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941 > Test 1 Travis > Flashcards

Test 1 Travis Flashcards

1
Q

Adding this to LA for retrobulbar block may enhance spread.

This substance is a hydrolyser of connective tissue

A

Hyaluronidase

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2
Q

successful block of retrobulbar block will be marked by these three effects

A

anesthesia
akinesia
blockade of oculocephalic reflex
(this is the dolls eye reflex - when blocked your eyes will not continue staying midline/focused on one object when blocked so ur eyes will move with ur head turn in sync)

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3
Q

blockade of retroperitoneal block should not be performed in what 3 diseases

A
  • bleeding disorder
  • extreme myopia (produces elongate globe of eye - high risk for globe perforation
  • open eye injuries (inc pressure behind eye - risk for extrusion of eye contact with LA inj)
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4
Q

blocking this nerve prevents squinting of eye

A

facial

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5
Q

three techniques of facial nerve block

A

van Lint
atkinson
O’brien

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6
Q

major complication of facial nerve block

A

SQ hemorrhage

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7
Q

name 3 peribulbar block sites

A

inferotemporal
superonasal
medial

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8
Q

in this ocular block you have profound analgesia but movement may still be present

A

sub-tenon block

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9
Q

tenon tissue fuses anteriorly with what structure

A

conjunctiva

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10
Q

tenon tissue encapsulates this structure posteriorly

A

globe

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11
Q

oculocariac reflex involves afferent ___ ____ nerve and efferent ____ ____ nerve.

A

afferent sensory trigeminal

efferent motor vagus nerve

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12
Q

these fibers have a short chronaxy bc of relatively low capacitance of their myelinated membrane

A

motor fibers

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13
Q

these fibers have a long chronaxy because of their higher capacitance of their non myelinated membranes

A

C Pain fibers

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14
Q

Short/Long duration is the best discriminator of distance btw needle and nerve

A

shorter

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15
Q

____ MHz best for shallow structures

____ MHz best for deeper

A

10-13 shallow

2-5 deep

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16
Q

US structures appearing
Black - high water content (vessels, local csf) are__
White - transmission blocked, bone, air are ___
Gray - intermediate density - organs

A

anechoic - ie big black vein on US
hyperechoic - ie whitest muscle nerve, bone
hypoechoic - organ

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17
Q

exhibiting this.. implies that the received echo varies up angle of insonation

A

anisotropy

transducer angle changes in image of US

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18
Q

best visualization of needle tip is when the bevel is oriented which way

A

directly toward or away from the transducer

why deep 90 degree insertions do not show up well i suppose?

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19
Q

this segment of the spinal cord provides for ventral rami of brachial plexus

A

C4 - T1

cervical enlargment

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20
Q

this segment of the spinal cord provides for lumbar and sacral plexus

A

L2 - L3

lumbar enlargment

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21
Q

CSF is produced by ___ ____ of cerebral ventricles

A

choroid plexus

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22
Q

CSF is reabsorbed by ____ _____ along the sagital sinus

A

arachnoid granulation

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23
Q

SAS space contains this much CSF

A

25 - 35 ml

some texts up to 80

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24
Q

total body CSF

A

100 - 150 ml

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25
Q

what is specific gravity?

A

density of substance compared to density of water

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26
Q

what is baricity?

A

SG LA : SG CSF

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27
Q

Specific gravity directly depends on these two things

A

protein in CSF

gravity

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28
Q

changes in specific gravity is related to presence of this substance (CSF)

A

bilirubin

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29
Q

relationship of temperture to SG

A

every 1 degree of inc temp = dec SG x 0.001

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30
Q

anterior 2/3 supply to cord

A

ASA (single)

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31
Q

anterior lower 1/3 supply to cord

A

Artery of Adamkiewics

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32
Q

Artery of Adamkiewics is also know as

A

arteria redicularis magna (ARM)

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33
Q

injury to Artery of Adamkiewics may cause this syndrome which is a spinal cord infarct

A

Anterior spiral artery syndrome

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34
Q

Artery of Adamkiewics is in what segments of spine

A

T9 - L1

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35
Q

posterior 1/3 supply to cord

A

PSA (pair)

