3 June Regional Techniques Pt4

Question 1

What is a common treatment for local anesthesia systemic toxicity?

Answer 1

100% oxygen and lipid therapy

Lipid therapy is often emphasized in cases of systemic toxicity due to local anesthetics, specifically propofol.

Question 2

What should be avoided when administering nerve blocks?

Answer 2

Propofol

Propofol can cause cardiovascular dysfunction and is not recommended in nerve block scenarios.

Question 3

What is the recommended dose of lipid therapy for local anesthesia systemic toxicity?

Answer 3

12 mL per kilo

This dosage is crucial for effective lipid therapy in cases of systemic toxicity.

Question 4

What is malignant hyperthermia?

Answer 4

A rare but serious reaction to certain anesthetics

It requires specific emergency protocols and is often included in anesthesia training.

Question 5

What is essential to monitor in the operating room regarding local anesthesia?

Answer 5

Teamwork and patient monitoring

Teamwork is vital during rare events like local anesthesia toxicity to ensure patient safety.

Question 6

What complications can arise from anticoagulation during epidural or spinal anesthesia?

Answer 6

Epidural hematoma

Anticoagulation increases the risk of bleeding, which can lead to serious complications.

Question 7

What is the ‘res ipsa loquitur’ principle in medical malpractice?

Answer 7

Let the thing speak for itself

This legal doctrine implies that the nature of the injury indicates negligence.

Question 8

What is the recommended skin prep for anesthetic procedures?

Answer 8

Chlorhexidine plus alcohol

Evidence suggests this combination is more effective than Betadine alone.

Question 9

True or False: Presedex is FDA approved for spinal anesthesia.

Answer 9

False

Presedex is often used off-label for this purpose despite not being FDA approved.

Question 10

What should be done before injecting a local anesthetic?

Answer 10

Ensure the antiseptic has dried completely

Proper drying time is necessary for effective antiseptic action.

Question 11

What is a common risk when performing spinal anesthesia?

Answer 11

Hypotension and bradycardia

These conditions can occur rapidly and require immediate treatment.

Question 12

What is the primary goal when performing a spinal block?

Answer 12

To ensure the local anesthetic reaches the subarachnoid space

Proper technique is crucial to achieve the desired outcome.

Question 13

Fill in the blank: When using a spinal needle, it is important to ______ to stabilize it.

Answer 13

Stabilize your needle

Stabilization is critical to prevent complications during the procedure.

Question 14

What should be included in the general anesthesia setup when performing a central block?

Answer 14

Induction drugs and emergency equipment

Preparing for potential emergencies is essential during anesthesia procedures.

Question 15

What is the purpose of using a filter needle?

Answer 15

To prevent glass particles from entering the syringe

Filter needles are used to ensure the safety and efficacy of the injected medication.

Question 16

What is a potential side effect of using Cytotec off-label?

Answer 16

Uterine contractions

Cytotec is not approved for this use but is commonly employed in practice.

Question 17

What is the purpose of a filter needle in medication preparation?

Answer 17

To ensure that no glass particles enter the medication

Filter needles are used to prevent glass shards from contaminating medication, especially when drawing from glass vials.

Question 18

What is the typical capacity of the syringe used for local anesthetic?

Answer 18

5 CC

This indicates that a relatively small amount of local anesthetic is administered, usually not exceeding 3 CC.

Question 19

What is the significance of the needle gauge when infiltrating local anesthesia?

Answer 19

A smaller gauge needle is preferred to minimize tissue trauma

Typically, a gauge of 22 or smaller is used for infiltration to reduce pain and tissue damage.

Question 20

What is the common local anesthetic mentioned in the text?

Answer 20

Lidocaine 1%

Lidocaine is frequently used for local anesthesia due to its effectiveness and rapid onset.

Question 21

What is the role of the introducer needle in spinal anesthesia?

Answer 21

To facilitate the insertion of the spinal needle

The introducer needle helps guide the spinal needle through the skin and into the subarachnoid space.

Question 22

What is the target location for spinal anesthesia?

Answer 22

L4-L5 interspace

This is the common site for administering spinal anesthesia due to the anatomy of the spinal column.

Question 23

True or False: The bevel of the spinal needle should always be facing down during insertion.

Answer 23

False

The bevel should be facing up to facilitate smoother entry into the spinal canal.

Question 24

Fill in the blank: The __________ is used to create a seal in the needle to prevent blood from clotting during insertion.

Answer 24

stylet

Question 25

What is the consequence of using a cutting needle for spinal procedures?

Answer 25

Increased risk of post-dural puncture headache ## Footnote Cutting needles can create larger holes in the dura mater, leading to cerebrospinal fluid leaks and headaches.

Question 26

What is the purpose of using a fenestrated drape in spinal anesthesia?

Answer 26

To maintain a sterile field while allowing access to the injection site ## Footnote Fenestrated drapes have openings that align with the surgical site, ensuring sterility.

Question 27

What is the standard practice for monitoring a patient's heart rate during a spinal procedure?

Answer 27

Every two and a half to three minutes ## Footnote Continuous monitoring is crucial for detecting any changes in the patient's condition during anesthesia.

