Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anesthesia 101 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

The axillary brachial plexus block targets the brachial plexus at the level of the branches, and provides anesthesia to which nerves?

A

Median n.
Radial n.
Ulnar n.
some Musculocutaneous n. (but is often missed bc it branches off plexus prior to the other nerves)

*block is named after the approach, but doesn’t actually include axillary n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The musculocutaneous n. is most commonly visualized between which two muscles?

A

Biceps

Coracobrachialis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which nerve blocks do not cover the medial upper arm, so additional coverage of the intercostobrachial n may need to be performed?

A 
Axillary brachial plexus block
or
Supraclavicular brachial plexus block
or 
Infraclavicular brachial plexus block

*intercostobrachial is not a branch of the brachial plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to perform intercostobrachial n block

A

subQ injection of local anesthetic just distal to axilla.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to perform U/S guided interscalene block (shoulder and upper arm)

A

U/S placed at level of cricoid cartilage, Identify carotid artery, move probe laterally and posteriorly, the roots of the brachial plexus is found between the ANTERIOR and MIDDLE scalene muscles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

With the interscalene brachial plexus block, the ____ n is frequently spared.

A

Ulnar n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The lumbar plexus block, aka psoas compartment block, covers which nerves?
Spares which nerves?

A

Femoral,
lateral femoral cutaneous,
obturator

Spares sciatic n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sciatic n. is responsible for innervation of which muscles?

A

Gastrocnemius
Soleus
Plantaris
Digital flexors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to perform lumbar plexus block

A

Pt is in lateral decubitus position

Needle is inserted at L4 transverse process

Once contacted, needle is redirected in cephalad manner and advanced until stimulation of quadriceps femoris occurs (knee extension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Femoral n innervates which muscles? What are their actions?

A

Iliopsoas
- Hip flexion

Quadriceps femoris
- Extension of lower leg at knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In adults, the conus medullaris ends at ____ and the dural sac terminates at _____

A

L1-L2

S1-S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In infants, the conus medullaris ends at ____ and the dural sac terminates at _____

A

L3-L4

S3-S4

*shifted down one interspace than adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Transtracheal injection of lidocaine, blocks ____ nerve, which anesthetizes sensation to _____, and motor function of ______, during awake intubations

A

recurrent laryngeal n.

s) - vocal cords and trachea
(m) - laryngeal muscles (EXCEPT cricothyroid m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In pts with complex regional pain syndrome (CRPS) of the lower extremity, a _____ block may offer significant relief

A

Lumbar sympathetic plexus block

- located at anterolateral aspect of lumbar vertebral bodies (L1-L5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The _____ n. alone innervates the pharynx, and can be anesthetized by injecting LA at the _______ through the peri-oral approach, which will help prevent the gag reflex

A

glossopharyngeal n (CN IX)

base of each of the anterior tonsillar pillars (palatoglossal fold)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The internal (sensory) branch of the superior laryngeal n. innervates the mucosa from the _________ to the _______.

It can be blocked by injecting LA at ______

A

epiglottis
vocal cords

Greater cornu of hyoid bone
Superior cornu of thyroid cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

The transtracheal block, will anesthetize the ______ nerves, which provides motor innervation to ______

A

recurrent laryngeal n.

all intrinsic muscles in the larynx

  • posterior cricoarytenoids (vocal cord abduction)
  • lateral cricoarytenoids (vocal cord adduction)
  • thyroarytenoids (vocal cord relaxation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A (meningocele / myelomeningocele) is associated with a tethered spinal cord, hydrocephalus and a latex allergy

A

myelomeningocele

*tethered spinal cord is a relative contraindication to neuraxial anesthesia d/t high potential for spinal cord injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

a ______ is where the meninges alone protrude through the defect in the vertebral column

A

meningocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

a ______ is where the meninges, nerve roots, and CSF, protrude through the defect in the vertebral column

A

myelomeningocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Medial to lateral, what are the neurovascular structures in the antecubital fossa?

A

Median n, brachial a, radial n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Subclavian vein central line

- approach and landmarks?

A

Insert needle 1 cm below mid-clavicle angled towards sternal notch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

L IJ central line has higher risk of what?

