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NA 1 > Regional - Exam 2 > Flashcards

Regional - Exam 2 Flashcards

1
Q

ABSOLUTE contraindications for CNB

A

-pt refuses #1
-coagulopathy or bleeding diathesis
-increased ICP
-severe aortic or mitral stenosis
-ichemic hypertrophic subaortic stenosis
-allergy
-hypovolemia
-infection at injection site
-timing

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2
Q

Relative contraindications for CNB

A

-coagulopathies
-sepsis

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3
Q

C Spine nerves emerge _ the respective vertebrae

A

above
-UNTIL C8, EMERGES BELOW CV 7

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4
Q

All spinal nerves beyond the cervical region emerge _ the respective vertebra

A

below

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5
Q

DC AC for neuraxial block?
-ASA or NSAIDS

A

no restrictions, safe w neuraxial blocks

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6
Q

DC AC for neuraxial block?
-clopidogrel (plavix)***

A

DC 5-7 days prior **

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7
Q

DC AC for neuraxial block?
-warfarin (coumadin)

A

DC 4-6(or 5) days WITH normal INR*** ( N= 1.0, therapeutic for AC=2-3)

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8
Q

Spinal anesthesia is AKA : (3 other names)

A

subarachnoid, intrathecal, SAB

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9
Q

Spinal anesthesia is a temporary interruption of nerve transmission in _ space produced by LA injection into _.

A

subarachnoid
CSF

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10
Q

T/F Spinal blocks can be used in wide variety of settings and can allow segmental control of which parts are blocked.

A

F, not as broad as epidural, all or nothing, total sensorimotor block

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11
Q

T/F epidurals can deliver LA via a single bolus, continuous infusion, titratable, or via PCA for postop pain

A

true
-can allow for segmental blocks

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12
Q

Which method of neuraxial block is diffusion dependent?

A

epidural
-requiring larger volumes than spinal

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13
Q

Typical LA volume required for a spinal block is _-_mL and for epidurals is _mL

A

spinal: 1-4mL
epidural: 20mL

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14
Q

_ blocks can take longer to achieve and longer to perform.

A

epidural

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15
Q

_ blocks can be given anywhere on spinal column unlike _ blocks which must be below spinal cord under L2

A

epidural
spinal

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16
Q

Which method of neuraxial block has a lower risk of PDPH and hypotension, spinal or epidural?

A

epidural

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17
Q

The spinal cord extends from the _ _ to the spinal level _ or _ (adults) and _ in kids

A

foramen magnum
L1/L2
L3

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18
Q

The dural sac can be found in adults at _ and kids at _

A

S2
S3

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19
Q

The epidural space is between the _ _ and _

A

vertebral canal and meninges

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20
Q

The dura extends from the _ _ to _ and terminates as the _ _

A

foramen magnum to S2
filum terminale

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21
Q

Which meningeal layer adheres to the spinal cord?

A

pia mater

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22
Q

Which area of the spinal cord contains CSF?

A

subarachnoid space

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22
Q

T/F the dural sac is the highest point one may give a spinal block

A

false, dural sack is at S2, spinal must stay below L2

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23
Q

T/F A spinal block can be placed at L1 or above

A

false!
must be BELOW L2

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24
Q

The vertebral column extends in midline from the _ of the _ to the pelvis

A

base of skull

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25
Q

T/F spinal canal’s functions are supporting head, protecting vertebral column, attaching point for extremities, and transmission of weight from trunk to LE

A

false, this is the job of the vertebral column

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26
Q

**The landmark which is the most prominent spinal process is _ which has the spinal segment _ beneath it. **

A

CV7, C8

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27
Q

* The landmark that is opposite to the inferior angle of the scapula is _*

A

T7

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28
Q

Tuffier’s line is a landmark connecting the iliac crests which is at the level of _ - _

A

L4-L5
-IMPORTANT FOR SPINALS

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29
Q

How many fused bones are there in vertebrae?

