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Principles of Anesthesia > Epidural Anesthesia (Exam I) > Flashcards

Epidural Anesthesia (Exam I) Flashcards

1
Q

What benefits are provided via an epidural (versus a spinal) ?

A
  • Predictable dermatome spread
  • Slower onset
  • Infusion (↑ duration)
  • Maintain ability to ambulate and void (If placed above (below?) T10)
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2
Q

What are the disadvantages to epidurals?

A
  • Longer time to place
  • slower onset
  • less dense block
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3
Q

What causes engorgement of the epidural venous plexus?

A
  • Obesity
  • Pregnancy
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4
Q

How does pKa affect onset of neuraxial anesthesia?

A

The closer pKa is to physiologic pH (7.4) the faster the onset.

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5
Q

What is the pKa of Lidocaine and prilocaine?

A

7.9

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6
Q

What drug is an exception to the pKa rule with an onset of action faster than lidocaine?
Why is this?

A

2-Chloroprocaine (pKa = 9) due to its 3% concentration.

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7
Q

What is the formula for pH?

A

pH = -log10 [H⁺]

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8
Q

What is the formula for Ka?

A

Ka = [H⁺][A-] ÷ [HA]

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9
Q

What is the formula for pKa?

A

pKa = -log(Ka)

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10
Q

What is the formula for Ka?

A

Ka = 10-pKa

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11
Q

Name the uptake of local anesthetics based on regional anesthetic technique (ex. IV vs SQ) in order from highest blood concentration to lowest.

A
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12
Q

What are the determinants of block spread with epidurals?

A
  • Volume
  • Site of injection
  • Dose of LA
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13
Q

Increases in CVP (coughing, pregnancy, etc) will result in _________ epidural pressure and thus more ________.

A

increased; spread

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14
Q

How much will lumbar epidural injection flow caudad from the site of injection?

A

Trick question. Lumbar injections produce a preferential cephalad spread

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15
Q

To achieve a T6 sensory level block from an L3-L4 injection, how many mL of epidural anesthetic must be given?

A

11 - 22 mL at 1-2 mL per segment

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16
Q

__mL of epidural anesthetic should be given as an incremental dose to avoid high spinals, sympathectomy, etc.

A

5

17
Q

What epidural anesthetic additive would notify the CRNA that the epidural is placed in the venous space?

A

Epinephrine (injection = ↑HR)

18
Q

________ will increase the duration of useful anesthesia with all epidural agents.

A

epinephrine.

19
Q

Epinephrine’s effects are greatest seen with which two LA’s?

A
  • Lidocaine
  • 2-Chloroprocaine
20
Q

Epinephrine’s effects are not as impressive with what LA’s?

A
  • Bupivacaine
  • Levobupivacaine
  • Ropivacaine
21
Q

What are the benefits of alkalinization of a local anesthetic?

A
  • ↑ concentration of non-ionized drug
  • ↑ rate of diffusion
  • ↑ speed of onset
22
Q

Name all the local anesthetics used for neuraxial anesthesia from those with a fast onset and short duration to those with a slow onset and long duration.

A

↑ Fast Onset / Short Duration

Chloroprocaine
Lidocaine
Mepivacaine
Ropivacaine
Bupivacaine

↓ Slow Onset / Long Duration

23
Q

1mEq for every 10mL of anesthetic of this drug can be given to speed up onset of action of said anesthetic.

A

Na⁺HCO₃⁻

Sodium Bicarbonate

24
Q

What concentration of chloroprocaine is used?

A

3%

25
Q

What concentration of Lidocaine is used for epidurals?

A

2%

26
Q

What concentration of Mepivacaine is used?

A

2%

27
Q

What concentration of Bupivacaine is used?

A

0.5 - 0.75%

28
Q

What metabolite of esters is important to know about?

A

PABA

29
Q

What local anesthetic is for epidural use only? (never for spinals)

A

2-Chloroprocaine 3%

30
Q

_______ has the greatest motor function depression while ______ has the least. (hint: local anesthetics)

A

Lidocaine = most motor blockade
Ropivacaine = Least

31
Q

What drugs should be used when a patient is 8-10cm dilated and complaining of pain?

A

Opioids (local anesthetics will cause motor blockade and decrease ability to push)

32
Q

Which epidural needle has the most curvature?

A

Tuohy (30°)

33
Q

How long from the tip of the Tuohy needle to the hub?

A

9cm

34
Q

What is the optimal catheter insertion depth for an epidural?

A

3-5cm

35
Q

The distance, in the average adult, from skin to epidural space is what?

A

4-6 cm

36
Q

What drug is used as a test dose for epidural placement?

A

Lidocaine 1.5% w/ 1:200k epinephrine

37
Q

What sign/symptoms would indicate a positive test dose during an epidural anesthetic?

A
  • HR ↑ by 20%
  • Tinnitus
  • Metallic taste
  • Circumoral numbness
38
Q

What will occur after a positive test dose is determined from an incorrect epidural placement?

A
  • Significant motor block (now you’re intrathecal!)
  • Peaked P-waves
  • T-wave changes in children

Principles of Anesthesia (24 decks)

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