A
  1. Pneumothorax (high-riding cupola of L lung)

2. Thoracic duct cannulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Femoral vein central line

- approach and landmarks?

A

palpate femoral artery,

insert needle medial to artery and 1-2cm below inguinal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Supraclavicular approach to central line placement

- approach and landmarks?

A

Lateral border of Sternocleidomastoid at its insertion point on clavicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

The MEDIAL lower leg is innervated by the _____ n., which is a branch of the femoral n.

A

saphenous

medial crural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

The sciatic n innervates the LATERAL lower leg and the skin of the foot through its 2 branches: ____ and ____

A

common peroneal
and
tibial n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

The ______ n. provides sensory innervation to the lateral posterior portion of the leg.

A

Sural n (S1-2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

The tibial n. is a branch of the ______ n. and provides sensory innervation to the _____

A

sciatic n.

heel and plantar regions of the foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How long do you have to wait to perform neuraxial anesthesia if the pt is on:

  • Therapeutic LMWH
  • Prophylactic LMWH
A
  • Therapeutic LMWH: 24h after last dose

- Prophylactic LMWH: 12h after last dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When performing caudal epidural, ______ is the structure that is transversed just prior to the epidural space.

A

Sacrococcygeal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

3 landmarks for caudal block

A 
2 PSIS and 
sacral hiatus (directly superior to coccyx)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Sciatic n. block is performed between which 2 bony landmarks?

A

Greater trochanter and ischial tuberosity

gluteal approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

The LATERAL lower leg is innervated by the _____ n. and the MEDIAL lower leg is ______,

A

sciatic.

saphenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

The sciatic n. block provides anesthesia to which n?

A

sciatic n and its two components

  • Tibial .
  • Common peroneal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

The common peroneal n. is a branch of the ______ n. and provides sensory innervation to the _____

A

sciatic

lateral lower leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Infraclavicular n. block traverses the pec major and minor (NOT serratus anterior bc the lung is immediately deep to it) and targets _____

A

the brachial plexus at the level of the cords

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Advantage of infraclavicular block over axillary block?

Disadvantage?

A

Includes the musculocutaneous and axillary n.

Higher risk of pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Pts with (low/high) baseline vagal tone at increased risk of bradycardia and cardiac arrest.

A

high

  • they would have lower resting baseline HR
  • baseline ANS favors parasympathetics
  • benefit from pretreatment with antimuscarinic (glycopyrolate or atropine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Motor stimulation with ____mA is associated with intraneural injection

A

< 0.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Benefits to retrobulbar blocks as opposed to peribulbar block?

Cons?

A
  1. Requires less LA
  2. Denser block

_____

  1. Higher risk of:
    - intravascular and intradural injection
    - retrobulbar hematoma
    - penetration of globe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Femoral n. block: contraction of the _____ m. indicates correct placement of the needle

A

quadriceps (posterior division - main trunk of leg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

The lumbar plexus block aka the psoas compartment block is primarily used for femoral shaft and neck fractures, as it covers which key nerves?

A

femoral n.
obturator n.
LFCN
genitofemoral n.

*spares the sciatic n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which lung lobe is most prone to collecting secretions in the supine pt?

A

R lower lobe - posterior segment

most inferoposterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

The R coronary artery supplies which walls of the heart?

A

Inferior and inferoseptal walls of the LV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When is coronary circulation described as R or L dominant?

A

Right:
- If Posterior descending a. arises from RCA

Left:
- If Posterior descending a. arises from LCx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

The lateral femoral cutaneous n contains fibers from the _____ n roots, and provides sensory innervation to the anterolateral thigh down to the knee

A

L2-L4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Femoral triangle to the adductor canal

A

Anteromedial wall: sartorius, posterior wall

Posterior wall: adductor longus and adductor magnus

Lateral wall: vastus medialis
(counterintuitive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

2/3 of the blood from the bronchial circulation drains into the ______, and 1/3 drains into the _____

A

Pulmonary vein

RV through pleurohilar veins or Pulmonary arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

The R bronchial tree gets its circulation from _______, and the L bronchial tree gets it from ______

A

R: intercostal arteries

L: Bronchial circ arising Directly from aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Superficial cervical plexus block procedure are often used for carotid endarterectomy. How is it performed?