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36
Q

all arterial branch from this artery

A

vertebral

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37
Q

anastomosis btw spinal arteries

A

arterial vasocorona

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38
Q

epidural widest space in spine

A

L2 (5 - 6 mm)

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39
Q

epidural narrowest space in spine

A

C5 (1.5 - 2 mm)

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40
Q

when supine these are the two lowest points in spine

A

T6 S2

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41
Q

when supine these are two highest points

A

C3 L3

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42
Q

this spinal abnormality results from attempt to restore center of gravity

A

lordosis

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43
Q

bony knob at base of neck on spine segment

A

C7 (most prominent)

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44
Q

lower limit of scapula on spine segment

A

T7 - 8

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45
Q

terminal point of 12th ribs on spine segment

A

L2

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46
Q

posterior iliac spines on spine segment

A

S2

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47
Q

sacral hiatus and sacrococygeal ligament on spine segment

A

S5

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48
Q

conus medularis adult

A

L1

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49
Q

dural sac ends

A

S2 (correlates with posterior iliac spine)

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50
Q

tufier or line across iliac crest

A

L4

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51
Q

dermatomes: clavicles

A

C5

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52
Q

dermatomes: lateral parts of upper limbs

A

C5, 6, 7

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53
Q

dermatomes: medial sides of upper limbs

A

C8, T1

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54
Q

dermatomes: thumb

A

C6

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55
Q

dermatomes: hand

A

C6-8

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56
Q

dermatomes: ring and little finger (pinky)

A

C8

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57
Q

dermatomes: level of nipples

A

T4

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58
Q

dermatomes: umbilicus

A

T10

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59
Q

dermatomes: inguinal or groin region

A

T12

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60
Q

dermatomes: anterior and inner surface of lower limbs

A

L1, 2, 3, 4

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61
Q

dermatomes: foot

A

L4, 5, S1

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62
Q

dermatomes: medial side of great toe

A

L4

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63
Q

dermatomes: posterior and outer surface of lower

A

S1, S2, L5

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64
Q

dermatomes: lateral margin of foot and little toe

A

S1

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65
Q

dermatomes: Perineum

A

S2, 3, 4

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66
Q

dermatomes: genital

A

S2, 3

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67
Q

dermatomes: anal spincter area

A

S5

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68
Q

sensory blockade interrupts both ___ and ___ stimuli

A

somatic

visceral

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69
Q

motor blockade produces relaxation of what

A

skeletal muscle

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70
Q

differential block seen more in ____ spinal segments

A

rostral

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71
Q

assessing blockade: nerve stimulation of this mA, Hz, and duration is considered equivalent to surgical stimulation

A

60 mA
50 Hz
5 sec

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72
Q

most sensitive indication of initial onset of sensory block (assessment type)

A

alcohol swab and similar tests

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73
Q

most accurate assessment of overall sensory block

A

pinprick or blunt needle

74
Q

vasomotor tone is primarily determined by what sympathetic fibers

A

T5 - L1

causes vasodilation of venous capacitance
pooling
dec SVR

75
Q

cardiac chemoreceptors in LV wall get stimulated causing this reflex

A

Bezold - Jarisch

76
Q

primary action of sympathetic blockade is due to this.

A

venodilation

77
Q

apnea is almost always due to ____ of the respiratory centers in medulla.

A

hypoperfusion

-due to severe hypotension

78
Q

Mortality of general anesthesia is __% higher than neuraxial

A

16.7%

79
Q

advantage of neuraxial: can assess TURP patients during surgery for patient to alert physician of __ __.

A

Bladder distension

80
Q

TURP syndrome s/s

A

hypervolemia
hyponatremia
ammonia toxicity

81
Q

8 things. absolute CI/going to hell if you administer neuraxial with these conditions/disease/situation

A 
infection at site
refusal
major coagulopathy
severe hypovolemia/blood loss
severe aortic or mitral stenosis or severe IHSS
increased ICP
procedure last longer than duration of block
abruptio placentae
82
Q

what about coumadin

A

dc at least 4 days prior

can do or remove if INR <1.5

83
Q

NSAIDS or ASA with neuraxial?

