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Minor Surgery 1 > Week Four - Questions > Flashcards

Week Four - Questions Flashcards

1
Q

Are anesthetics generally vasoconstrictors or vasodilators?

A
  • Anesthetics are generally vasodilators

- Cocaine is a vasoconstrictor!

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2
Q

What are the four most widely used local anesthetic agents today?

A
  • Procaine (novocaine)
  • Tetracaine (pontocaine)
  • Lidocaine (xylocaine)
  • Bupivacaine (marcaine)
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3
Q

Which of the four most widely used local anesthetic agents are esters and which are amides?

A

Esters

  • Procaine
  • Tetracaine

Amides

  • Lidocaine
  • Bupivacaine
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4
Q

Which type (esters or amides) of local anesthetic agents are most likely to cause allergies?

A
  • Esters
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5
Q

What are the mechanisms of action of local anesthetics?

A
  • Prevent or relieve pain by preventing the generation and conduction of nerve impulses
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6
Q

Which nerve fibers are most sensitive to actions of local anesthetics?

A
  • Small nerve fibers
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7
Q

Do local anesthetics used at typical rates and concentrations wear off with time, and is there typically a complete recovery in nerve function with no damage to nerve cells or fibers?

A
  • Yes, and yes
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8
Q

What can be added to tetracaine and lidocaine when used for topical anesthesia to produce vasoconstriction?

A
  • Epinephrine
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9
Q

What are the benefits of adding epinephrine to local anesthetics?

A
  • Decreases bleeding, making surgery easier
  • Prolongs the duration of the anesthesia by retarding absorption at the site of the injection
  • Minimizes the amount of anesthesia needed
  • Less anesthesia = decreased systemic toxicity
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10
Q

What are the potential side/bad effects of local epinephrine injection?

A
  • May induce hypoxic damage if used in areas of the body where there is limited circulation
  • Category C - do not use in pregnancy: may cause premature labor
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11
Q

How quickly will epinephrine in a local anesthetic produce its full effect?

A
  • 5-10 minutes for the full vasoconstriction, even though the anesthetic itself may only take 1-2 minutes
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12
Q

**Which type(s) of preparations of local anesthetics have preservatives, and which do not?

A

**- Epinephrine, multi-dose vials

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13
Q

In general, with the administration of local anesthetics, which sensation or function disappears first, and which follow in what order?

A
  1. Sensation of pain
  2. Sense of cold and warmth
  3. Sense of touch
  4. Deep pressure
  5. Motor function
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14
Q

In what order do which sensations and functions return as a local anesthetic wears off?

A
  • Reverse order
  1. Motor function
  2. Deep pressure
  3. Sense of touch
  4. Sense of cold and warmth
  5. Sensation of pain
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15
Q

What are some of the major drug interactions/bad effects with local anesthetics?

A
  • Bradycardia
  • Hypotension
  • Sedation
  • Muscle twitching
  • Fatigue
  • Indigestion and constipation
  • Dermatitis
  • MAOIs –> HTN crisis
  • Carbamazepine/Cyclobenzaprine - potentiate effects of drug
  • Tricyclic and tetracyclic antidepressants→ in the presence of exogenous epi can produce prolonged HTN crisis and dysrhythmia
  • Phenothiazines→ When combined w/ vasodilator effects of all local anesthetics can cause profound hypotension
  • Hypersensitivity reactions
  • True allergic response in < 1% of people
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16
Q

What is the most frequent CNS action of local anesthetics?

A
  • Sedation
17
Q

Into which tissues is it not safe to inject local anesthetics containing epinephrine?

A
  • Fingers
  • Toes
  • Nose
  • Penis
  • Female genitalia
18
Q

What is the purpose of adding sodium bicarbonate to local anesthetics?

A
  • Buffering with sodium bicarbonate makes the anesthetic’s pH closer to physiological pH, which reduces pain on infiltration
  • For nerve blocks, alkalization makes it more readily cross the nerve membrane, which leads to a faster onset of action
19
Q

Can sodium bicarbonate be safely added to local anesthetic products containing epinephrine? Why/why not?

A
  • It can be added, but needs to be added just immediately before use because epinephrine is chemically unstable in anesthetic solutions alkalinized by sodium carbonate
20
Q

What are the effects of adding sodium bicarbonate to local anesthetic products containing epinephrine?

A
  • Decreases the overall activity of epinephrine
21
Q

What is “infiltration anesthesia?”

A
  • Injection of local anesthetic directly into tissue without considering the course of cutaneous tissue
22
Q

What are the “two” definitions of a field block?

A
  • Injection in an inverted V just proximal to and to each side of the lesion (not into the lesion) with no attempt to locate specific nerves –> anesthetizing the region distal to the site of injection
    > Blocks nerve transmission from the injected site to the brain
  • Injection completely around the boundaries of the lesion, with no attempt to locate specific nerves –> an anesthetized “field” inside of the boundaries of the anesthesia
23
Q

What are the two advantages of a field block over an infiltration anesthesia?

A
  • Less drug can be used to provide a greater area of anesthesia
  • Not injecting anesthetic directly into the lesion avoids distortion of the anatomy of the lesion and allows the pathologist to correctly interpret the biopsy specimen
24
Q

**What are the various routes of administration of local anesthetics?

A
  • Injection
  • Topical
  • Intravenous regional anesthesia
  • Spinal anesthesia
  • Epidural anesthesia
25
Q

**What are the considerations when choosing an infiltration anesthetic?

A
  • Adding epinephrine doubles the duration of the action
    > Decrease the total amounts used by 33%
  • Be cautious using lidocaine 2% since it is stronger and you could end up using more than necessary
  • Side effect profile
  • History of use (stick to what pt has had good results with in the past)
  • Length of procedure
  • Will there be significant post-procedure pain
26
Q

What are the maximum allowable safe single doses of plain 1% lidocaine and 0.25% bupivacaine alone and with epinephrine?

A
  • 1% Lidocaine: 4.5 mg/kg
  • 1% Lidocaine with epinephrine: 7 mg/kg
  • 0.25% bupivacaine: 3 mg/kg
  • 0.25% bupivacaine with epinephrine: 3.5 mg/kg
27
Q

What alternatives to local anesthesia are available when a patient is apparently allergic to the ones commonly used?

A
  • Do skin testing if possible
  • If the allergen is an ester, use an aminde
  • Injecting Benadryl in place of a local anesthetic may reduce most or all of the pain
  • Local ethyl chloride
  • Place ice directly over the wound for a short period of decreased pain sensation
  • Don’t use anesthetic for small lacerations
28
Q

What are the advantages and disadvantages of vertical mattress sutures?

A

Advantages
- Everts the edges better than other stitches
- Helps to close a large area of dead space in a wound
- Strong stitch provides added support to a wound under stress
- Can be used as a “stay” suture
> Use initially to align and approximate wound edges, then remove after other sutures were used to close it

Disadvantages

  • Time consuming to place properly
  • Can result in “railroad tracking” scars if tied too tight or left in place for too long

Minor Surgery 1 (9 decks)

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