A
  1. 5 sacral
    4 coccyx
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30
Q

How many total vertebrae are there? In which regions?

A

33 total
7 C
12 T
5 L
5 S
4 C

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31
Q

***The caudal end of the epidural space can be accessed via the _ _

A

sacral hiatus
-an opening formed by incomplete POSTERIOR fusion of FIFTH sacral vertebrae***
-important landmark for caudal anesthesia

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32
Q

The cervical and lumbar curves are _ anteriorly and _ posteriorly

A

convex
concave

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33
Q

The thoracic and sacral curves are _ anteriorly and _ posteriorly

A

concave
convex

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34
Q

What significance does anatomical curves of vertebral column offer?

A

influences spread of LA in SUBARACHNOID space along with gravity and baricity of LA

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35
Q
A
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36
Q

If pt laying supine, which points are high points? ***

A

C5 and L5

High 5!

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37
Q

If pt laying supine, which points are low points? ***

A

T5 and S2

When going thru low point ppl say “Thats 5ad”, and “Sorry” 2

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38
Q

The spinal canal extends from the _ _ to the _ _

A

foramen magnum
sacral hiatus

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39
Q

Contents of the spinal CANAL

A

-spinal cord
-spinal nerves
-epidural space

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40
Q

***Boundaries of spinal CANAL:

A

Ant: vertebral body*
Lat: pedicles*
Post: spinous processes and LAMINAE*
-help guide placement of needle for neuraxial techniques ***

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41
Q

Which articulate posterior elements of adjacent vertebrae?

A

Vertebral facet (zygapophyseal) joints

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42
Q

The _ articular process protrudes caudally and overlaps the inferiorly adjacent vertebra’s _articular process

A

inferior
superior

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43
Q

The junction of the lamina and pedicles gives rise to

A

inferior and superior articular processes

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44
Q

Which ligaments reinforce the vertebral column anterior and posteriorly?

A

Ant and Post LONGITUDINAL ligaments

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45
Q

**Give the order of structures the needle will pass before it reaches the subarachnoid space for a spinal block:

A

1.skin
2. subcut tissue
3. supraspinous lig
4. interspinous lig
5. LF
6. epidural space (STOP IF EPIDURAL*)
7. dura
8. arachnoid

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46
Q

Which ligament connects the apices of the spinous processes?**

A

supraspinous

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47
Q

The supraspinous lig is strong and fibrous, connects the spinous processes from the _ to _**

A

sacrum to C7

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48
Q

Which ligament is a thin membranous and connects spinous processes?**

A

infraspinous lig
-supraspinous connects this via apices and is strong and fibrous

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49
Q

Which ligament has a DENSE supply of yellow elastin fibers?

A

LF

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50
Q

Which ligament will give a sense of resistance to one placing a neuraxial needle?***

A

lig flav

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51
Q

***The spinal CORD spans:

A

CONTINUOUS above medulla oblongata and extends to lumbar region as CONUS MEDULLARIS**~LV1/LV2

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52
Q

**The landmark which is the posterior superior iliac spine is found at level. **

A

S2 and S3

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53
Q

Cauda equina is where we typically place _ blocks.

A

spinal
-bundle of nerve roots in the SUBARACHNOID space past conus medullaris
-covered in PIA mater so sensitive to LA**not dura like other parts

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54
Q

Nerves exit the _ _ which is between pedicles of 2 adjacent vertebrae

A

intervertebral foramen

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55
Q

***How many spinal nerves are there?

A

62!! 31 PAIR***
-8C
-12T
-5L
-5S
-1C

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56
Q

Target sites of neuraxia anesthesia?

A

spinal nerve roots and spinal cord

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57
Q

Dura mater is tough, fibrous and INelastic and extends from the _ _ to the _ (S2)

A

cranial vault
sacrum

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58
Q

Which meninge is thin, vascular, fibroelastic tissue and terminates at filum terminale?

