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Regional Anesthesia > TEST - in general from PRODIGY > Flashcards

TEST - in general from PRODIGY Flashcards

1
Q

MILLILITER dose range for LA dosing for caudal anesthesia

A

0.5-1.0mL / kg

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2
Q

define ‘field block’

A

injection of large amount of LA into SQ to block cutaneous nerves

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3
Q

popliteal blocks disrupt transmission in the _____ n.

A

sciatic

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4
Q

popliteal block and ______ n. blocks will provide complete anesthesia below knee.

A

saphenous

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5
Q

After spinal, pt. has RR 16bpm, SpO2 100%, c/o dyspnea… where is block level?

A

T2-T4 blocks indicate sensory loss to chest wall movement = dyspnea despite WNL RR… C2-C3 will result in denervation to phrenic nerve and intercostal muscles = hypoxia, hypercarbia, respiratory arrest

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6
Q

spinal epidurals occur in this order: the _______ is inserted first then the ________ is performed 2 interspaces below

A

epidural, spinal

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7
Q

ANTERIOR border of epidural space? POSTERIORLY?

A

believe it or not, ANT. is posterior longitudinal segment and POS. is vertebral lamina and ligamentum flavum

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8
Q

lumbar spinal peaks at which interspace?

A

L3

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9
Q

INJECTION of hyperbaric spinal @ L3 means the drug will spread which direction?

A

caudal and cephalad since L3 is the peak

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10
Q

what nerve fibers/ spinal column level innervate urinary bladder tone

A

S2-S4

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11
Q

caudal anesthesia is good below whiche level?

A

level of umbilicus

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12
Q

spinal-epidural rationale for labor pain… which is first?

A

spinal for early, epidural for active labor

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13
Q

what cardiac condition is C.I. for neuraxial anesthesia

A

aortic stenosis

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14
Q

pregnant patients receive what fraction of spinal anesthetic than non-pregnant patients?

A

1/3 less

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15
Q

epidural blood patch: how much autologous blood and where?

A

15mL one interspace below level of dural puncture

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16
Q

epidural opioids exert effects on receptors at which LAMINA (2) aka the ___________ ___________.

A

II and III aka substantia gelatinosa

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17
Q

epinephrine, clonidine, and phenylephrine dosing to prolong spinal

A 
epi = 0.1-0.2ml 1:1000 
clonidine = 75-100mcg
phenylephrine = 2-5mg (no way but this is from PRODIGY)
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18
Q

appropriate opioid dosing for morphine, fentanyl and sufenta in spinal blocks

A

FENTANYL = 10-25 mcg
SUFENTA = 10mcg
preservative free MORPHINE = 250mcg

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19
Q

epidural catheter needle placement (BL and unilateral)

A

cephalad for BL, 45 towards side you wish to blck

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20
Q

epidural DC’d ___ hours prior LMWH dosing

A

2

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21
Q

SAS (subarachnoid space) extends to __-___ in adults and __-___ in kiddos

A

S2-S3, L1-L3

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22
Q

SPINAL-epidural blocks: injection of epidural anesthetic does what to your previously doses spinal anesthetic?

A

increases block height

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23
Q

which areas/level of spinal column are MOST dependent when supine

A

T4-T8

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24
Q

SCIATIC nerves divides into which two n.? Superior or inferior to popliteal fossa?

A

tibial & common peroneal n. and superior to knee

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25
Q

popliteal artery lateral to semiTENDONosis tendon? T or F

A

True dat

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26
Q

PDH relieved in which posish’

A

supine

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27
Q

is patient age a C.I. for spinal anesthesia?

A

nope

28
Q

primary innervation of PENIS

A

PUDENDAL

29
Q

SCIATIC nerve roots are

A

L4-S3

30
Q

spinal anesthesia DURATION determined by

A

dose and LA chosen (opioids increase duration too)

31
Q

caudal anesthesia: more likely to have intrathecal anesthesia in kiddos or adults? why?

A

kids, d/t epidural sac extension to S3 in kids

32
Q

caudal anesthesia covers

A

procedures below diaphragm - rectal, inguinal, lower extremity surgery

33
Q

sacral hiatus is insertion point for CAUDAL anesthesia… it’s location is b/t

A

S4 and S5

34
Q

epidural space is largest at what level of spinal column (general)

A

LUMBAR

35
Q

PABA is? found in what LA?

A

PARA-aminobenzoic acid in ESTER local anesthetics

36
Q

femoral n. block which is most lateral? n., artery, vein?

A

n.

37
Q

first pop in spinal is? second?