A

can receive regardless of last dose

84
Q

SQ heparin

A

not CI
do block > 1h before heparin and
remove 1 h prior to dose or 4h after dose

85
Q

LMWH

A

hold 12 hours prior to block
restart 24h post after surgery
remove at least 2h prior to restarting lovenox or 10h after dosing

86
Q

Hold ticlopidine for

A

14 days

87
Q

hold clopidogrel and parasugrel for

A

7 days

88
Q

hold abciximab for

A

2 days

89
Q

hold eptifibatide for

A

8 hours

90
Q

3 herbs to caution with bleeding

A

garlic - 7 days
ginko - 26 h
ginsen - 36h

*return time to normal hemostasis
no indication to DC prior to neuraxial

91
Q

this type of needle associated with less PDPH, no cauda equina puncuture and stays more midline

A

noncutting

92
Q

give two names for the anatomical location of L4

A

tuffier’s line
aka intercristal line
(btw iliac crests)

93
Q

this condition is betadine enters SAS

A

chemical arachnoiditis

94
Q

neurtalizes iodine

A

alcohol

95
Q

skin to dura depth in all three patient types
thin
typical
obese

A

2.5 cm
5 cm
9 cm

96
Q

needle smaller than this gauge needs introduces (spinal)

A

25 g

97
Q

these landmarks are avoided with paramedian approach

A

supraspinous lig

interspinous lig

98
Q

this largest interspace is used during the taylor approach

A

L5

99
Q

adding these to LA makes hypobaric

A

sterile H20

opioids (except demerol) - think “getting high”

100
Q

makes LA isobaric

A

mix with CSF

mix with NS

101
Q

most important factors determining level of blockade

A

baricity
positioning
LA dose

102
Q

DOA from shortest to longest

A

lidocaine < rop < bup/levobup < tetra

103
Q

epi/neo best prolongs LA in this order from best to worst

A

tetra < lido < bup

104
Q

clonidine produces dose dep analgesia w/o side effects by activating ___ alpha __ receptors in the ____ ____.

A

post synaptic alpha 2

substantia gelatinosa

105
Q

repeating a dose of lidocaine following a “failed” spinal may cause this (so dont do it)

A

cauda equina syndrome

106
Q

characteristics of cauda equina syndrome

A

bowel and bladder dysfx
paralysis of legs
sensory deficits
pain from multiple nerve root injuries

5% lidocaine can be neurotoxic

107
Q

this agent can increase duration of spinal and can be the solo injected spinal

A

opioids

108
Q

describe how opioids when injected into spine

A

passive diffusion into dorsal horn
bind to opioid receptors
block substance P release

109
Q

pain from gluteal region radiating to BLE ..sx start within a few hrs to 24h post recovery (can have redicular back pain) may need opioids to tx…spontaneously disappear within 10 days

A

Transiet Neurologic symptoms

110
Q

the extent of epidural spread is is determined by these two most important factors

A

dose

site of inj (ie ED space cervical

111
Q

volume most effects ___ and concentration mostly affects ____

A

spread

density

112
Q

successful analgesia can be obtained with relatively ___ volumes and ___ concentrations

A

low volumes

high concentrations

113
Q 
where would your epidural catheter desination be in these procedures:
labor epidural
abd surgery
thoracic
chronic pain
A

labor L2 - L3
abd T8 - T10
thoracic T4 - T5
c. pain C7 - T1

114
Q

injecting into ED space too fast may cause these 3 things

A

inc CSF pressure
h/a
inc ICP

115
Q

(epidural) segmental spread may be (3-4x) higher in these two types of patients. May need to use lower volume (0.5ml/segment)

A

elderly

OB

116
Q

(slide on neuraxial opioids) two factors influencing diffusion

A

lipid solubility

molecular weight

117
Q

late depression of ventilation occurs with this drug (neuraxial)

A

morphine

118
Q

early depression of ventilation occurs with this drug (neuraxial)

A

fentanyl

119
Q

the concentration of opioid is selected to acheive an infusion rate of ___ ml/hr. Lower infusion rates may not deliver adequate analgesia, while higher rates will be associated with motor block and inability to ambulate. (PP slide on dosing regimens for neuraxial opioids - in italics on bottom)