A

PIA

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59
Q

The epidural space extends from the _ _ to the _ _

A

foramen magnum
sacral hiatus

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60
Q

The epidural space produces negative pressure of _ cmH2O with inspiration

A

-9cm H2O

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61
Q

***Contents of epidural space:

A

-nerves
-vessels (arteries and vertebral venous plexus AKA BATSON veins)
-fat
-lymphatics
-connective tissue

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62
Q

Skin to epidural space distance ranges from 2-9cm but is TYPICALLY:

A

4cm

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63
Q

*** Contents of subarachnoid space:

A

-numerous arachnoid trabeculae-spongy masses
-spinal cord
-nerves
-CSF
-blood vessels

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64
Q

*Blood supply of the spinal cords comes from _ anterior and _ posterior arteries

A

1
2

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65
Q

T/F A benefit of having neuraxial anesthesia only is pts do not need to fast

A

false, yeah they do!
-less risk of N/V can still happen tho

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66
Q

Optimal cases for neuraxial anesthesia:

A

-cases of perineum, lower abdomen, and LE
-laboring pt -> CS
-**TURP to monitor for TURP syndrome
-upper abdominal surg
-cholecystectomy or gastrectomy

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67
Q

Primary site of action of neuraxial anesthesia is _ _ and the secondary is the _ _

A

nerve roots
spinal cord

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68
Q

*Factors influencing sensitivity of nerve fiber to LA:

A

-anatomical position(location or number of axons)
-chemical factors(myelination-more sensitive)

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69
Q

*Factors influencing onset, duration, and differential blockade of different functions of body:

A

-which fiber is blocked
-which LA is being used
-both affect DIFFERENTIAL sensitivity

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70
Q

Physiological causes of differential blockade:

A

-distance AND type of nerve fibers relative to the injection site (diffusion causes spread and less LA available the farther the spread)

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71
Q

If giving a spinal block at L3/L4, expect a sympathetic block to be about _ dermatomes beyond motor block, and pain/touch sensory block to be about _ dermatomes from motor block

A

2-4 dermatomes
2-3 dermatomes

SENSORY BLOCK WILL BE 2 ABOVE MOTOR
SYMPATHETIC BLOCK WILL BE 2 ABOVE SENSORY

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72
Q

Why could B fibers be the easiest to be affected by neuraxial blocks and cause sympathectomy?

A

-lightly myelinated, small in size, usually found on outside of nerves

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73
Q

Neuraxial fiber block order:

A

-B (pre ganglionic- autonomic**)
-A Delta + C fibers (C>A deltapost ganglionic-pain/temp/touch)
-rest of A fibers (gamma>beta>alpha-proprioception +motor)

B>C>Ad>AG>Ab>Aa

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74
Q

Neuraxial fiber recovery order occurs in _.

A

reverse
-motor/proprioception function comes back 1st
-A alpha>beta>gamma
-A delta > C
-B

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75
Q

***Neuraxial sensorimotor function block order:

A
  1. sympathetic function
  2. pain
  3. temp, touch, pressure
  4. proprioception
  5. motor function
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76
Q

Spinal block distribution is dependent on:

A

-Baricity
-Pt position (except isobaric)
-Dose(concentration) of LA

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77
Q

Giving a spinal block for perineal/anal procedures should have block around -

A

S2-S5
-saddle block

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78
Q

Giving a spinal block for foot and ankle procedures should have block at_

A

L2

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79
Q

Giving a spinal block for thigh/LE procedures should have block at _

A

L1

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80
Q

Giving a block for TURP, vaginal delivery, or hip procedures should have block at _

A

T10

TURP T10

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81
Q

Giving a block for LE (with tourn) procedures should have block at _

A

T8

Tourn T8

82
Q

Giving a block for intestinal, GYN, or urology cases should have block at _

A

T6
inTestinal

83
Q

Giving a block for abdominal procedures should have block at _

A

T4

84
Q

T4 block correlates with

A

nipple line

85
Q

T6-T7 block correlates with

A

xiphoid process

86
Q

T10 block correlates with

A

umbilicus

87
Q

L1 block correlates with

A

inguinal ligament

88
Q

C8 block correlates with

A

fingers

89
Q

Hyperbaric LA is _ dense than CSF and spreads _ more easily.

