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Anesthesiology Round 2!!! > Local And Regional Anesthetics > Flashcards

Local And Regional Anesthetics Flashcards

1
Q

Esters - hydrolysis, examples, do they have allergic rxn?

A
  • Hydrolysis by pseudo cholinesterase enzyme
  • Cocaine, chloroprocaine, procaine, tetrocaine
  • Yes, they are known for allergic reactions
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2
Q

Amides (local anesthetics) - metabolism, examples, allergic rxn?

A

Liver metabolism CYP450
Lidocaine, bupivicaine, ropivicaine, etidocaine, mepivicaine

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3
Q

Lidocaine:

A

Weak base - pKa of 7.8
Mainly ionized at physiological pH
1h duration
2h duration w/ adrenaline
CNS and CVS toxicity
Max dose:
- 200mg (20ml of 1%)
- 500mg (50ml of 1%)

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4
Q

Bupivicaine:
Dose

A

Max of 150mg (30ml of 0.5%)
Selective cardiotoxicity
Highly plasma protein bound
Tachyphylaxis is rare

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5
Q

What is tachyphylaxis?

A

Appearance of progressive decrease in response to a given dose after repetitive administration of the drug

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6
Q

Does increased fraction of unionized drug increase the onset of action?

A

Yes

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7
Q

Factors increasing potency and duration of action of local anesthetics?

A

Greater oil/water partition coeffectient = greater lipid solubility = greater potency

Greater protein binding = greater greater duration of action

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8
Q

What to do in systemic toxicity with local anesthetics?

A

Lipids and CPR

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9
Q

Lidocaine toxicity starts at?

A

3 Ug/mL with circumoral and tongue numbness

Goes all the way to coma, respiratory collapse and CVS collapse

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10
Q

Main disadvantage of regional anesthesia? The others are easy to guess

A

Hypotension

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11
Q

Spinal injection properties?

A

Lumbar region only
Brief but high block quality

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12
Q

Epidural injection qualities?

A

Can be done anywhere on spinal cord
Longer but less ecfdcfice block
Requires 5-6x higher dosage

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13
Q

Type of local anesthetic blocks?

A

Motor - muscle paralysis, weakness
Sensory - total anesthesia
Sylpathetics - hypotension, bradycardia

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14
Q

Sequence of events with regional anesthetics:

A
  • 1 - sympathetic block - vasodilation
  • 2 - loss of pain and temperature sensation
  • 3 - loss of proprioception
  • 4 - loss of touch and pressure sensation
  • 5 - loss of motor function
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15
Q

Chloroprocaine:

A

Use of vasoconstrictors is contraindicated
Good short duration spinal procedure

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16
Q

Lidocaine:

A

60 to 90 mins
Sensory and motor block
60-75mg
Transient neurologic symptoms in 1/3

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17
Q

Bradycardia is caused by blockade where?

A

T1 to T4

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18
Q

Which regional anesthetic is greatly affected by vasoconstrictors?

A

Tetracaine

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19
Q

Spinal injection for sylpathetics block vs motor block

A

Motor block is 2 dermatomes lower

20
Q

Hyperbaric anesthetic is mixed with?
Hypobaric?

A

Dextrose
Sterile water

21
Q

Absolute spinal injection contraindications?

A

Sepsis
bacteremia
Skin infection
Hypovolemia
Coagulopathy
Anticoagulation
Increase ICP
Lack of consent

22
Q

Relative spinal injection contraindication:

A

Peripheral neuropathy
Heparin
Psychosis
Aspirin or antiplatelet
Demyelunated CNS disease
Cardiac lesion
Emotional instability
Prolong surgery
Surgical team resistance

23
Q

Epidural anesthesia location?