A

insert needle over posterior border of SCM and injecting LA along C2-C4 nerve roots.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

The ______ is the fusion of the C7-T1 cervical sympathetic ganglia and lies on the anterior surface of the C7 vertebral body.

A

Stellate ganglion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What level is the stellate ganglion block performed?

A

C6 at Chassaignac tubercle

close proximity to the ganglion, which lies anterior to C7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How do you perform stellate ganglion block?

A
  1. Neck extension
  2. Locate cricoid cartilage (at C6)
  3. Run fingers laterally until you palpate anterior tubercle of C6 transverse process
  4. Push carotid a and jugular v laterally
  5. Insert 25g 1.5in needle until you reach bone and inject 5-10mL of LA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Benefits of TAP blocks

A

Limited side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Goal of TAP blocks

A

Block anterior rami of T7-L1

- Analgesia to skin, m, and parietal peritoneum of abd wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

(Cardiac MRI / 2-D ECHO) is best at determining ventricular EF.

A

Cardiac MRI

  • std error 5%
  • No radiation or contrast
  • Habitus is not an issue

(Echo std error 10%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Femoral n. contains divisions of L ____. It courses through the _____ m. and then between the psoas and ilacus m., covered by the _______

A

L2, L3, L4

Psoas major m.

Fascia iliaca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

The historical “three-in-one” block provides blockade of which n?

A

femoral n.
lateral femoral cutaneous n.
obturator n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Femoral n, a, v, which is more lateral?

A

Lateral to medial:

Nerve -> arterty -> vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Injecting LA at the greater cornu of the hyoid bone blocks which nerve?
- What sensory innerv. does it block?

A

Internal branch of the superior laryngeal n.
- sensory innervation to the base of the tongue, epiglottis, aryepiglottic folds and arytenoids

*can prevent laryngospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Transtracheal LA injection at the cricothyroid membrane blocks which n?

A

Recurrent laryngeal n.

- vocal cords ABduction and trachea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

(Short axis / long axis) and towards the direction of flow is the best way to obtain red signal on color doppler US

A

Short axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Mechanism of Intravenous regional anesthesia (ie: bier block)

A

Vascular supply of LA to the distal peripheral nerves contribute to anesthesia

65
Q

Which nerves are responsible for vocal cord adduction and abduction?

Vocal cord relaxation (LOWERS voice pitch)?

A

ADDuction:
- Lateral cricoarytenoids

ABduction:
- Posterior cricoarytenoids

Relaxation:
- Thyroarytenoid ms.

*All of these intrinsic muscles are supplied by the recurrent laryngeal nerves.

66
Q

Which n is responsible for elongating the vocal cords (tensor), and RAISING the pitch of the sound produced?
What is it innervated by?

A

cricothyroid m.
- innervated by the superior laryngeal n.

*Say “cricothyroid” in a high pitch every time to help remember

67
Q

How do you identify the vertebra prominens (C7) during placement of paravertebral catheters?

A

The most cephalad vertebra that remains IMMOBILE during neck flexion and extension

68
Q

The _____ provides sensation to the entire larynx above the glottis.

A

Internal branch of the superior laryngeal n

69
Q

Laryngospasm is mediated by the ______ n.

A

Internal branch of the superior laryngeal n

  • afferent limb
  • sensory
  • can do a superior laryngeal n block.

Recurrent Laryngeal n.

  • efferent limb
  • motor
  • can do a transtracheal block
70
Q

Superior laryngeal n.

- Which branch provides sensory and motor innervation?

A

Internal branch: sensory

External branch: motor

“SIME”

71
Q

What happens when the aCH receptor opens (aCH binds to both a-subunits)?

*The receptor opens when the ligand binds, not when depolarization happens!

A

Conformational change of ion channel ->

  • Influx of Calcium and Sodium.
  • Efflux of Potassium

=
Sodium current exceeds potassium current

72
Q

The _____ n. roots exit above the numbered pedicle.

The _____ n. roots exit below the same numbered pedicle.

A

cervical
(ie: C3 exits above C3 pedicle)

Lumbar
(ie: L4 exits below L4 pedicle)

73
Q

Where best to hear these murmurs?