A

more
up

90
Q

How to make more dermatomes anesthetized with neuraxial block:

A

increase dose

91
Q

How to keep dermatomes anesthetized longer with neuraxial block:

A

add Epi to LA
-increases DOA

92
Q

Shortest acting LA

A

lidocaine

93
Q

Longer acting LA

A

Tetracaine

94
Q

Which LA is isobaric?

A

Mepivacaine

95
Q

Serum conc of LA depends on:

A

injection technique
site of injection
additives

96
Q

Bupivicaine max dose

A

3mg/kg

97
Q

Lidocaine max dose

A

4.5mg/kg
7mg/kg with Epi

98
Q

Mepivacaine max dose

A

4.5mg/kg
7mg/kg with Epi

99
Q

Prilocaine max dose

A

8mg/kg

100
Q

Ropivacaine max dose

A

3mg/kg

Rop = 3 letters

101
Q

T/F Adding opioids increases sensorimotor block in spinal blocks

A

false, just sensory only

102
Q

Adding fentanyl to spinal LA
-dose

A

15-25mcg

103
Q

Adding morphine to spinal LA
-dose

A

0.1-0.5mg
-up to 1mg

104
Q

Spinal anesthesia can cause CV changes via blocking the _ _

A

sympathetic chain (preganglionic)
-B fiber ae easiest to block, higher the block, higher level of sympathectomy

105
Q

MOA of CV effects after spinal block:

A

causes venous dilation leading to
-reduced preload and HR, SVR (results in reduced CO)too
-venous system depends on gravity for return, position/pt wt plays role in this too

106
Q

Tx for CV effects after LA spinal block:

A

give fluids (preferably before this happens) or epi if absolutely needed
-know how to calc maintenance fluids

107
Q

N/V from spinal block is probably due to chemical sympathectomy with unopposed _ tone and/or hypotension

A

parasympathetic tone
-give fluids, treat for hypotension

108
Q

If a pt is tachycardic after spinal block, it is likely due to _ _ with hypotension

A

baroreceptor rrflex

109
Q

If a pt is bradycardic this could be from a sympathetic block on cardiac _ _ which are found on T1-T4**

A

accelerator fibers
-SLOW onset
-treat with epi and ephedrine

110
Q

Main causes of hypotension following a spinal block:

A

decreased CO from decreased preload and/ or hypovolemia

111
Q

Mgmt of hypotension from spinal:
-monitor VS

A

-Tx BP (healthy pt >33% drop, CV pt >20-25% drop)
-watch ST segment
-give supp O2

112
Q

Mgmt of hypotension from spinal:
-fix BP

A

Restore preload
-crystalloid/colloids 500-1500mL(won’t help much if pt euvolemic)
-Trend bed
-displace uterus
-pressors

113
Q

Mgmt of hypotension from spinal:
-pressors

A

Ephedrine (DOC)
-5-15mg IV
Phenylephrine
-50-100mcg IV
Epi
-5mcg IV

114
Q

Spinal block impact on CBF

A

can disrupt autoregulation if hypotensive
-keep MAP >50-55mmHg

115
Q

T/F CBF autoregulation is directly influenced by SNS

A

false

116
Q

Spinal block influence on renal f’n:

A

changes are proportional to changes in arterial BP
-GFR can decrease if blood flow decreases

117
Q

Spinal block into thoracic region can affect _ and _ muscles, leading healthy pt to think theyre not breathing

A

intercostal and abdominal
-if pt talking and spo2 ok theyre fine

118
Q

GI effects from spinal block:

A

continued peristalsis from contracted gut and relaxed sphincters, good for GI surgeon

119
Q

The PNS of the gut doesn’t get blocked because the _ nerve doesn’t get blocked by neuraxial spinal block allowing for continued peristalsis

A

vagus

120
Q

Spinal blocks are performed below the level of _ and use Tuffier’s Line as a landmark which is seen at -.

