spinal and epidural part 4

Question 1

causes of unilateral block

Answer 1

catheter may be inserted too far
catheter tip might be too close to a nerve

Question 2

the 4 solutions discussed in lecture for unilateral block

Answer 2

adjust the catheter (pull back 1-2 cm) ensure 3-5 remains in epidural space
reposition patient
administer more anesthetic
catheter replacement

Question 3

most frequent symptom of LAST

Answer 3

seizure
with bupivacaine cardiac arrest may come before seizure

Question 4

when is LAST more common

Answer 4

peripheral nerve blocks

Question 5

s/s lidocaine toxicity 1-5mcg/mL

Answer 5

analgesia

Question 6

s/s lidocaine toxicity 5-10mcg/ml

Answer 6

tinnitus
skeletal muscle twitching
numbness of lips and tongue
restlessness
vertigo
blurred vision
hypotension
myocardial depression

Question 7

s/s lidocaine toxicity 10-15mcg/mL

Answer 7

seizures
loss of consciousness

Question 8

s/s lidocaine toxicity 15-25mcg/mL

Answer 8

coma
respiratory arrest

Question 9

s/s lidocaine toxicity >25mcg/mL

Answer 9

CV collapse

Question 10

CNS toxicity from LAST risk increase with

Answer 10

hypercarbia
hyperkalemia
metabolic acidosis

Question 11

CNS toxicity from LAST risk decrease with

Answer 11

hypocarbia
hypokalemia
CNS depressants

Question 12

CV toxicity bupivacaine impact of LA on heart functions

Answer 12

decrease heats automaticity, conduction velocity, action potential duration nd effective refractory period
depress myocardium by affects intracellular calcium regulation

Question 13

key factors determining the extent of cardiotoxicity

Answer 13

LA affinity tot he voltage sodium channels in active and inactive states
rate of dissociation from the receptor during diastole

Question 14

bupivacaine has a ________ affinity to voltage sodium channel and a _________ dissociation rate from receptor during diastole

Answer 14

high affinity
slower dissociation

Question 15

difficulty of cardiac resuscitation from most to least

Answer 15

bupivacaine
levobupivacaine
ropivacaine
lidocaine

Question 16

treatment of LAST

Answer 16

manage airway
treat seizures with benzos not prop
modified ACLS (cautious with epinephrine)
lipid emulsion therapy 20%

Question 17

how is lipid emulsion give

Answer 17

over 70kg start with 100mL bolus for 2-3 minutes followed by 250mL infusion over 15-20 minuets repeat or double if unstable
under 70kg start 1.5mL/kg followed by 0.25ml/kg

Question 18

epidural/spinal hematoma cord ischemia reversible is

Answer 18

laminectomy is performed in <8hours

Question 19

what is arachnoiditis caused by

Answer 19

inflammation of meninges
non approved administration of drugs into intrathecal or epidural space
using non preservative free solutions
betadine contamination (didn’t wipe off excess)

Question 20

what should you always have as back up for regional set up

Answer 20

general set up

Question 21

what are the 3 common reasons for block failure

Answer 21

wrong dose
wrong location
wrong position

Question 22

what are the cutting needles

Answer 22

quincke
pitkin
cause spinal headache

Question 23

non cutting needles

Answer 23

sprotte
whitacre
pencan
greene
gertie marx

Question 24

what is the advantage of using pencil point tip in a SAB

Answer 24

drag fewer contaminants into subnormal tissue
significantly less risk for PDPH

Question 25

which needle has the most curvature

Answer 25

tuohy

Question 26

multi orifice catheters have a lower incidence of but a higher incidence of

Answer 26

inadequate anesthesia inadvertent intravascular placement

Question 27

what is the test dose comprised of

Answer 27

3mL of 1.5% lidocaine mixed with epinephrine (1:200,000)

Question 28

accidental IV placement with test dose will see what symptoms

Answer 28

increase HR 20% tinnitus metallic taste in mouth numbness around the mouth