  • AR:
  • AS:
  • MR:
  • MS:
  • MVP:
  • PDA:
  • VSD:
A
  • AR: 3rd/4th parasternal interspace
  • AS: 2nd parasternal interspace
  • MR: apex of heart into axilla (L of nipple)
  • MS: apex of heart into axilla
  • MVP: apex of heart
  • PDA: inferior-mid clavicle
  • VSD: LL sternal border
74
Q

Name that murmur:

  • Blowing, holosystolic murmur
  • Mid-diastolic murmur w/ opening snap
  • Late systolic click
A
  • Blowing, holosystolic murmur: MR
  • Mid-diastolic murmur w/ opening snap: MS
  • Late systolic click: MVP
75
Q

I regional or local anesthesia w/ no supplemental sedation, what is the required monitoring needed?

A

ventilation w/ only qualitative observation (ie. chest rise)

76
Q

Qualifying circumstances for billing unique clinical situations

A
  1. Extremes of age (< 1 or > 70)
  2. Use of deliberate total body hypothermia
  3. Controlled hypotension
  4. Emergency conditions

*invasive lines are eligible for additional billing, but isnt a qualifying circumstance

77
Q

The arteria radicularis magna aka the artery of Adamkiewicz is known for what?

A

It supplies the ANTERIOR two thirds of the lower spinal cord.

Almost always found on the L side of the aorta.

78
Q

Compromise of the arteria radicularis magna aka the artery of Adamkiewicz will cause what symptoms?

A

Loss of motor function and pinprick below the level of the lesion

79
Q

Clopidogrel, ASA/dipyridamole, prasugrel, and ticagrelor needs to be stopped for how long before neuraxial anesthesia?

A

5-7 days

80
Q

Popliteal fossa from medial to lateral

A

Popliteal a -> Popliteal v -> Tibial n -> Common peroneal n.

81
Q

The fascia iliaca block covers which nerves?

A

Femoral

Lateral femoral cutaneous

82
Q

What nerve is close to the great saphenous vein, and is a known complication of nerve injury during vein harvest for CPB?

A

Saphenous nerve

- branch of femoral

83
Q

The ______ is a branch of the sciatic n. and divides at lvl of knee

A

common peroneal n.

84
Q

The most common isolated mononeuropathy of the lower extremity

A

Common peroneal n
(branch of sciatic)
- ie: during lithotomy position in stirrups or excessive hip flexion (sciatic n. stretch)

85
Q

_______ n. is responsible for foot dorsiflexion and provides cutaneous sensation to small patch of skin btwn first and second toes

A

Deep peroneal n

- commonly injured by trauma to lateral knee -> foot drop

86
Q

Which n is commonly injured by trauma to lateral knee -> foot drop

A

Deep peroneal n

  • foot dorsiflexion
  • sensation to small patch of skin btwn first and second toes
87
Q

_____ n innervates the peroneus longus and brevis (allows for foot eversion), and provides sensation to lateral lower leg and most of dorsum of foot

A

superficial peroneal n

88
Q

The _____ n. innervates the lower leg posterior compartment m. primarily responsible for foot plantar flexion.
- Also provides cutaneous sensation to posterolateral lower leg and lateral foot. ( heel)

A

Tibial n.

- commonly injured by trauma to lower leg/ankle

89
Q

N/V occurs after spinal ~ __% of the time, d/t _____

A

20%

Unopposed parasympathetic (vagal) activity after sympathetic block –>
inc peristalsis of GI tract
(NOT hypotension, although that can contribute/exacerbate nausea)

90
Q

Useful meds to treat n/v after spinal, especially with a high (T5) spinal

A

Atropine or glycopyrrolate
- anticholinergics (parasympathetic blocking)

*Glyco does NOT cross placenta

91
Q

Which n innervates the cricothyroid muscle?

A

EXTERNAL branch of superior laryngeal n.

92
Q

sensory and motor innervation of larynx and trachea are supplied by ____ n. Which branches into _____ and _____.

A

Vagus n.

  • recurrent laryngeal n.
  • superior laryngeal n.
93
Q

The external branch of superior laryngeal n. provides motor function to the cricothyroid muscle, which acts to ______

A

tense the vocal cords during phonation

*“SIME”
Internal branch: sensory
External branch: motor

94
Q

How do these intrinsic muscles in the larynx affect the vocal cords?