A

L2
L4-L5

121
Q

Should feel a “pop” after going thru _ with needle

A

LF

122
Q

Needles with gauges larger than _ G don’t need an introducer

A

22G

123
Q

The _ needle has highest rate of PDPH bc its used for spinals and cutting

A

Quincke

124
Q

Check BP Q - min with spinals

A

3-5 min

125
Q

During a spinal, aspirating approx _ mL of CSF tell you you’re in the _ region

A

0.2ml
subarachnoid

126
Q

When using Quincke needle, move bevel to face _ to avoid cutting dura

A

hip

127
Q

***Midline approach- spinal

A

midline
lower 1/3 of interspace
slightly cephalad direction (10* angle)

128
Q

Benefit of Paramedian approach for spinals

A

can use it to avoid calcified ligaments or work around when pt anatomy is difficult (kyphosis)
-thoracic epidural insertion bc steepness of spin processes

129
Q

Epidurals, compared to spinals have an increased risk of _ but lower risk of _

A

LAST (b/c Batsons veins are closeby)
PDPH

130
Q

Epidural LA MOA:

A

spinal roots in CSF (subarachnoid space)*, mixed nerves in epidural space and spinal cord via DIFFUSION

131
Q

Granulations in the _ mater increase the rate of diffusion in epidural blocks

A

dura

132
Q

Epidural site of action:

A

-spinal nerve roots**
-rootlets
-mixed spinal nerves
-DRG?
-SC
-Brain (bc impulses won’t conduct via SC)

133
Q

Main factors impacting level of epidural block:

A

-dose (concentration AND volume); more volume, more vertical spread
-injection site (and rate)
-NOT baricity

134
Q

The ideal anesthetic insertion point for epidurals is at the _ level

A

surgical

135
Q

Lumbar epidural blocks tend to have a greater cranial than caudal spread bc there’s a delay at _ - _ and these nerves are larger and harder to block

A

L5-S1

136
Q

T/F Lumbar blocks are more evenly spread than midthoracic blocks for epidurals

A

false

137
Q

The _ needle is used for epidural blocks and the average appropriate depth is _-_cm

A

Tuohy (idk how to spell lol)
4-6cm

138
Q

The Tuohy (spelling?) needle has markings that are _ cm increments and is _ cm from tip to prox hub and _ cm from tip to distal hub

A

1cm
9cm
11cm

139
Q

Once placed properly, the epidural catheter should be thread _-_cm into pt beyond needle tip.

A

3-5cm
-so if 4cm in pt with needle, thread just past 9cm and pull back until 9cm

140
Q

For cervical and lumbar epidural blocks, approach should be _ while thoracic should be _ due to the steepness of SPINOUS PROCESSES

A

MIDLINE
PARAMEDIAN

141
Q

With paramedian epidural approach, use anatomic landmarks to plan insertion and _ to redirect when necessary

A

bone
-usually thoracic vertebra LAMINA

142
Q

Epidural insertion site
-mastectomy

A

T1

143
Q

Epidural insertion site
-thoracotomy

A

T4

144
Q

Epidural insertion site
upper abd

A

T7-T8

145
Q

Epidural insertion site
-lower abd

A

T10

146
Q

Epidural insertion site
above knee LE

A

L1-L2

147
Q

Epidural insertion site
below knee LE

A

L3-L4

148
Q

Epidural insertion site
Perineal

A

L4-L5

149
Q

Tuohy needle is - G and rounded at the tip to prevent crossing thru _

A

17-18G
dura
-keep bevel UP

150
Q

In epidural placement after loss of resistance technique, if unable to thread catheter, what do you do?**

A

-add 1mL NS to open space to thread cath
-if still unable to, WRONG SPOT, try again using same puncture site

151
Q

LF is _-_mm thick

A

5-6mm

152
Q

T/F aspirating is only necessary with spinals bc epidural space doesn’t have CSF***

