Spinal & Epidural Part 3 ( Tubog) Exam 1 Flashcards
Which of the following are effects of high thoracic (T4) level dermatomal spread of local anesthetic? (Select all that apply)
a.) Increase in tidal volume
b.) Small decrease in vital capacity
c.) Decrease in expiratory reserve volume (ERV)
d.) Increase in inspiratory reserve volume
b.) Small decrease in vital capacity
c.) Decrease in expiratory reserve volume (ERV)
Special considerations for patients under neuraxial anesthesia include: (Select all that apply)
a.) Use caution in COPD, Pickwickian syndrome
b.) Feelings of dyspnea in the normal population
c.) Loss of the ability to take big breaths and strong cough
d.) Increased respiratory rate
a.) Use caution in COPD, Pickwickian syndrome
b.) Feelings of dyspnea in the normal population
c.) Loss of the ability to take big breaths and strong cough
What is the typical reason for apnea during neuraxial anesthesia?
a) Blockage of accessory muscles of respiration
b) Increased tidal volume
c) Reduced blood flow to the brainstem, affecting the brain’s breathing centers
d) Nerve paralysis due to high concentrations of local anesthetics
c) Reduced blood flow to the brainstem, affecting the brain’s breathing centers
Which of the following is unchanged even with high thoracic level dermatomal spread of local anesthetic?
a) Vital capacity
b) Expiratory reserve volume (ERV)
c) Tidal volume
d) Accessory muscles of respiration
c) Tidal volume
High thoracic blockade can result in the blockade of accessory muscles of respiration such as __________ and __________ muscles.
Answer: intercostal, abdominal
- intercostal
- abdominal
High concentrations of local anesthetics in the spinal fluid rarely cause __________ that stops breathing.
nerve paralysis
Small decreases in vital capacity during neuraxial anesthesia is due to loss of __________ muscle contribution in forced expiration.
abdominal
Which of the following are functions of parasympathetic efferent innervation in the GI tract?
a.) Tonic contractions
b.) Sphincter relaxation
c.) Peristalsis
d.) Secretion
e.) Transmit visceral pain
a.) Tonic contractions
b.) Sphincter relaxation
c.) Peristalsis
d.) Secretion
The sympathetic innervation of the GI tract includes:
a.) Inhibition of peristalsis
b.) Inhibition of gastric secretion
c.) Transmission of sensations of satiety
d.) Sphincter contraction
e.) Vasoconstriction
a.) Inhibition of peristalsis
b.) Inhibition of gastric secretion
d.) Sphincter contraction
e.) Vasoconstriction
What is the primary nerve involved in parasympathetic innervation of the GI tract?
a) Splanchnic nerve
b) Superior mesenteric ganglion
c) Vagus nerve
d) Inferior mesenteric ganglion
c) Vagus nerve
Which of the following is a function of sympathetic afferent innervation in the GI tract?
a) Transmit sensations of satiety
b) Transmit visceral pain
c) Promote peristalsis
d) Sphincter relaxation
b) Transmit visceral pain
Parasympathetic afferent innervation transmits sensations of __________, distension, and nausea.
satiety
Sympathetic innervation of the GI tract stems from __________ to __________.
- T5
- L2
Sympathetic efferent innervation inhibits peristalsis and gastric secretion and causes sphincter contraction and __________.
vasoconstriction
Parasympathetic efferent innervation includes tonic contractions, sphincter relaxation, peristalsis, and __________.
secretion
Which organs receive sympathetic innervation from T5 to L2?
a.) Liver and Gall Bladder
b.) Stomach
c.) Small Intestine
d.) Colon
e.) Bladder
All the Above
* a.) Liver and Gall Bladder
* b.) Stomach
* c.) Small Intestine
* d.) Colon
* e.) Bladder
Which of the following organs are innervated at T4?
a.) Esophagus
b.) Heart
c.) Stomach
d.) Liver and Gall Bladder
a.) Esophagus
b.) Heart
The heart receives sympathetic innervation primarily from which spinal levels?
a) T1 and T2
b) T3 and T4
c) T5 and T6
d) T7 and T8
b) T3 and T4
Sympathetic innervation of the kidney and testes stems from __________ to __________.