A

ligamentum flavum, dura mater

38
Q

cardiac arrest s/p spinal indicated by what symptoms? caused by a blockade of which fibers at T1-T5

A

bradycardia & hypotension, cardioacceleratory

39
Q

things that increase likelihood of PDPH… list em’

A

young females, multiple attempts, large gauge needle use

40
Q

insertion of needle 2cm medial and caudal to anterior iliac spine and injecting 10-15mL LA after entering fascia lata you are blocking which n.?

A

lat. femoral cutaneous n.

41
Q

hyperbaric spinal is placed @ L3, which direction will it travel if patient remains sitting position? Caudal, cephalad, both?

A

caudal for a ‘saddle block’

42
Q

paramedian approach - which part of vertebrae would you likely encounter first? Pedicle? spinous process, lamina, or transverse process?

A

lamina

43
Q

most common pediatric neuroaxial anesthetic?

A

caudal

44
Q

most common SE of epidural anesthetics?

A

urinary retention

45
Q

most common SE for morphine epidural anesthetic? bupivicaine?

A

MORPHINE - pruritis

BUPIVICAINE - hand weakness followed by hypotension

46
Q

which n. prevents ADDUCTION of legs?

A

obturator

47
Q

which position is best for a combined spinal/epidural technique? sitting, standing on head, lateral, prone?

A

SITTING

48
Q

popliteal n. located __________ (in space) to popliteal artery?

A

laterally

49
Q

which n. block in combo w/ popliteal fossa n. block would completely (when done right) would completely anesthetize the foot?

A

SAPHENOUS n. - remember, we are blocking the SCIATIC n. prior to jump off point of TIBIAL and PERONEAL branches… what remain is the terminal branch of the femoral n.

50
Q

which spinal needle is a ‘cutting’ needle?

A

Quincke

51
Q

IMPORTANT PENIS INNERVATION STUFF B/C WE HAVE PENISES : What n. block the penis?

A

pudendal, genitofemoral, and ilioinguinal

52
Q

saphenous n. can be blocked posterior to to medial malleolus? TRUE or FALSE

A

FALSE - anterior

53
Q

epidural segmental spread is directrly related to _______ (DOSE, POSITION, VOLUME, or BARICITY)

A

VOLUME - REMEMBER, spinals are DOSE dependent

54
Q

how much epinephrine is in an epidural test dose lidocaine?

A

EPI - 15mcg
lido - 45 mcg
or 3ml of 1.5% lido (15mgml) and 1:200,000 epi

55
Q

3 part question on spinal blockade sympathectomy.
1. What levels block cardioaccelatory fibers? 2. What does cardioaccelatory blockade cause? 3. A sensory block at T6 means autonomic (sym) block at T_ and motor at T_.

A

spinal anesthesia cause sympathomemectomy which causes venous pooling via dilation of venous capitance vessels (minimal arterial dilation) AKA: venodilation.
Cardioaccelatory blockade occurs b/t T1-T4 - so watch out for BRADYcardia and decreased contractility.
T4 and T8 respectively

56
Q

SYMPATHECTOMY is results in

A

unopposed VAGAL activity (parasympathetic),

57
Q

SLUDGE is the handy acronym for crazy PNS crap what does it mean?

A

Salivation: stimulation of the salivary glands
Lacrimation: stimulation of the lacrimal glands
Urination: relaxation of the internal sphincter muscle of urethra, and contraction of the detrusor muscles
Defecation: relaxation of the internal anal sphincter
Gastrointestinal upset: Smooth muscle tone changes causing gastrointestinal problems, including diarrhea
Emesis: Vomiting

58
Q

sympatholysis d/t neuroaxial anesthetics do what to the GI tract?

A

peristalsis = generalized constriction of bowel, increased bloodflow, increased intralumen pressure

59
Q

Tip of the scapula (shoulder blade duh) corresponds w/ which thoracic vertebrae?

A

T7

60
Q

most prominent cervical vertebrae is?

A

C7

61
Q

tip of twelfth rib corresponds w/ which thoracic vertebrae?

A

L1

62
Q

iliac crest corresponds w/ which thoracic vertebrae?

A

L4

63
Q

sacral cornua, coccyx, and pos. sup. iliac spines are all good surface anatomy markers for?

A

caudal anesthesia

64
Q

Caudal anesthesia: are paresthesias, and ‘fullness’ normal senstations w/ injection?

A

yep

65
Q

What is the cause of APNEA w/ spinal anesthesia? treatment?

A

from the lack of perfusion to brainstem… corrected w/ hemodynamic resuscitation

Regional Anesthesia (4 decks)

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