na+ channel
- Prevents Na+ influx => no depolarization = no impulse
transmission
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5
Q

Complication with inferior alveolar n. block

A

Spread and block of lingual nerve

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6
Q

2 pharmacological compound types of local anesthetics

A
  • aminoesters

- aminoamides

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7
Q

EMLA cream produces anesthesia with a depth of approximately ______

A

1 cm

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8
Q

BE CAREFUL with infraorbital block in cats and

brachycephalic dogs due to _________

A

risk of ocular puncture

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9
Q

6 factors influencing the onset of local anesthetics

A
  • lipophilicity
  • pKa
  • concentration
  • dose and volume
  • proximity to nerve
  • type of nerve
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10
Q

T/F

local infiltration does not target a specific nerve

A

T

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11
Q

5 factors influencing the duration of local anesthetics

A
  • vascular effect
  • tissue blood flow
  • vasoconstrictor?
  • dose
  • affinity to the Na receptor
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12
Q

Landmarks in small animals for epidural anesthesia (3)

A
  • Iliac crest
  • Medial sacral crest
  • Spinous process of L7
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13
Q

Why is the lumbosacral space used for small animal epidural anesthesia and the sacrococcygeal space used in large animals?

A

the spinal cord ends at L7 in small animals while in large animals the spinal cord ends at L7

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14
Q

indication for local infiltration anesthesia

A

Anesthesia for skin and underlying

tissues

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15
Q

_________ anesthetics are hydrolyzed by the cholinesterase enzyme (plasma and liver)

A

aminoesters

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16
Q

DO NOT use lidocaine with epinephrine when there is not ___________

A

collateral circulation

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17
Q

________ anesthetics undergo Hepatic metabolism (microsomal

enzymes)

A

aminoamides

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18
Q

3 target nerves in lumbar paravertebral nerve block

A

T13, L1, L2

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19
Q

__________ most commonly used in small animals for epidural anesthesia

A

Lumbo-sacral space

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20
Q

“Loss of Resistance” technique for epidural anesthesia (4)

A 
1. Advance the Tuohy needle until the
interarcuate ligament is perceived
2. Remove the stylet and attach the
syringe to the hub
3. Apply small pressure to the plunger
and advance the needle through the
interarcuate ligament
4. The resistance to the injection of air
drops suddenly when needle enters
the epidural space
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21
Q

CNS signs of LA toxicity will appear before CV signs, except for with __________ toxicity

A

Bupivacaine

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22
Q

the epidural space is between the ________ and ________

A
  • interarcuate (flavum) ligament

- duramater

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23
Q

what is the benefit of peripheral nerve blocks?

A

Injection of a small volume of local anesthetic produces a great area of desensitization

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24
Q

Smaller nerve fibers are more susceptible to LA because _____________

A

shorter length of axon is required to be blocked to halt the conduction completely

25
Q

Intraneural injections produce _______!!!!

A

nerve damage

26
Q

(aminoesters/aminoamides) undergo slower metabolism

A

aminoamides

27
Q

2 target structures of local infiltration anesthesia

A
  • free nerve ending

- nociceptors

28
Q

Local anesthetics are weak _______, therefore in _____ pH they are ionized

A
  • bases

- acidic

29
Q

with (aminoesters/aminoamides) toxicity from accumulation is more likely

A

aminoamides

30
Q

__________: Anesthesia for superficial mucosal

tissues

A

topical/surface anesthesia

31
Q

what is the risk of the hanging drop epidural technique

A

false negatives can occur

32
Q

2 parts of nociception

A
  • sympathetic stimulation (catecholamine release, ↑ HR and BP)
  • stress response (ACTH, ↑ cortisol and blood glucose)
33
Q

Generally local anesthetic cannot cross the epidermis (exept _____)

A

EMLA

34
Q

(aminoesters/aminoamides) are more likely to result in anaphylactoid reactions

A

aminoesters

35
Q

why do you want to use small volumes for large animal epidural anesthesia

A

avoid sciatic nerve block, which will affect motor function of the pelvic limb

36
Q

What are the medical benefits to the significant reduction of anesthetic and analgesic drugs enabled through pre-emptive analgesia?

A

Reduction intraoperative complications

hypotension, bradycardia, nausea, GI disturbances

37
Q

3 methods of finding nerves

A
  • Blindly
  • Electrolocation - electric nerve stimulation
  • Ultrasound
38
Q

potential CV toxicity signs (6)

A
  • Bradycardia
  • Increased PQ interval
  • Increased QRS duration
  • Ventricular premature complexes
  • Reduction of myocardial contractility
  • CV collapse / cardiac arrest
39
Q

(smaller/larger) and (myelinated/unmyelinated) nerve fibers are more susceptible to local anesthetics

A
  • smaller

- myelinated

40
Q

2 ways of determining whether the needle is in the epidural space

A
  • Hanging drop technique

- Loss of resistance to injection

41
Q

local anesthetic toxicity manifests as _______ and ________ signs

A
  • CNS

- Cardiovascular

42
Q

T/F

Lumbar paravertebral block provides Better analgesia than “inverted L” technique

A

T

43
Q

difference between spinal and epidural anesthesia

A

spinal anesthesia gois into the subarachnoid space while epidural anesthesia

44
Q

4 examples of aminoester local anesthetics

A
  • procaine
  • tetracaine
  • benzocaine
  • cocaine
45
Q

Examples of peripheral nerve blocks (5)

A
  • infraorbital
  • maxillary
  • inferior alveolar (mandibular)
  • intercostal
  • lumbar paravertebral
46
Q

3 reasons to provide regional anesthesia

A
  • pre-emptive analgesia
  • better intra and postop pain control
  • prevents stress response (better immune system activity)
47
Q

__________ most commonly used in large animals for epidural anesthesia

A

Sacrococcygeal space

48
Q

3 reasons a patient may have a high plasmatic level of local anesthetics

A
  • high dose
  • direct venous injection
  • reduced biotransformation or elimination (liver/renal disease)
49
Q

Examples of local infiltration blocks

A
  • line block
  • intratesticular block
  • inverted L
  • ring block
50
Q

Degree of ionization will depend on the ___ and ____ of the tissue

A
  • pKa

- pH

51
Q

the toxicity of local anesthetics is associated with ___________

A

high plasmatic levels

52
Q

_______ is a peripheral nerve block used for flank surgeries in ruminants

A

lumbar paravertebral block

53
Q

3 steps of epidural “Hanging Drop” technique

A 
1.Advance the Tuohy needle until the
interarcuate ligament is perceived
2.Remove the stylet and fill the hub of
the needle with saline
3. When the needle enters the
epidural space the drop should be
aspirated
54
Q

Myelinated fibers are more susceptible to be blocked because __________.

A

LA pools near the

axonal membrane

55
Q

Order in which nerve sensations are blocked by local anesthetics (6)

A
  • pain
  • cold
  • warm
  • touch
  • deep pressure
  • motor function
56
Q

__________: pH at which 50% of a drug is present in its ionized (charged) form and 50% is in its unionized (neutral) form

A

pKa

57
Q

2 target structures of topical local anesthesia

A
  • free nerve endings

- nociceptors

58
Q

3 uses of local infiltration

A
  • Resection of cutaneous or superficial masses
  • Surgical closure of lacerations
  • Procedures involving an appendage

Anesthesiology (13 decks)

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