A

6 - 10 ml /hr

120
Q

sacral anatomy changes around this age which makes identifying

A

12 yo

121
Q

major complications of caudal includes

A

unintentional needle trauma to epidural venous plexus in sacral region and dural puncture (more likely in infant)

122
Q

most frequent neuraxial complication that is usually mild and self limiting

A

back pain - from muscle strain/relaxation

123
Q

intravascular inj more significant with doses given in these two spaces

A

epidural
cuadal
(both receive high volumes)

124
Q

injected into this area with epidural dose will have effects similar to high spinal. onset 15-30 min. tx like high spinal

A

subdural inj - spreads to the very thin arachnoid quicker than interdural

125
Q

this neuraxial side effect may cause compression of neural tissue and cause injury and ischemia with what resulting symptoms 3 symptoms, and tx

A 
--spinal or epidural hematoma
1 back pain
2 motor weakness
3 sphincter dysfunction
---immediate MRI/ or CT surgical decompression within 12 hrs
126
Q

this neuraxial side effect occurs in four stages.. and what are they

A

abscess

  1. back pain
  2. nerve root/redicular pain
  3. motor/sensory deficit
  4. paralysis
127
Q

causes of abscess. list most common and others

A

most common Staph Aureus
alpha hemolytic streptococci
psoriasis - poor skin prep
DM, sterroids, chronic infections (HIV, herpes)

128
Q

back pain plus fever .. do what

A

remove cath and culture tip

129
Q

location and characteristics of PDPH

A

bilateral, frontal, retroorbital, occipital and extends to neck. throbbing or constant with photophobia and nausea (cerebrovasodilation, dec CSF pressure)

130
Q

with PDPH you have loss of hydrolic support where medulla and brainstem are dropped into foramen magnum this stretches the ____ and pulls down on the _____.

A

meninges

tentorum

131
Q

this tx stimulates production of CSF

A

hydration

caffiene

132
Q

supine position increases? or decreases? hydrostatic pressure - which drives fluid out of the ____

A

decreases

dura

133
Q

whats in fioricet

A

benzo + tylenol + caffeine

134
Q

do this upper airway block for PDPH- emerging technique

A

sphenopalatine ganglionic

135
Q

oculocardiac reflex most likely in this procedure/population

A

children

strabismus

136
Q

local infiltration into this muscle for oculocardiac reflex, after stopping stimuli and giving anticholinergics

A

rectus muscle

137
Q

during retrobulbar block we inject into this structure

A

extraocular muscle cone

138
Q

clinical signs of brainstem anesthesia after opthalmic anesthetic

A

alt concsciousness proceeding to apnea, cardiac instability, dilation of contralateral pupil
(manifests within 6-10 min) Seizures are NOT a typical feature

139
Q

differential excessive opioids from brainstem anesthesia from opthalmic block

A

opioids- miosis

brainstem anesth - mydriatic and nonreactive pupil with akinesia of that globe

140
Q

this is the degree of difficulty demonstrated by a sound wave being transmitted thru a medium; density (p) x acoustic velocity (c); z = pc.

A

acoustic impedence

-increases if propogation speed or denstity of medium increased

141
Q

how does frequency change US image

A

US gradually absorbed by tissue

higher frequency = more rapid absorption and less distance propogation. Ergo- use low freq for deeper scan

142
Q

5 US transducer manipulation techniques

A 
depth
frequency
focusing
gain
doppler
143
Q

correlation btw nerve diameter and conduction velocity

A

larger diameter = faster conduction

smaller = slower

144
Q

major site of LA effect

A

“h” gate of alpha subunit in the Na channel

145
Q

LA binds in Na channel in these two states

A

inactivated
open
(this is frequency blcokade)

146
Q

myelin axons rely on ____ _____ for impulse propogation, at least __ consequtive Nodes of Ranvier must be blocked to prevent transmission down axon

A

saltatory conduction

2

147
Q

tachyphylaxis to LA is more likely if…

A

blocking agent is NOT reinjected soon after the first signs of returning sensation. be sure to reinject frequently with first signs of returning sensations.