A

false, while epidural space doesn’t have CSF, if it is aspirated, you know you’ve gone too far (thru dura) and if heme is aspirated you’re at risk for injecting into vasculature

153
Q

T/F negative aspiration of CSF or blood means you’re in the epidural space and you’re gtg

A

FALSE!
-could be up against tissue in WRONG spot, ok to inject sm amt of NS to “flush”
-TEST DOSE negativity is the ticket

154
Q

The test dose for epidurals consists of_ mL of _ % Lidocaine and 1: _ of Epi

A

3mL
1.5%
1:200,000
= 45mg Lido + 15mcg Epi

155
Q

T/F a test dose should be given for ALL epidural blocks regardless of location

A

false-don’t give if >T10 block

156
Q

Test doses for epidurals, if given in wrong spot can cause:

A

-sensory block in 3-5 min
-15-20 bpm increase in HR for 2-3 min (may not be seen in old pt, OB, or those on BBs)
-if + REMOVE

157
Q

T/F must aspirate before every injection

A

true!

158
Q

T/F dose, site, and baricity effect spread of all neuraxial LA

A

false,
epidural spread doesn’t depend on baricity and depends more on volume than concentration unlike spinals

159
Q

Bupi <0.25% epidurak will cause a

A

sympathectomy

160
Q

Bupi 0.5% epidural can cause

A

dense sensory block
mild motor block

161
Q

Bupi 0.75% epidural can cause

A

full anesthetic block (sympath + full sensorimotor)

162
Q

***Typically want to give - mL of epidural LA per dermatome segment you’re trying to block (while considering it spreads vertically)

A

1-2mL

163
Q

**If giving epidural at T12-L1 and need coverage up to T8, how many mL of LA do you give?

A

~5 dermatomes
so 5-10mL **

164
Q

Adding Bicarb to LA epidural does what?

A

raises pH and increases rate of diffusion /speed of onset
-alkalization speeds onset for LA

165
Q

If adding bicarb to LA epidural, how much should be added?

A

1mL of 8.4% Na Bicarb to 9mL of LA

166
Q

High spinal carries respiratory risk bc

A

paralysis of accessory muscles, weak cough, unable to ventilate or protect airway

167
Q

Urine rtn/ poor bladder tone can happen from a _ blockade of S2-S4

A

sympathetic

168
Q

**PDPH ppl at risk:

A

-female
-preg
-younger

169
Q

PDPH s/s

A

-positional HA(frontal, occipital, radiating to neck, better laying flat or with abd pressure)
-N/V
-less often: ocular and auditory s/s

170
Q

PDPH tx

A

-pvn
-supine (bedrest compresses CSF leak)
-fluids
-pain meds
-CAFFEINE
-EPIDURAL BLOOD PATCH (10-20mL)

171
Q

T/F Epidural hematoma and abscess have same symptoms

A

true
-ACUTE back pain and/ or sensory and motor deficits PROGRESS to paraplegia and INCONTINENCE*** (12hr-2days postop)
-dx: MRI
-tx: surg decompress w/in 8hr

172
Q

High/ total spinal
-s/s

A

-severe hypotension
-bradycardia
-resp distress (rapidly changes to apnea)**
-from high spread of LA on SC and brainstem

173
Q

High/ Total Spinal
-tx

A

supportive
-airway: vent + O2
-CV: pressors and fluids (atropine for brady or ephedrine or epi for both brady and low BP)

174
Q

Bladder + bowel dysfunction and leg weakness after receiving lidocaine 5% is most likely what syndrome?

A

cauda equina syndrome

175
Q

LAST
-factors influencing plasma conc.

