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AAA-ANESTHESIOLOGY > TYPES OF ANESTHESIA: LOCAL, REGIONAL, GENERAL (Part 2) > Flashcards

TYPES OF ANESTHESIA: LOCAL, REGIONAL, GENERAL (Part 2) Flashcards

1
Q

What defines a difficult airway in anesthesia?

A

A clinical situation where the anesthesiologist experiences difficulty with facemask ventilation, tracheal intubation, or both.

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2
Q

What is difficult facemask ventilation?

A

Inability to provide adequate ventilation due to issues such as inadequate mask seal, excessive gas leak, or excessive resistance to gas flow.

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3
Q

What are signs of difficult facemask ventilation?

A

Absent or inadequate chest movement, breath sounds, cyanosis, gastric air entry, decreasing oxygen saturation, absent CO2 exhalation, and hemodynamic changes.

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4
Q

What is difficult laryngoscopy?

A

Inability to visualize any portion of the vocal cords after multiple attempts at conventional laryngoscopy.

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5
Q

What defines difficult tracheal intubation?

A

When tracheal intubation requires multiple attempts, with or without tracheal pathology.

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6
Q

What is considered a failed intubation?

A

When placement of the endotracheal tube (ETT) fails after multiple attempts.

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7
Q

What are conditions associated with difficult intubation?

A

Tumors, infections (e.g., submandibular abscess), congenital anomalies, trauma, obesity, and anatomical variations like micrognathia.

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8
Q

What are the nerve blocks used for awake intubation?

A

Lingual and pharyngeal branches of the glossopharyngeal nerve, bilateral superior laryngeal nerve block, transtracheal block, and atomized lidocaine.

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9
Q

What is the technique for a transtracheal block?

A

Penetrate the cricothyroid membrane and inject 4mL lidocaine at the end of expiration.

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10
Q

Which complications can occur following intubation?

A

Desaturation, sudden end-tidal CO2 decline, rising end-tidal CO2, increased airway pressure, and decreased airway pressure.

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11
Q

What is an indication for extubation?

A

When the patient has adequately recovered from muscle relaxants and secretions are suctioned.

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12
Q

How should an endotracheal tube be removed during extubation?

A

Deflate the cuff, untap the ETT, and pull it swiftly in one smooth motion.

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13
Q

What are common complications of laryngoscopy and intubation?

A

Malpositioning, airway trauma, physiological reflexes, and tube malfunction.

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14
Q

What are the types of airway trauma from intubation?

A

Dental damage, lip or tongue lacerations, sore throat, and dislocated mandible.

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15
Q

What physiological responses to airway instrumentation can occur?

A

Hypoxia, hypercarbia, hypertension, tachycardia, intracranial hypertension, and laryngospasm.

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16
Q

What is a common issue with endotracheal intubation in the right mainstem bronchus?

A

The right mainstem bronchus is more susceptible, leading to stronger breath sounds in the right lung, requiring tube adjustment.

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17
Q

What are the hemodynamic changes during airway instrumentation?

A

Increased blood pressure, cardiac rate, and arrhythmias indicating light anesthesia.

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18
Q

What causes laryngospasm?

A

A forceful involuntary spasm of the laryngeal muscles triggered by sensory stimulation of the superior laryngeal nerve.

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19
Q

How is laryngospasm treated?

A

By providing positive-pressure ventilation with 100% oxygen and administering IV lidocaine (1-1.5 mg/kg), or succinylcholine for persistent cases.

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20
Q

What are the indications for emergency airway management?

A

To protect the airway, provide oxygenation, and manage anticipated clinical course.

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21
Q

What are the strategies for direct laryngoscopy?

A

Prepare the team, optimize the patient, oxygenate, and position optimally to visualize the larynx.

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22
Q

What is the BURP technique in laryngoscopy?

A

Backward, upward, rightward pressure on the thyroid cartilage to improve visualization.

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23
Q

How is cricoid pressure applied?

A

By applying downward pressure on the cricoid ring to reduce the risk of aspiration.

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24
Q

What are the possible positives of cricoid pressure?

A

It may decrease the risk of passive aspiration.