A

Widest L2
Narrowest C5
Prefer L3-L4
Skin to epidural space is 4-6cm

24
Q

Anesthetic test:

A

3mL lidocaine 1.5% with epinephrine 1:200,000

25
Q

Epidural techniques

A

Midline
Paramedian
Taylor L5-S1
Caudal - pediatrics single shot

26
Q

Lower pKa effect on local anesthetics:

A

-> Un-ionizes faster -> faster onset of action

Also why adding sodium bicarbonate (NaHCO3) increases speed of onset

27
Q

Regional anesthesia advantages:

A

Cheap
High patient satisfaction
Maintain patient airway
Decreased blood loss
Selective muscle relaxation
Decreased incidence of DVT and PE

28
Q

Regional anesthesia disadvantages:

A

Hypotension
Risk of toxicity
Many patients prefer to be asleep
Skills required
Patient can talk
Patient anxiety
Not reliable

29
Q

Location of spinal and epidural anesthesia:

A

Spinal - Lumbar only, subarachnoid space

Epidural - Along spinal cord, epidural space

30
Q

Where does the spinal cord end in the vertebral column in adults and infants?

A
  • Adults - L1/L2
  • Childern - L3
31
Q

Dura and arachnoid end at?

A

S2

32
Q

Chlorprocaine:

A
  • 11mg/kg -> up to 13 w/ E
  • CONTRAINDICATED WITH VASOCONSTRICTORS
  • Enhanced by fentanyl and clonidine
  • Used in short procedures
33
Q

Lidocaine:

A
  • 5mg/kg -> up to 7 w/ E
  • 60 - 90 mins
  • Good sensory and motor block
  • Transient neurological symptoms in a third of patients
  • Used in short procedures
34
Q

Bupivicaine:

A
  • 2.5mg/kg -> up to 3mg/kg w/ E
  • 90-120 mins
35
Q

Tetracaine:

A
  • 2.5mg/kg -> up to 3mg/kg w/ E
  • 90 - 120 mins
  • Effect is doubled with vasoconstrictors
36
Q

Blockade where causes bradycardia?

A

T1-T4

37
Q

Most ideal patient position for regional anesthesia:

A
  • Regional anesthesia
38
Q

Complications for spinal anesthesia:

A
  • Failed block
  • Back pain
  • Hypotension
  • Local anesthesia toxicity
  • High blockade
  • Urinary retention
  • Local infection
  • Meningism
  • Epidural hematoma
  • Spinal headache
39
Q

Factors affecting distribution of spinal anesthesia:

A
  • Level of injection
  • Shape of spinal column
  • Patient height
  • Angulation of needle
  • Volume of CSF
  • Characteristics of local anesthetic (density, specific gravity, baricity)
  • Dose
  • Patient position
40
Q

Absolute contraindications of spinal anesthesia:

A
  • Sepsis
  • Back pain
  • Skin infection
  • Severe hypovolemia
  • Coagulopathy
  • Therapeutic anticoagulation
  • Increase intracranial pressure
  • Lack of consent
41
Q

Relative contraindications of spinal anesthesia:

A
  • Peripheral neuropathy
  • Mini-dose heparin
  • Psychosis
  • Aspirin or other antiplatelet drugs
  • Demyelinated CNS diseases
  • Certain cardiac lesions (aortic stenosis)
  • Emotional instability
  • Prolong surgery
  • Sirgical team resistance
42
Q

Verterbal canal is widest at ____
Narrowest at ____
Preferable location of administration _____
Distance from skin to epidiral space ______

A

L2
C9
L3-L4
4-6cm (can be from 3-8cm)

43
Q

Epidural test (dose, explain)

A

3mL lidocaine 1.5% w/ epinephrine

  • Test for intravenous or intrathecal catheter placement

Positive test:
- Tachycardia
- High BP
- Light headedness
- Metallic taste in mouth
- Ringing in ears
- Facial numbness

44
Q

Does patient position affect epidural anesthesia?

A

NO

45
Q

Complications of epidural administration:

A
  • Penetration of blood vessels
  • Hypotension
  • Nausea and vomiting
  • Headache
  • Back pain
  • Intravascular catheterization
  • Dural puncture
  • Infection

Anesthesiology Round 2!!! (30 decks)

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