  • posterior cricoarytenoids
  • lateral cricoarytenoids
  • thyroarytenoids
A
  • posterior cricoarytenoids (vocal cord abduction)
  • lateral cricoarytenoids (vocal cord adduction)
  • thyroarytenoids (vocal cord relaxation)
95
Q

How does injury to b/l recurrent laryngeal n present?

A

The vocal cords will assume position midway btwn abduction and adduction
(only having superior laryngeal n.)
- stridor and respiratory distress
- loss of phonation

*will require tracheostomy

96
Q

How does injury to unilateral recurrent laryngeal n present?

  • phonation?
  • respiration?
A

Ipsilateral vocal cord adduction (paramedian position)

  • difficulty with phonation
  • no respiratory distress
97
Q

______ innervates the hypopharynx, while the glossopharyngeal n. alone innervates the pharynx

A

Both hypoglossal and glossophayngeal

98
Q

L unilateral vocal cord paralysis may occur after ___ ligation as the L recurrent laryngeal n. loops under the aortic arch in same vicinity

A

Patent ductus arteriosus (PDA)

99
Q

List in order of most vascular to least, which injection sites will the highest blood level of local anesthetic following completion of the block

A

Intravenous > Intercostal bock > caudal > epidural > brachial plexus > axillary > lower limb > subcutaneous

IICEBALLS

100
Q

Most important factors of systemic LA absorption and block duration

A

Use of vasoconstrictors (ie. epi)

location of block

101
Q

Blocking which nerves prevent coughing?

A

Recurrent laryngeal and superior laryngeal

102
Q

Which three nerves provide sensory and motor innervation to the airway?

A
  1. Glossopharyngeal
  2. Recurrent laryngeal
  3. Superior laryngeal
103
Q

The internal br of superior laryngeal n provides sensory innervation to base of tongue, epiglottis, aryepiglottic folds
- what are 2 diff ways you can block it?

A
  1. Cotton soaked in LA placed in piriform sinus w/ R-angled clamp for 5-10 min
  2. Injection of LA at Greater cornu of hyoid bone through thyrohyoid membrane
104
Q

A pt has been receiving LMWH, how long until after last dose can you perform neuraxial procedure?

A

Therapeutic dose: wait 24 hours

Prophylactic dose: wait 12 hours

105
Q

You performed neuraxial procedure and did NOT leave catheter, how soon can you restart LMWH?

A

Therapeutic dose:

  • wait 24 hours after non high bleeding risk surgery
  • wait 48-72 hours after high bleeding risk surgery

Prophylactic dose: wait 12 hours

106
Q

You performed neuraxial procedure and DID leave catheter, how soon can you restart LMWH?

A

Therapeutic dose:
- Do not administer LMWH while neuraxial catheter is in place

Prophylactic dose:

  • Do not administer twice daily dose
  • Can administer once daily prophylactic dose 12 hours after insertion
107
Q

When can you remove neuraxial catheter after once daily prophylactic dose of LMWH?

A

12 hours after last dose

108
Q

You just removed neuraxial catheter, how soon can you restart LMWH?

A

Therapeutic dose:

  • wait 4 hours after removal
  • or 24 hours after needle/catheter placement, whichever is greater

Prophylactic dose:

  • wait 4 hours
  • or 12 hours after needle/catheter placement, whichever is greater
109
Q

What is laryngospasm?

A

involuntary, sudden closure of BOTH true and false vocal cords

110
Q

Disproportionate opening of false vocal cords during expiration describes ____

A

coughing

111
Q

The middle cardiac vein is usually associates with the ____

A

POSTERIOR descending coronary artery (typically from RCA)

112
Q

The anterior cardiac vein is associated w/ the ______

A

RCA

113
Q

The great cardiac vein is associated with the _____

A

L ANTERIOR descending artery

114
Q

Describe the oculocardiac reflex, which is most often encountered in children undergoing strabismus sx

A

Traction on extraocular muscle or pressure on eyeball -> stimulate ciliary ganglion -> ophthalmic division of TRIGEMINAL n -> gasserian ganglion -> trigeminal nucleus -> vagus n -> bradycardia/arrhythmia/cardiac arrest

115
Q

What nerve fiber is responsible for FASTEST transmission of nociception, temp and touch?