148
Q

segments of the spine for larynx

A

c3 (epiglottis) - C6 (cricoid)

149
Q

transverse arytenoids do this

A

closes rima glottis

150
Q

hypoglossal cranial nerve

A

12

151
Q

RLN and SLN sensory division locations

A

SLN above cords (to epiglottis)

RLN below cords

152
Q

anesthesia to nasal septum and nasopharynx blocks these 3 nerves

A

anterior ethmoidal
nasopalatine
sphenopalatine
(origin - opthalmic and maxillary divisions of trigeminal)

153
Q

benzocaine or cetacaine spray provides anesthesia to ___ portion of tongue and mouth by blockade of ____ and ____ nerves

A

anterior

trigeminal and glossopharyngeal

154
Q

treatment for methylhemaglobinemia

A

1-2 mg/kg 1% Methylene Blue - slow IV push over 5-10 min (vargo)

155
Q

when doing a glossopharyngeal block - if you have tachycardia it is bc of blockade of what nerve fiber

A

afferent of glossopharyngeal arising from carotid sinus

156
Q

contraindication for transtracheal block

A

increased ICP
open globe injury
.. also goiter or tumor

157
Q

monitor patients for at least this duration for s/s of LAST

A

30 min (due to biphasic pattern)

158
Q

rare complication to US gel related to preserves is called ___ ___. These 3 substances.

A 
contact dermatitis
1. propylene glycol
2. parabens
3. imidazolidinyl urea
(PPI)
159
Q

neuropathy prognosis from PNB neuro damage

A

95 % resolved in 4-6 wks

99 % resolved in 1 year

160
Q

how to confirm nonstimulating cath position

A

bolus saline thru catheter - spread on US

161
Q

to widen space to threat catheter inj this

A

d5w (not saline)

162
Q

pulse width =

A

duration

163
Q

this current = intraneural needle placement

A

< 0.3

164
Q

PNS + central neuraxial block.. okay or not?

A

yes

165
Q

these nerve fibers have long chronaxy

A

C fibers

bc entire axon counts and needs longer duration of stimulus

166
Q

pulses used at duration of ____ are most effective over all (rheobase or chronaxy)

A

chronaxy

167
Q

advance needle until this mA and duration reached

A
  1. 3 - 0.5 mA

0. 1 ms

168
Q

shallow structures < 4 cm use ___ MHz

Deeper __

A

shallow 10-13

deep 2-5

169
Q

most common cause of artifact

A

contact artifact from loss of acoustic coupling btw transducer and skin

170
Q

topical anesthesia not appropriate for which eye surgery

A

posterior chamber

171
Q

ocular blocks (most common and effective for akinesia and profoudn analgesia) anesthetize these cranial nerves

A 
III oculomotor
IV trochlear
V trigeminal
VI abducens
VII facial
172
Q

optic nerve is a continuation of the brain and the dura mater divides at the enterance of …

A

optic nerve into the orbit

173
Q

blockade of optic nerve occurs in the

A

optical epidural space

174
Q

in retrobulbar block, LA injected where

A

behind eye into cone formed by extraocular muscles

needle advanced 3.5 cm toward apex of cone

175
Q

this resp syndrome probably due to inj of LA into optic nerve sheath with spread to CSF.. and Tx of this

A

PRBA

  • post-retrobulbar block apnea - apnea in 20 min, resolves within hour
  • supportive and positive pressure ventilation
176
Q

what gives the spine its flexibility

A

cartilaginous disks

movable joint surfaces (24 of 33 vertabrae)

177
Q

provides passageway for spinal nerves to exit

A

intervertebral foramen

178
Q

rudimentary articulate process on sacrum and coccyx which is more prominent in children and is an important landmark for caudal anesthesia (“horns”)

A

cornu

179
Q

this ligament in spine is typically absent/poor in cervical region, thin membrarous lig, thickest in lumbar

A

Interspinous lig

180
Q

meningies protect the cord from forament magnum to ___ ___ ___

A

cauda equina base

181
Q

cause inc SG of CSF

A

adv age
glucose
protein
uremia

182
Q

for pts with pulm disease, dermatomes needed above this location should alert providers to weigh benefits/risks due to high risk

A

above umbilicus

941 (7 decks)

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