Question 28

What does a 'pop' indicate during the insertion of the spinal needle?

Answer 28

The needle has entered the subarachnoid space ## Footnote This sound is critical for confirming proper needle placement.

Question 29

What is the expected outcome when cerebrospinal fluid (CSF) is observed during the procedure?

Answer 29

Confirming successful entry into the subarachnoid space ## Footnote The presence of CSF indicates that the needle is correctly positioned for administering anesthesia.

Question 30

List the steps involved in preparing for spinal anesthesia.

Answer 30

* Perform timeout procedure * Mark landmarks * Prepare medications * Sterilize the area * Insert the introducer * Insert the spinal needle ## Footnote Each step is crucial for ensuring patient safety and procedural success.

Question 31

What is the typical dosage of lidocaine used for local anesthesia in this context?

Answer 31

3 CC ## Footnote While the syringe holds 5 CC, typically only 3 CC is administered for effective numbing.

Question 32

What should be done if CSF does not flow freely after needle insertion?

Answer 32

Rotate the needle slightly ## Footnote Adjusting the needle position can help achieve proper placement for CSF flow.

Question 33

What should be assessed continuously during a spinal procedure?

Answer 33

Pulse oximeter and blood pressure ## Footnote Continuous assessment is crucial for patient safety during spinal anesthesia.

Question 34

What does a lack of CSF flow indicate during a spinal procedure?

Answer 34

Potential obstruction ## Footnote A lack of CSF flow may suggest a problem with the needle placement.

Question 35

What is a sign of correct CSF flow during a spinal procedure?

Answer 35

Swirling sound or sign ## Footnote The swirling sign indicates proper CSF flow and is best seen in high-resolution imaging.

Question 36

What should be done if resistance is felt during CSF injection?

Answer 36

Pull back slightly and redirect the needle ## Footnote Redirecting is necessary to avoid causing paresthesia or injury to the patient.

Question 37

What is considered acceptable when blood is observed during CSF aspiration?

Answer 37

A pinch of blood ## Footnote A small amount of blood may be normal but continuous blood is not acceptable.

Question 38

What should be done if a spinal block is partial after 15-20 minutes?

Answer 38

Consider switching to general anesthesia ## Footnote If the spinal block is inadequate, general anesthesia may be necessary.

Question 39

What is a key difference between spinal and epidural anesthesia?

Answer 39

Epidural uses a catheter ## Footnote Catheters are used in epidural anesthesia to allow for continuous medication delivery.

Question 40

What gauge needles are commonly used for epidural anesthesia?

Answer 40

18 or 19 gauge ## Footnote Larger gauge needles are often required for epidural procedures.

Question 41

What is the purpose of the loss of resistance syringe?

Answer 41

To identify the epidural space ## Footnote This syringe helps in detecting loss of resistance when entering the epidural space.

Question 42

What should be considered when using a glass loss of resistance syringe?

Answer 42

Support the plunger with a pinky ## Footnote This prevents accidental release and spillage of the contents.

Question 43

How much catheter should ideally remain in the epidural space?

Answer 43

3 to 5 cm ## Footnote This ensures effective distribution of the anesthetic.

Question 44

What do the markings on the epidural catheter indicate?

Answer 44

Centimeters of catheter inserted ## Footnote Markings help in ensuring the correct depth of catheter placement.

Question 45

What does a multi-orifice catheter in an epidural setup allow for?

Answer 45

Even distribution of local anesthetic ## Footnote It allows for better spread of medication in the epidural space.

Question 46

What is a common calculation needed after measuring skin to epidural space?

Answer 46

Subtract visible skin length from total length ## Footnote This calculation helps determine how much catheter to insert.

Question 47

True or False: An epidural catheter must be secured to prevent displacement.

Answer 47

True ## Footnote Securement is crucial as movement can dislodge the catheter.

Question 48

What is a potential issue when using a stiffer catheter?

Answer 48

Difficulty navigating the epidural space ## Footnote Stiffer catheters can be more challenging to maneuver.

Question 49

What is the significance of the markings on an epidural catheter?

Answer 49

They indicate the depth of insertion ## Footnote Accurate placement is vital for effective anesthesia.

Question 50

What is the result of 5 plus 5?

Answer 50

10

Question 51

If you have 9 minus 3, what is the answer?

Answer 51

6

Question 52

What is the minimum age for administering an epidural on a patient with a tattoo?

Answer 52

At least five months old

Question 53

What type of ink is commonly used in tattoos that requires special consideration for epidural placement?

Answer 53

Henna

Question 54

For epidural placement, where should the needle be pointed?

Answer 54

Cephalad

Question 55

What is the recommended depth for inserting the epidural needle into the epidural space?

Answer 55

3 to 5 cm

Question 56

What is the purpose of the loss of resistance technique in epidural placement?

Answer 56

To identify when the needle is in the epidural space

Question 57

What should you do if you feel resistance while inserting the epidural needle?

Answer 57

Slow down as you approach the ligamentum

Question 58

What is the term used for the technique that involves using air or saline to confirm needle placement in the epidural space?