A

A-delta fibers

*A fibers are large myelinated nerves w/ high conduction speed

116
Q

What nerve fiber is responsible for conduction of proprioception and motor function?

A

A-alpha

117
Q

What nerve fiber is responsible for touch, pressure, and transmitting info from Meissner corpuscles and Merkel disks?

A

A-beta

118
Q

What nerve fibers are responsible for transmission of nociception?

A

Type A-delta

  • large, myelinated
  • sharp, immediate, well localized

C fibers

  • small, unmyelinated
  • dull, achy, not well localized
119
Q

Sensitivities of different nerve fibers to local anesthetics from most to least sensitive

A

Sympathetics > pain/sensory > Motor

aka

Small myelinated (A-delta, A-gamma) > Large myelinated (A-alpha, A-beta) > C (unmyelinated)

“sympathetic people matter”

120
Q

Which pts are most at risk for permanent new/worsening neurologic injury from neuraxial anesthesia?

A
  • Pts w/ space-occupying extradural lesions (ie. tumors, epidural lipoma)
  • reduced cross-sectional area (ie: spinal stenosis, ligamentum flavum hypertrophy)
121
Q

(True/false) pts with CNS diseases (MS), trauma to spinal cord, and post-polio syndrome RARELY have exacerbation of diseases following neuraxial anesthesia

A

True

122
Q

the _____ n provides innervation to the biceps muscle (elbow flexion) and is often missed during an axillary nerve block

A

musculocutaneous nerve

123
Q

the _____ n provides sensory innervation to the medial brachium and is not covered by an axillary nerve block (and others)
(needs to be blocked if upper arm tourniquet is used)

A

intercostobrachial

124
Q

The _____ n. should be blocked during spinal anesthesia for a lateral wall bladder surgery

A

obturator n.

  • innervates adductor muscles of thigh
  • can be stimulated and “jerk” reflex can result in surgeon being kicked, ureter injury, or bladder perforation
125
Q

What lung function is most affected with thoracic and lumbar epidurals?

A

Peak expiratory pressure (PEP)
- reduced 40% bc it is largely dependent on abdominal musculature (relative to thoracic muscle)

Cough
- by 50%

126
Q

The external jugular vein receives blood from posterior and deep structures of the head and empties into the _____

A

subclavian vein

127
Q

Subcutaneous infiltration of the entire width of the medial axillary fossa will block _____ n.

A

intercostobrachial

128
Q

Supraclavicular block covers which nerves?

A
  1. Musculocutaneous
  2. Radial
  3. Ulnar
  4. Median

*NOT intercostobrachial as it is not a branch of the brachial plexus

129
Q

In the elderly, what does it mean that the compliance of the epidural space is decreased? How does that affect neuraxial anesthesia?

A

The space will expand less when LA is injected

- cranial and caudal spread will be increased

130
Q

In the elderly, what does it mean that the dura mater is more permeable? How does that affect neuraxial anesthesia?

A

There is an increased number of arachnoid villi

- the LA can now more easily reach the spinal nerve roots

131
Q

A high grade stenotic lesion along the ____ may result in AV node block

A

posterior descending artery

branch of the RCA

132
Q

Structures encountered from lumbar paramedian approach to spinal anesthesia?

A

Ligamentum flavum -> epidural space -> dura mater -> arachnoid mater

*supraspinous and interspinous ligaments are not encountered

133
Q

The anterior spinal artery supplies blood to _____, which contains the corticospinal and spinothalamic tracts, which provides sensation of _____

A

anterior two thirds of spinal cord

pain and temp
- can be loss below the lvl of a lesion

134
Q

(anterior/posterior) spinal cord syndrome is more common

A

anterior
- only supplied by 1 anterior spinal artery (artery of ademkiewicz)

*posterior is supplied by 2 posterior spinal arteries

135
Q

anterior spinal cord syndrome will have which sensation INTACT below the level of the lesion? which is LOST?