- T10
- L1
Sympathetic innervation of the GI tract stems from which spinal levels?
a) T1-T5
b) T3-T7
c) T5-L2
d) L1-L5
c) T5-L2
Which of the following are results of increased parasympathetic activity due to neuraxial anesthesia?
a.) Relaxes sphincters
b.) Increases peristalsis
c.) Decreases GI blood flow
d.) Small, contracted gut with active peristalsis
a.) Relaxes sphincters
b.) Increases peristalsis
d.) Small, contracted gut with active peristalsis
Changes resulting from unopposed vagal tone include:
a.) Increased GI blood flow
b.) Nausea and vomiting
c.) Decreased incidence of ileus
d.) Small, contracted gut with active peristalsis
a.) Increased GI blood flow
b.) Nausea and vomiting
d.) Small, contracted gut with active peristalsis
What effect does neuraxial anesthesia have on sympathetic tone?
a) Increases sympathetic tone
b) Reduces sympathetic tone
c) Has no effect on sympathetic tone
d) Inhibits parasympathetic tone
b) Reduces sympathetic tone
What is the incidence of nausea and vomiting in patients due to the changes in unopposed vagal tone caused by neuraxial anesthesia?
a) 10%
b) 15%
c) 20%
d) 25%
c) 20%
Local anesthetics used in neuraxial blocks decrease the activity of __________ nerves.
sympathetic
One of the resulting changes in unopposed vagal tone is a __________, contracted gut with active peristalsis.
small
With less sympathetic inhibition, the __________ system becomes more dominant.
parasympathetic
Neuraxial anesthesia reduces postoperative incidence of __________ in abdominal surgery.
ileus
Which of the following are effects of neuraxial opioids on the bladder?
a.) Decrease in detrusor contraction
b.) Increase in bladder capacitance
c.) Increase in detrusor contraction
d.) Decrease in bladder capacitance
a.) Decrease in detrusor contraction
b.) Increase in bladder capacitance
Which of the following are true regarding the effects of sympathetic blockade above T10?
a.) Affects bladder control
b.) Urinary sphincter tone relaxed
c.) Increase in renal blood flow
d.) Decrease in bladder capacitance
a.) Affects bladder control
b.) Urinary sphincter tone relaxed
What is the effect on renal blood flow when mean arterial pressure (MAP) is maintained during neuraxial anesthesia?
a) Increased renal blood flow
b) Decreased renal blood flow
c) No change in renal blood flow
d) Fluctuating renal blood flow
c) No change in renal blood flow
What is a common complication associated with neuraxial anesthesia due to changes in bladder function?
a) Increased urine output
b) Decreased bladder capacitance
c) Urinary retention/incontinence
d) Increased detrusor contraction
c) Urinary retention/incontinence
Neuraxial anesthesia causes no change in renal blood flow when __________ is maintained.
mean arterial pressure (MAP)
Sympathetic blockade above T10 affects bladder control and causes urinary sphincter tone to be __________.
relaxed
Addition of neuraxial opioids leads to a decrease in __________ contraction and an increase in bladder __________.
- detrusor
- capacitance
These changes in bladder function often lead to urinary __________ and the need for a foley catheter with neuraxial anesthesia.
retention/incontinence
Which of the following are elevated due to the activation of somatic and visceral afferent fibers from pain, tissue trauma, and inflammation?
a.) Cortisol
b.) Epinephrine
c.) Norepinephrine
d.) Vasopressin
e.) Activation of renin-angiotensin-aldosterone system
All the Above:
* a.) Cortisol
* b.) Epinephrine
* c.) Norepinephrine
* d.) Vasopressin
* e.) Activation of renin-angiotensin-aldosterone system
Neuraxial blockade can:
a.) Partially suppress the neuroendocrine response to major invasive surgery
b.) Totally block the neuroendocrine response to lower extremity surgery
c.) Increase the release of cortisol and epinephrine
d.) Provide maximal benefits if applied before the surgical stimulus
a.) Partially suppress the neuroendocrine response to major invasive surgery
b.) Totally block the neuroendocrine
d.) Provide maximal benefits if applied before the surgical stimulus
What is a key benefit of neuraxial blockade in the context of neuroendocrine response?
a) Increases cortisol and epinephrine levels
b) Partially suppresses or totally blocks the neuroendocrine response
c) Enhances the activation of the renin-angiotensin-aldosterone system
d) Reduces blood pressure
b) Partially suppresses or totally blocks the neuroendocrine response
Which of the following are characteristics of esters and amides in local anesthetic pharmacology?
