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8362 T&T Exam1 > Mod IV: Regional Anesthesia Part 3 > Flashcards

Mod IV: Regional Anesthesia Part 3 Flashcards

1
Q

Regional Anesthesia

Which blocks are a/w INCIDENTAL BLOCKADE?

A

IntraScalene

Supraclavicular

Superficial Cervical plexus

Paravertebral

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2
Q

Regional Anesthesia - INCIDENTAL BLOCKADE​

Which nerves can be accidentaly blocked as a result of IntraScalene/Supraclavicular/Superficial Cervical block

A

Phrenic nerve

Recurrent laryngeal n.

Sympathetic cervical ganglion

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3
Q

Regional Anesthesia - INCIDENTAL BLOCKADE​

Phrenic nerve block could cause:

A

Diaphragm paralysis

Which could cause ↓ ventilation

Very common!!!

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4
Q

Regional Anesthesia - INCIDENTAL BLOCKADE​

Recurent laryngeal nerve block could cause:

A

Vocal cord paralysis

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5
Q

Regional Anesthesia - INCIDENTAL BLOCKADE​

Sympathetic cervical ganglion block could cause:

A

Horner’s Syndrome

Rare condition characterized by miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face). It is caused by <strong>damage to the sympathetic nerves of the face</strong>

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6
Q

Regional Anesthesia - Complications and Risks

INTRAVASCULAR INJECTION could lead to:

A

LA TOXICITY

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7
Q

Regional Anesthesia - Complications and Risks

Most nerves run close to vascular structures. This is a blessing and a curse, why?

A

Facilitates identification of nerve structures, but

increase risk of INTRAVASCULAR INJECTION

=> LA TOXICITY

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8
Q

Regional Anesthesia - Complications and Risks

What is less worisome about intra-arterial injection of LA?

A

Most arteries flow to the periphery

Allows local some time to be absorbed by tissue

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9
Q

Regional Anesthesia - Complications and Risks

What’s the danger of Vertebral, Carotid injection of LA?

A

Direct flow to brain

Cause almost immediate seizure, neurological LA toxicity S/S

Even LA volumes of 1-3ml

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10
Q

Regional Anesthesia - Complications and Risks

Consequenque of intravenous injection of LA:

A

LA Systemic Toxicity (LAST)

Most veins flow directly to heart

Neurological S/S may be delayed or absent

CV instability may be first sign

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11
Q

Regional Anesthesia - Complications and Risks

What could be a reason why there would be No aspiration of blood during US/needling, even after IV puncture?

A

Compression of vessels may hide IV puncture

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12
Q

Regional Anesthesia

How to prevent Local Anesthetic Systemic Toxicity?

A

Monitors: ECG, BP, O2Sat

Communication with Pt

Frequent gentle aspiration every 3-5ml

Slow injection of LA

Avoid traumatic needling

Judicious dosing of LA

EPI marker in ↑ Vol blocks

<strong>Be prepared!!!</strong>

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13
Q

Prevention of Local Anesthetic Systemic Toxicity

Which Monitors must be used and for how long after high dose blocks?

A

ECG, BP, O2Sat

Continuous monitoring for at least 30 min

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14
Q

Prevention of Local Anesthetic Systemic Toxicity

What are some symptoms of Local Anesthetic Systemic Toxicity that may be communicated/reported by the pt?

A

Metal taste

Ears ringing

Circumoral numbness

Anxiety

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15
Q

Prevention of Local Anesthetic Systemic Toxicity

Aspiration:

A

Frequent gentle aspiration every 3-5ml

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16
Q

Prevention of Local Anesthetic Systemic Toxicity

To prevent Local Anesthetic Systemic Toxicity, decrease dose for which pts?

A

Advanced age

Poor cardiac function

Preexisting conduction abnormalities

↓ Plasma proteins

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17
Q

Prevention of Local Anesthetic Systemic Toxicity

What could you use to prevent LAST if you must inject large volume of LA?

A

Use “EPI marker”

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18
Q

Prevention of Local Anesthetic Systemic Toxicity

When using EPI marker in ↑ Vol blocks, >10% ↑ HR may indicate:

A

IV injection

19
Q

Prevention of Local Anesthetic Systemic Toxicity

While readying a plan to use in case of Local Anesthetic Systemic Toxicity, which checklist and flowchart are useful?

A

ASRA checklist

NYSORA flowchart

20
Q

Prevention of Local Anesthetic Systemic Toxicity

Why should you have 20% Lipid Emulsion in the area where blocks are performed?