A

-dose
-rate absorbed
-site injected/ use of adjuncts
-biotransformation or elimination of drug

176
Q

LAST
-early s/s

A

CAN BE MASKED IF PREMEDICATED W BENZO
-dizzy
-tongue numb*
-difficulty focusing
-tinnitis**
-confusion
-muscle twitching

177
Q

LAST
-late s/s

A

-ton/clon sx
-coma
-resp + cardiac arrest

178
Q

LA are myocardium depressants
-arrhythmias seen:

A

-conduction delays (long PR, CHB, asystole)
-stubborn ventricular dysrhythmias (despite traditional therapies)

179
Q

LA are myocardium depressants
-low blood levels LA cause

A

-small INCREASE in CO, BP, HR from SNS activity and VASOCONSTRICTION

180
Q

LA are myocardium depressants
-high blood level of LA cause

A

-low BP from low PVR, low CO, and arrhymias
-arrest

181
Q

LAST
-pvn

A

-US GUIDANCE
-benzos as premedication can lower seizure rate but mask s/s
-be ready for anything
-LA and resusc drugs close by
-double check dose(give LOWEST effective dose)
-deliver in increments (3-5ml w/ 15-30s pause between)
-aspirate Q injection!
-TEST DOSE! (45mg Lido 15mcg Epi!)
-VERBAL communication w pt

182
Q

LAST
-Tx, resp

A

O2-mask, LMA, ETT

183
Q

LAST
-Tx CV/meds

A

-lift legs, fluids, BP meds
-anticonvulsants (benzos, prop, thiopental)
-standard arrhythmia drugs (EXCEPT CCB, sodium valproate, phenytoin, vasopressin, and other LAs)

184
Q

LAST
-lipid infusion

A

-if pt unresponsive to standard resusc. but can give immediately after securing airway*
-bolus
-infusion
-CHEST COMPRESSIONS TO CIRCULATE
-repeat bolus Q 3-5 up to 3mg/kg
-leave infusion on until CV stable

185
Q

Intralipid bolus dose

A

Pt <70kg :
1.5mL/kg (IBW) over 2-3min
repeat bolus x3 for persistent CV collapse; upper limit 12mL/kg in 1st 30 min

Pt >70kg
20% Interlipid
100mL over 2-3 min

186
Q

Intralipid infusion

A

Pt<70kg:
0.25-0.5mL/kg /min

Pt >70kg:
200-250mL over 10-20 min
-keep on for at leas t10 min after CV stable

187
Q

LA toxicity requires close control on what factor due to the factor’s influence on inotropic/chronotropic effects?

A

O2 + ventilation
-hypoxia, acidosis, and hypercarbia worsen this

188
Q

LAST
-TEST DOSE concentrations and actual dose

A

3mL of 1.5% Lidocaine + 1:200,000 Epi
= 45mg Lido + 15mcg Epi

189
Q

How long to hold coumadin for during regional case?

A

5 days

190
Q

Which risk factors for development of post dural puncture headache are correct? Pick 2:
a. Elderly
b. female
c. pregnant
d. short

A

c+ d, female + pregnant

191
Q

Which is the last ligament a needle passes thru when giving an epidural?

A

LF

192
Q

During a spinal, which needle type is most likely to cause post dural puncture headache?

A

Quincke

193
Q

What structure “pops” during a subarachnoid block when done properly?

A

LF

194
Q

MOA of LA injection into epidural space:

A

-distributes along epidural space
-retained in fatty tissue
-diffuses thru dural cuffs

195
Q

A Quincke or Whitacre can be used for a _ block

A

spinal

196
Q

Baricity and positioning affect _ blocks

A

spinal

197
Q

A/an _ block can be given at cervical, thoracic, or lumbar levels.

A

epidural

198
Q

The onset of _ blocks are 10-20 min

A

epidural

199
Q

The _ block gives segmental anesthesia

A

epidural

200
Q

After placing a spinal block, your pt is bradycardic 10 mins later. This means their block level went up to _ - _.

A

T1-T4

201
Q

If you want a spinal block to move cephalad, mix _ _ with the LA.

A

sterile water
-not dextrose or CSF

202
Q

Your pt complains of rapid HR and ringing in the ears after a successful test dose and epidural is placed. What should you do?

A

remove the epidural cath asap

NA 1 (31 decks)

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