a.) Esters are metabolized by pseudocholinesterase
b.) Amides are metabolized by the hepatic P450 system
d.) Esters have no cross-sensitivity
c.) Amides produce para-aminobenzoic acid (PABA)
a.) Esters are metabolized by pseudocholinesterase
b.) Amides are metabolized by the hepatic P450 system
Which of the following statements are true regarding local anesthetic allergies?
a.) More common allergy is with esters
b.) Esters produce para-aminobenzoic acid (PABA)
c.) Amide allergic reaction is rare
d.) There is cross-sensitivity between esters and amides
e.) Amides contain preservative methylparaben, similar to PABA
a.) More common allergy is with esters
b.) Esters produce para-aminobenzoic acid (PABA)
c.) Amide allergic reaction is rare
e.) Amides contain preservative methylparaben, similar to PABA
Which type of local anesthetic is metabolized by pseudocholinesterase?
a) Amides
b) Esters
c) Both amides and esters
d) Neither amides nor esters
b) Esters
What determines the onset of action for local anesthetics?
a) Protein binding
b) Lipid solubility
c) pKa
d) Metabolism
c) pKa
Which of the following is the correct order of peripheral nerve inhibition by local anesthetics?
a) C fibers, B fibers, small diameter A fibers, large diameter A fibers
b) B fibers, C fibers, large diameter A fibers, small diameter A fibers
c) B fibers, C fibers, small diameter A fibers, large diameter A fibers
d) Small diameter A fibers, large diameter A fibers, B fibers, C fibers
c) B fibers, C fibers, small diameter A fibers, large diameter A fibers
Cocaine is also metabolized by the __________.
liver
Local anesthetic potency is influenced by __________ .
lipid solubility
Duration of action for local anesthetics is influenced by __________ .
protein binding
Which of the following statements about the mechanism of action of local anesthetics are correct?
a.) Local anesthetic agents are weak bases.
b.) Compounds with a pKa close to physiologic pH will have a faster onset of blockade.
c.) More molecules remain in the nonionized state at physiologic pH.
d.) Local anesthetic agents block calcium channels to exert their effect.
a.) Local anesthetic agents are weak bases.
b.) Compounds with a pKa close to physiologic pH will have a faster onset of blockade.
c.) More molecules remain in the nonionized state at physiologic pH.
What is the primary ion channel targeted by local anesthetics?
a) Calcium channel
b) Potassium channel
c) Sodium channel
d) Chloride channel
c) Sodium channel
Local anesthetic agents are __________ bases.
weak
Compounds with a pKa close to physiologic pH will have a __________ onset of blockade.
faster
In the nonionized state, local anesthetic molecules are able to cross the __________ to exert their action.
cell membrane
Which of the following factors influence the vascular uptake and plasma concentration of local anesthetics?
a.) Site of injection
b.) Tissue blood flow
c.) Physiochemical properties
d.) Metabolism
e.) Addition of vasoconstrictor
All the Above
* a.) Site of injection
* b.) Tissue blood flow
* c.) Physiochemical properties
* d.) Metabolism
* e.) Addition of vasoconstrictor
Local anesthetic injections in the __________ region result in lower blood concentrations compared to tracheal injections.
sciatic
Which of the following statements about isobaric solutions are correct?
a.) Density equal to CSF
b.) Has a baricity of 1
c.) Tends to stay in place where it is injected
d.) Sinks within the CSF, moving downward from the point of injection
a.) Density equal to CSF
b.) Has a baricity of 1
c.) Tends to stay in place where it is injected
Which of the following local anesthetic solutions are hyperbaric?
a.) Bupivacaine 0.75% in 8.25% dextrose
b.) Lidocaine 5% in 7.5% dextrose
c.) Tetracaine 0.5% in 5% dextrose
d.) Procaine 10% in water
- a.) Bupivacaine 0.75% in 8.25% dextrose
- b.) Lidocaine 5% in 7.5% dextrose
- c.) Tetracaine 0.5% in 5% dextrose
- d.) Procaine 10% in water
What is the behavior of a hyperbaric solution within the CSF?
a) Tends to stay in place where it is injected
b) Rises within the CSF, moving upward from the point of injection
c) Sinks within the CSF, moving downward from the point of injection
d) Distributes evenly throughout the CSF
c) Sinks within the CSF, moving downward from the point of injection
Which local anesthetic solution would be considered hypobaric?
a) Bupivacaine 0.75% in saline
b) Lidocaine 0.5% in water
c) Tetracaine 0.5% in saline
d) Procaine 10% in water
b) Lidocaine 0.5% in water