Unit 4: Uses of LA

Question 1

what are the used of LA

Answer 1

Topical​

Local Infiltration​

Peripheral N. Block​

Intravenous​

Epidural ​

Spinal​

Tumescent Liposuction​

Question 2

the max amount of lidocaine plane is ____

Answer 2

300mg

Question 3

the max amount of lidocaine with epi is ____

Answer 3

500

Question 4

112.5 mgs of Bupivacaine with Epi and 250 mgs of Lidocaine with Epi were both given during a plastic surgery case. ​

​

What are the percentages of each local anesthetic based on the recommended maximum single dose in mgs?​

Answer 4

you gave 50% of the max of epi and bup

which is 100% of the max

Question 5

Where can you do topical anesthesia?

Answer 5

Applicable on the mucous membranes of the nose, mouth, tracheobronchial tree, esophagus, or GU tract. ​

Question 6

cocaine is ___ ____ as a topical anesthetic than tetracaine and lidocaine

Answer 6

more effective

Question 7

inhalation of lidocaine does not alter airway resistance

T or F

Answer 7

T

Question 8

Procaine and Chloroprocaine are _____ as topical anesthetics​

Answer 8

ineffective

Question 9

EMLA is composed of ….

Answer 9

Lidocaine 2.5% and Prilocaine 2.5% = 5% LA​

Question 10

dose of EMLA is

Answer 10

Dose: 1 to 2 gms/ 10 cm2 area​

Question 11

EMLA
Readiness: ____ minutes OOA​

Answer 11

45 min

2 hours​: Skin grafting​

10 minutes​
Cautery of genital warts​

Venipuncture, lumbar puncture​

Arterial cannulation (Nitroglycerine)​

Myringotomy​

Question 12

EMLA is contraindicated with _____ allergies

Answer 12

amide

Question 13

EMLA can cause ___ because it contains propivicaine

Answer 13

methemoglobinemia

Question 14

Epi is contraindicated in ____ anesthesia of end arteries

Answer 14

local infiltration

end arteries: ears, toes, nose, penis

Question 15

Local infiltration is _____ placement of LA

Answer 15

extravascular

SubQ

Question 16

peripheral NB is achieved by

Answer 16

LA injection into tissues surrounding individual peripheral nerves or nerve plexuses. ​

Question 17

MOA of peripheral NB

Answer 17

MOA: diffusion from outer mantle to central core of nerve along a concentration gradient.​

S/SX: proximal affected first and then distal.​

@End: proximal comes back first & then distal.​

*** Smallest sensory and ANS fibers first, and then larger motor and proprioceptive axons.​

Question 18

Smallest _____ and ANS fibers first, and then larger ___ and proprioceptive axons.​

Answer 18

sensory; motor

Question 19

onset of action of lidocaine and bupivacaine

Answer 19

OOA: Dependent on LA pK​

Lidocaine: 3 minutes​

Bupivacaine: 15 minutes​

Question 20

duration of a LA depends on the ____

Answer 20

dose

Question 21

the “stop light sign” can be seen in what block?

Answer 21

interscalene

Question 22

What is the Bier block?

Answer 22

IV injection of LA into an extremity isolated from the rest of the systemic circulation with a tourniquet​

Sensation and muscle tone dependent on tourniquet​

Question 23

What drugs are used for the Bier block?

Answer 23

Ester or amide LA can be used​

Mepivacaine > Lidocaine, but …​

Most commonly used: Lidocaine​

Question 24

in the Bier block what cuff do you deflate first?

Answer 24

distal, then proximal

Question 25

What is the sequence of neuraxial anesthesia

Answer 25

SNS​

Sensory​

Motor​

Question 26

Answer 26

(ANS first ) BP: will drop over 20mmHg

HR: Increase

(sensory 2nd)
assess with cold alcohol pad to see if sensory is effected

Motor is last. You then assess the movement of the extremity

Question 27

SAB is an injection os LA in _____

Answer 27

subarachnoid area of spinal cord

Question 28

With SAB youll have a ___ confirmation

Answer 28

CSF
act on preganglionic fibers

Question 29

Sensory effect is on ___ level of denervation​

SNS effect is __ spinal segments cephalad of sensory​

Motor effect is___ spinal segments below sensory​

Answer 29

Sensory effect is on same level of denervation​

SNS effect is 2 spinal segments cephalad of sensory​

Motor effect is 2 spinal segments below sensory​

Question 30

T1-T4 is the ___ accelerator

Answer 30

cardiac

Question 31

If the assessed sensory level after SAB is at Thoracic 6 (Tip of Xiphoid Process), what are the: ​

SNS level​

Motor level of the block? ​

​

Answer 31

T4

T8

Question 32

Most common drugs for SAB are:

Answer 32

Most common: Tetracaine, Lidocaine, Bupivacaine, Ropivacaine, and Levobupivacaine​

Question 33

SAB Dosage is according to:​

____ of patient (volume of subarachnoid space)​

Answer 33

Height:

Segmental level of anesthesia desired​

Duration of anesthesia desired​

Question 34

Pt is 5’5, how many mls will you give

Answer 34

1.5ml

Question 35

most common epidural anesthesia drug is ____

Answer 35

lidocaine

Question 36

onset of epidurals is

Answer 36

15-30 min
slow diffusion

Question 37

Epidural anesthesia can cross the placental barrier with the epidural and affect the fetus for ___ to ___ hr

Answer 37

24-48hr

Question 38

Bupivacaine or Lidocaine will cross the transplacental barrier more?​

Answer 38

lidocaine will because it is more rapid in onset

Question 39

what is the difference with epidural vs SAB?

Answer 39

No differential zone of SNS, sensory, and motor blockade ​

Large doses required​ for the differential

Question 40

Tumescent Liposuction​ uses SQ infiltration of ____ volumes

Answer 40

large

Question 41

Tumescent Liposuction​

LA Plasma Peak is ___ to ____ hours s/p injection​

Answer 41

12-14

Question 42

Tumescent Liposuction
Recommended dose:​

Regional Anesthesia Lidocaine with Epi: ___ mg/kg​

Answer 42

7
Highly diluted Lidocaine with Epi Tumescent: 35 to 55 mg/kg​

Theory: 1 gm of SQ can absorb up to 1 mg of Lidocaine​

(aka: Tissue Buffering System)​

Question 43

Local anesthesia with ____ aspirates & prolonged postoperative analgesia​

Answer 43

bloodless