A

A lipid infusion improves success of resuscitation from cardiac arrest because of local anesthetic toxicity if given immediately after a local anesthetic overdose

21
Q

Regional Anesthesia - Detection of LAST

Most important step:

A

Recognition/Diagnosis

22
Q

Regional Anesthesia - Detection of LAST

Why is frequent communication with the pt important?

A

Make sure they know what symptoms to report

23
Q

Regional Anesthesia - Detection of LAST

CNS symptoms:

A

May be subtle/absent

Metal taste, tinnitus, double vision, dizziness, circumoral numbness

Excitation: agitation, confusion, twitching, seizure

Depression: Drowsy, obtunded, coma, apnea

24
Q

Regional Anesthesia - Detection of LAST

Benefit and drawback of Benzodiazepine sedation when suspecting LAST

A

May prevent seizure

Also may prevent Pt from reporting CNS symptoms

25
Q

Regional Anesthesia - Detection of LAST

Cardiovascular signs:

A

May be first/only

Excitation followed by depression may be present

↑ BP, ↑HR,

Ventricular ectopy, multiform VT, VF

Progressive ↓BP, bradycardia => asystole

26
Q

Regional Anesthesia - Detection of LAST

Hallmarks of cardiac toxicity of LA

A

Ventricular ectopy, multiform VT, VF

27
Q

Regional Anesthesia - Detection of LAST

Hallmark of severe LA toxicity:

A

Progressive ↓BP, bradycardia => asystole

28
Q

Regional Anesthesia - Detection of LAST

How do S/s of LAST progress?

A

May be slow or very fast

Some S/S may be subtle or absent

29
Q

Regional Anesthesia - Detection of LAST

ALWAYS BE VIGILENT IN MONITORING DURING AND AFTER RA!!

A

True

30
Q

Regional Anesthesia - Treatment of LAST

Why should you Get Help! Fast!

A

You cannot manage this alone!

Call for Lipid Emulsion

ASRA checklist, NYSORA flowchart

Alert Cardiopulmonary bypass team

Or nearest facility with one

31
Q

Regional Anesthesia - Treatment of LAST

Airway management interventions:

A

100% via mask

Secure airway!!!!

ETT/vent

32
Q

Regional Anesthesia - Treatment of LAST

How could you abolish seizure?

A

Versed

Propofol

Avoid propofol if CV unstable

33
Q

Regional Anesthesia - Treatment of LAST

How would you manage cardiac arrhythmias?

A

CPR/ACLS

EPInephrine/vasopressin (controversial)

Amiodarone (300/150)

Magnesium 1-2 grams

34
Q

Regional Anesthesia - Treatment of LAST

In the management of cardiac arrhythmias, which drugs should be avoided?

A

Calcium channel blockers

Beta blockers

Lidocaine

Phenytoin

Vasopressin (controversial)

35
Q

Regional Anesthesia - Treatment of LAST

20% Lipid Emulsion Therapy - When to start?

A

Based on clinical severity and rate of progression

Use your professional judgment

36
Q

Regional Anesthesia - Treatment of LAST

20% Lipid Emulsion Therapy - BOLUS dose:

A

1.5 ml/kg

(~100ml)

Based on lean body weight

37
Q

Regional Anesthesia - Treatment of LAST

20% Lipid Emulsion Therapy - INFUSION rate:

A

0.25 ml/kg/min

(~18ml/min)

38
Q

Regional Anesthesia - Treatment of LAST

20% Lipid Emulsion Therapy - If persistent CV collapse:

A

Repeat BOLUS Q 5minutes

39
Q

Regional Anesthesia - Treatment of LAST

20% Lipid Emulsion Therapy - If hypotension continues:

A

DOUBLE INFUSION rate 0.5 ml/kg/min

40
Q

Regional Anesthesia - Treatment of LAST

20% Lipid Emulsion Therapy - after CV stable:

A

CONTINUE INFUSION

For at least 10 minutes after CV stable

41
Q

Regional Anesthesia - Treatment of LAST

20% Lipid Emulsion Therapy - Upper limit over first 30 minutes:

A

10 mg/kg

42
Q

Diagnosis and Treatment of LA Toxicity

NYSORA LA toxicity flow chart

A

NYSORA LA toxicity flow chart

43
Q

Diagnosis and Treatment of LA Toxicity

Checklist for Treatment of Local Anesthetic Systemic Toxicity

A

Checklist for Treatment of Local Anesthetic Systemic Toxicity

(American Society of Regional Anesthesia and Pain Medicine)

8362 T&T Exam1 (16 decks)

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