Answer 58

Loss of resistance

Question 59

What is the test dose for epidural anesthesia?

Answer 59

1.5% lidocaine and epinephrine, total of 3 cc

Question 60

What are the two main reasons for administering a test dose during epidural placement?

Answer 60

* To ensure it is not intravascular * To ensure it is not intrathecal

Question 61

What indicates a positive test dose for epidural anesthesia?

Answer 61

Increase in heart rate

Question 62

What should you do if a patient reports a ringing sensation in their ears after a test dose?

Answer 62

Assess for intravascular placement

Question 63

What is the danger of leaving an epidural catheter in place without monitoring?

Answer 63

Risk of accidental administration of incorrect medication

Question 64

What color is commonly used for taping the epidural catheter to indicate its purpose?

Answer 64

Red

Question 65

What is the hanging drop method used for in epidural placement?

Answer 65

To identify epidural space by observing fluid suction

Question 66

True or False: You can use both air and saline in the loss of resistance syringe.

Answer 66

True

Question 67

What should you do immediately after inserting the epidural catheter?

Answer 67

Secure and tape the catheter

Question 68

Fill in the blank: The epidural needle should be inserted at the __________ vertebrae.

Answer 68

L4-L5

Question 69

What is the purpose of the epidural catheter during labor?

Answer 69

To provide analgesia

Question 70

What might happen if you administer too much local anesthesia in the subarachnoid space?

Answer 70

Need for general anesthesia

Question 71

What is a common sensation patients may report if the epidural goes intrathecal?

Answer 71

Numbness in legs

Question 72

What should you monitor for patients on blood pressure medications during epidural placement?

Answer 72

Systolic blood pressure differences

Question 73

What is the purpose of taping the IV with red tape in the hospital?

Answer 73

To indicate special precautions for pregnancy.

Question 74

When should the test dose be given during contractions?

Answer 74

At the end of the contraction.

Question 75

What is the significance of monitoring systolic blood pressure in patients on heart medications?

Answer 75

To observe the difference in blood pressure after administering medications.

Question 76

What is meant by the term 'impending doom' in the context of anesthesia?

Answer 76

A situation where patients may feel they are about to pass out.

Question 77

How does the onset time of epidural anesthesia compare to subarachnoid anesthesia?

Answer 77

Epidural has a slow onset while subarachnoid is immediate.

Question 78

What is the typical initial test dose for epidural anesthesia?

Answer 78

Three CC, often given as one and a half CC increments.

Question 79

What does a negative test dose indicate in epidural anesthesia?

Answer 79

That the catheter is not intravascular.

Question 80

How much local anesthetic is typically administered per segment in epidural anesthesia?

Answer 80

One to two ml per segment.

Question 81

What is the recommended top-up dose for epidural anesthesia?

Answer 81

50% of the initial dose.

Question 82

What should be done every time an incremental dose is administered?

Answer 82

Always aspirate.

Question 83

What does 'two segment regression' mean in the context of epidural anesthesia?

Answer 83

The sensory level has regressed down by two segments.

Question 84

What are the common local anesthetics used in epidural anesthesia and their durations?

Answer 84

* Cocaine: ~60 minutes * Bupivacaine: ~120 minutes

Question 85

What is a 'wet tap' in the context of epidural anesthesia?

Answer 85

A complication where the dura mater is punctured, leading to a post-dural puncture headache.

Question 86

What are the signs of a post-dural puncture headache?

Answer 86

Headache that worsens when upright.

Question 87

What should be assessed if a patient reports pain during catheter insertion?

Answer 87

Check if the needle is in midline and consider redirecting.

Question 88

What is the technique for ensuring enough space in the epidural space when using saline or air?

Answer 88

Use a 10 cc syringe to ensure adequate space.

Question 89

What should be done if there is difficulty threading the catheter?

Answer 89

Turn the catheter and push gently.

Question 90

What is combined spinal-epidural anesthesia?

Answer 90

It involves administering spinal anesthesia first, followed by epidural anesthesia.

Question 91

Why is it beneficial to use the same local anesthetic for both spinal and epidural anesthesia?

Answer 91

To simplify pharmacokinetics and dynamics.

Question 92

True or False: Incremental dosages in epidural anesthesia should be administered without aspiration.

Answer 92

False.

Question 93

What is the best practice when preparing for an emergency C-section?

Answer 93

Prepare the OR and have regional anesthesia kits ready.

Question 94

What is one main reason for simplifying pharmacokinetics and pharmacodynamics?

Answer 94

To remember only one pharmacokinetics and one dynamics for drug administration.

Question 95

What example drug is mentioned in relation to pharmacokinetics and dosing?

Answer 95

Lidocaine

Question 96

What is the benefit of using the same drugs in pharmacokinetics and pharmacodynamics?

Answer 96

Makes it easy to remember the dose and pharmacokinetic details.

Question 97

What type of session is mentioned at the end of the text?

Answer 97

A class tomorrow

Question 98

Fill in the blank: Have fun in the _______.

Answer 98

lab