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25
What are the possible negatives of cricoid pressure?
It can increase complexity, make ventilation more difficult, and hinder visualization of the vocal cords.
26
When should cricoid pressure be released?
When the team leader or intubator decides, or during active vomiting or difficulty ventilating.
27
What is the gold standard for confirming tube placement?
Continuous waveform capnography, indicating the tube is in the trachea.
28
What should be checked when confirming tube placement?
Capnography, pulse oximetry, chest rise, and auscultation of the thoracic and upper abdominal areas.
29
What is the LEMON airway assessment used for?
To assess airway difficulty, including looking for blood or facial trauma, evaluating the 3-3-2 rule, and checking for obstruction or neck mobility.
30
What are the steps in direct laryngoscopy?
Prepare the team, visualize the epiglottis, visualize the glottis, and pass the tube with external laryngeal manipulation if needed.
31
What is the 3-3-2 rule in airway evaluation?
3 fingers in the mouth, 3 fingers under the jaw, and 2 fingers from the thyroid to jaw.
32
What is external laryngeal manipulation in laryngoscopy?
A technique where the right hand applies pressure to the thyroid cartilage to improve visualization during intubation.
33
How should a bougie be used in intubation?
The bougie is inserted horizontally into the corner of the patient's mouth and advanced through the glottic opening.
34
What is cricoid pressure used for during intubation?
To decrease the risk of aspiration, but it may complicate tube placement and airway visualization.
35
What does the ASA recommend to limit aerosolization of droplet particles during COVID-19 intubation?
Designate experienced anesthesia professionals, wear PPE including N95 or PAPR, face shield, fluid-resistant gown, double gloves, and shoe covers.
36
What is the purpose of rapid sequence induction (RSI) in COVID-19 intubation?
To avoid manual ventilation and minimize aerosolization of viral particles.
37
Why should awake fiberoptic intubation be avoided in COVID-19 cases?
To reduce the risk of aerosolization.
38
What does the MACOCHA score predict?
It predicts difficult tracheal intubation in critically ill ICU patients.
39
What factors are included in the MACOCHA score?
Mallampati Class III or IV, Obstructive sleep apnea, Cervical spine limitation, Limited mouth opening <3 cm, Coma, Severe hypoxemia (SpO2 <80%), Non-anesthetist operator.
40
What is the difference between spinal and epidural anesthesia?
Spinal anesthesia is performed below L1/L2 into the subarachnoid space, while epidural anesthesia is performed in the epidural space at any vertebral level.
41
What is used to identify the subarachnoid space during spinal anesthesia?
The presence of cerebrospinal fluid (CSF) after puncturing the dura mater.
42
What needle is commonly used for spinal anesthesia?
The Quincke needle (cutting needle) or pencil-point needles like Whitacre and Sprotte.
43
What is the difference in onset time between spinal and epidural anesthesia?
Spinal anesthesia has a rapid onset (2-5 minutes), while epidural anesthesia has a slower onset (15-20 minutes).
44
What are the common complications of spinal anesthesia?
Post-dural puncture headache (PDPH) and hypotension.
45
What is the main complication associated with epidural anesthesia?
There is no significant risk of post-dural puncture headache (PDPH), but hypotension may occur.
46
What factors affect the dermatomal spread of spinal anesthesia?
Baricity of the local anesthetic, position of the patient, drug dosage, site of injection, and intraabdominal pressure.
47
How does the baricity of the local anesthetic affect its spread?
A hyperbaric solution spreads cephalad, while a hypobaric solution spreads caudad depending on patient positioning.
48
What is the role of the isobaric anesthetic solution in spinal anesthesia?
It tends to remain at the level of injection without significant migration.
49
What is the significance of the patient’s position in spinal anesthesia?
Positioning can affect the spread of anesthesia; e.g., a Trendelenburg position helps spread a hyperbaric solution upwards.
50
What are the structures pierced during epidural anesthesia?
Skin, subcutaneous tissue, interspinous ligament, ligamentum flavum, epidural space, and dura mater.
51
Which anesthesia method is commonly used for Cesarean sections and orthopedic surgeries?
Spinal and epidural anesthesia.
52
What needle is commonly used for epidural anesthesia?
The Tuohy needle, which has a blunt bevel and a curved tip.
53
How does the Tuohy needle help in epidural anesthesia?
The blunt tip helps to push the dura away instead of penetrating it.
54
What are the possible complications of epidural anesthesia?
Dural puncture, hematoma, infection, and nerve injury.
55
How is the sitting position used in neuraxial anesthesia?
It helps identify the midline and maximizes flexion of the spine for optimal needle insertion.
56
What is the advantage of the lateral decubitus position for neuraxial anesthesia?
It allows easier access to the epidural or spinal space, especially in patients with obesity.
57
What is BUIE's (Jackknife) position used for?
It is used for anorectal procedures and ensures the block is performed in the same position as the surgery.
58
What is the significance of the dermatomal spread of spinal anesthesia?
It determines the level of anesthesia and helps guide the type of surgery that can be performed.
59
What is the impact of spinal curvature on spinal anesthesia?
Curvature such as scoliosis or kyphoscoliosis can make block placement more difficult, requiring alternative approaches.
60
What is caudal anesthesia used for in pediatrics?
It is commonly used in procedures like circumcision, inguinal herniorrhaphy, and clubfoot repair.
61
What type of needle is used for caudal anesthesia?
A short-bevel 22-gauge needle.
62
What is the loss-of-resistance technique used for?
To identify the epidural space during epidural anesthesia placement.
63
What are the main factors affecting the spread of spinal anesthesia?
Baricity of the local anesthetic, the patient’s position, drug dosage, and intraabdominal pressure.
64
What is the typical dose of bupivacaine for spinal anesthesia?
2.5-3.5 mL of bupivacaine 0.5% heavy solution.
65
What does a hyperbaric solution in spinal anesthesia do?
It is denser than cerebrospinal fluid and spreads cephalad when the patient is in a head-down position.
66
What is the advantage of the paramedian approach in patients with scoliosis?
It may be easier to access the epidural space in patients with spinal curvature or previous surgery.
67
What specific gravity is typically used in hyperbaric spinal anesthetic solutions?
A specific gravity range of 1.0227-1.0278 is common for hyperbaric solutions like bupivacaine with dextrose.
68
How does the patient's height affect the spread of spinal anesthesia?
Height can influence how the anesthetic spreads, with taller patients potentially requiring adjustments in drug dosage and positioning.
69
What are digital nerve blocks used for?
Minor surgeries on the fingers or as a supplement to incomplete brachial plexus or terminal nerve blocks.
70
Where is the sensory innervation for each finger provided from?
Four small digital nerves that enter each digit at its base in each of the four corners.
71
How is the needle inserted for a digital nerve block?
A 26-gauge needle is inserted at the medial and lateral aspects of the base of the selected digit, and 2 to 3 mL of local anesthetic is injected.
72
Why is epinephrine sometimes added to the local anesthetic for a digital nerve block?
To reduce blood flow to the digit, though it may cause ischemia.
73
What is the ideal block for procedures like trigger finger release or ingrown toenail excision?
Digital nerve block.
74
What is the common source of the digital nerves in the hand?
The median and ulnar nerves, which divide in the palm to supply the fingers.
75
Where do the common digital nerves supply in the hand?
The first common palmar digital nerve supplies the thumb, the second supplies the web space between the index and middle fingers, and the third communicates with the ulnar nerve for the web space between the middle and ring fingers.
76
What does the digital nerve supply?
The skin of the distal phalanx of the fingers.
77
How is a digital nerve block performed on the fingers?
A needle is inserted at the bifurcation between the metacarpal heads, with dorsal or volar injections accomplishing similar results.
78
What is a complication of a digital nerve block?
A large volume may lead to vascular compromise.
79
Where is the needle inserted for a digital nerve block on the fingers?
The needle is inserted between the metacarpal heads, proximal to the thenar web space at the distal palmar crease.
80
What is the technique for nerve blocks of the toes?
Block the dorsal and volar nerves on one side of the toe, then redirect the needle across the dorsal surface for the second injection.
81
What is the indication for a penile nerve block?
Circumcision and distal hypospadias repair, especially when a caudal block is contraindicated.
82
What nerves provide sensory innervation to the penis?
The dorsal nerves, derived from the pudendal nerve (S2-S4), accompanied by vessels.
83
How is the penile nerve block technique performed?
The needle is inserted 5-10 mm lateral to the midline of the subpubic space, with a 'pop' felt when it enters the fascial compartment.
84
How is the subpubic approach for penile nerve block different from the alternative approach?
The subpubic approach requires bilateral insertion, while the alternative involves a subcutaneous ring block around the base of the shaft.
85
What is the maximum amount of local anesthetic injected for a penile nerve block in children?
0.1 mL/kg, to a maximum of 5 mL.
86
What are the potential complications of a penile nerve block?
Hematoma.
87
What is the landmark for a penile nerve block?
The base of the penis and Buck's fascia.
88
Why should the penis be gently retracted during the penile nerve block procedure?
To make Scarpa's fascia taut and facilitate accurate needle insertion.

AAA-ANESTHESIOLOGY (14 decks)

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