A

intact: proprioception and vibration
loss: motor, temp, pain

136
Q

diagnostic test of choice for retained epidural catheter fragment. When

A

CT scan

  • leave if asymptomatic
  • neurosurgery consult if
137
Q

Most important factor affecting spread of local anesthetic in:
Epidurals:
Spinals:

A

Epidurals:
- volume

Spinals:

  • dosage
  • baricity
  • pt positioning
138
Q

Acute hemodynamic changes during carotid endarterectomy can occur secondary to compression of ____, with increased baroreceptor output leading to decreased sympathetic discharge and increased parasympathetic discharge

A

carotid SINUS baroreceptors
- a mechanoreceptor

  • think “sinus pressure”
  • pressure on the sinus

*the carotid body is a chemoreceptor

139
Q

The carotid body is a (chemoreceptor/mechanoreceptor)

A

chemoreceptor

140
Q

(true/false) hearing loss is associated with spinal anesthesia

A

true

  • unknown why
  • transient (1-3d)
141
Q

(true/false) there is a decrease in ventilatory response to hypercapnea under spinal/epidural anesthesia

A

false

- INCREASED ventilatory response to hypercapnea

142
Q

Structures such as blood, which has high water content, which reflects the (most / least) amount of beam rays on ultrasound

A

LEAST
- hypoechoic

*air reflects a good amt back too, need gel

143
Q

Structures such as bone/tendon, which has low water content, which reflects the (most / least) amount of beam rays on ultrasound

A

MOST

- hyperechoic

144
Q

An elevated cardiac fractional area change correlates with _____. This is (increased/decreased) with spinal anesthesia

A

above normal EF and increased Cardiac output

decreased

145
Q

Spinal anesthesia results in hypotension from what 3 mechanisms?

A

Sympathectomy
_____________
1. Arterial dilation
2. Venous dilation

Parasympathetic dominance +
Bezold-Jarisch reflex
_____________
3. Bradycardia

146
Q

What is the Bezold-Jarisch reflex?

A

Parasympathetic-mediated reflex
- acute decrease in LV preload -> stretch receptors in LV sense and slow heart in order to allow LV additional time to fill and increase preload

147
Q

The right coronary artery (RCA) supplies which walls of the heart?

A
  1. RA
  2. Anterior and posterior RV
  3. Upper atrial septum
  4. Posterior third of interventricular septum
  5. Inferior and inferoseptal walls of LV
148
Q

The _______ n supplies cutaneous innervation via its branches to the anteromedial thigh (anterior cutaneous branches), and medial side of lower leg and foot (saphenous n)

A

femoral nerve

149
Q

Pts with ankylosing spondylitis airway related complications

A
  1. Decreased ROM of cervical spine
    - intervertebral disc ossification
  2. Atlantoaxial instability
  3. TMJ hypomobility (ill sealing facemasks)
  4. Constrictive lung disease from pulmonary fibrosis
150
Q

Why are pts with ankylosing spondylitis at increased risk of epidural hematoma?

A
  1. Freq on NSAIDs
    - plt dysfunction and bleeding risk
  2. Lumbar spine fusion from ossification
    - diff placement/repeated attempts
151
Q

What is the Bainbridge reflex?

A

Preload in the heart causes stretch of the myocardium –>

increases intrinsic activity of the hart

152
Q

The great radicular artery (aka largest thoracic radicular artery aka arteria radicularis magna aka artery of Adamkiewicz) originates from ____

A

the aorta btwn T9-T12

153
Q

Posterior spinal cord syndrome will have which sensation INTACT below the level of the lesion? which is LOST?

A

intact: motor, temp, pain

loss: proprioception and vibration
- posterior spinal cord is responsible for these sensations

154
Q

What n. supplies the AFFERENT limb of the laryngospasm reflex?

A

Internal branch of the superior laryngeal n.

- sensory

155
Q

Areas of regional anesthesia from highest to lowest vascularity

A

Intravenous > Tracheal > Intercostal > caudal/paracervical > epidural > brachial plexus > sciatic/femoral > spinal > subcutaneous

156
Q

What n. supplies the EFFERENT limb of the laryngospasm reflex?

A

recurrent laryngeal n.

- motor

157
Q

The ___ rib is associated with the first thoracic vertebra on Xray

A

first

158
Q

Which nerve blocks are associated with phrenic n blockage?

A

Supraclavicular (50% of the time)
Interscalene brachial plexus (100% of time)
Stellate ganglion block

Anesthesia 101 (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions