Exam 1 Part 5

Question 1

MAC according to the ASA responsibilities include:

Answer 1

• same as general standards
• offer psychological support and comfort

Question 2

MAC technique requires the use of oxygen. True or false.

Answer 2

False

Question 3

Monitoring MAC

Answer 3

Same as general

• oxygenation
• circulation
• ventilation
• temperature

Question 4

Capnography necessary for only ventilated patient. True or false.

Answer 4

True

Question 5

Neuraxial anesthesia, like spinal and epidural anesthesia is most commonly performed under MAC or awake?

Answer 5

awake

Question 6

Neuraxial preparation

DAMOS

Answer 6

• sedation
• oxygen
• monitors
• drugs
• airway

Question 7

ABSOLUTE neuraxial contraindications

Answer 7

• infection at the site of infection
• patient refusal
• coagulopathy
• hypovolemia
• increased ICP
• severe aortic or mitral stenosis

Question 8

Relative neuraxial contraindications

Answer 8

• sepsis
• uncooperative patient
• neurologic deficit
• severe spinal deformity

Question 9

Controversial neuraxial contraindications

Answer 9

Prior back surgery

Inability to communicate

Complicated surgery

Surgeon preference

Question 10

Iliac crest crosses body of ___

Answer 10

L4

Question 11

T7 - T8 interspace at ____ of ______.

Answer 11

base

scapula

Question 12

Coumadin

Answer 12

Need PT/INR

Question 13

Plavix

Answer 13

Need 7 days

Question 14

spinal ligaments (3)

Answer 14

• ligamentum flavum
• supraspinous ligament
• interspinous ligament

Question 15

T6 dermatome

Answer 15

xiphoid process

Question 16

Block of posterior nerve roots interrupts ______ and _____ sensation.

Answer 16

somatic

visceral

Question 17

Blockade of anterior nerve roots prevent ____ and ____ outflow.

Answer 17

Motor

autonomic

Question 18

Somatic blockade interrupts painful stimuli and abolishes skeletal muscle tone.

Results in _____ blockade.

Answer 18

differential blockade

Question 19

Differential blockade: mainly _____ at site of injection.

2 dermatomes away ____ blockade

2 dermatomes away from that, _____ blockade

Answer 19

• motor
• sensory
• sympathetic (test with ice)

Question 20

Autonomic blockade:

Sympathetic response originating from ____ region.

Spans T __ to ___

Answer 20

thoracolumbar

T1 - L2

Question 21

Parasympathetic is from _____ region.

Will NOT block vagus since vagus from brainstem

Answer 21

craniosacral

Question 22

Cardiovascular blockade results in

Answer 22

decrease BP, HR, contractility, vasomotor tone

inhibit cardiac accelerators at T1-T4

Question 23

Epidural results in urinary retention. True or false?

Answer 23

True

Question 24

Advantages of epidurals:

Answer 24

• Decreased risk of post dural puncture headache (later)
• Decreased risk of hypotension because of slower onset
• greater control over intensity of sensory block
• greater control over motor block

Question 25

Disadvantages of epidural

Answer 25

* slower onset time * block is less dense

Question 26

Epidural test dose: * Volume: * Concentration: Why test dose?

Answer 26

* 3 ml of 1.5% lidocaine with 1:200,000 epi (5mcg/ml) To ensure we are in the right space

Question 27

Epidural increase in HR indicates what during a test dose?

Answer 27

The epidural is in the vein/artery.

Question 28

If the patient complains cannot feel legs right after giving test dose, indicates what?

Answer 28

the epidural is in the spinal region

Question 29

Local agent used in epidural has to be ______ \_\_\_\_\_\_.

Answer 29

PRESERVATIVE FREE

Question 30

Spinal anesthesia pharmacology

Answer 30

* preservative free * add vasoconstrictors and/or opioids * baricity

Question 31

CSF specific gravity is _____ to \_\_\_\_\_.

Answer 31

1.003-1.008

Question 32

To make hypobaric solution add ____ which is ____ than CSF. To make hyperbaric solution add _____ which is ____ than CSF.

Answer 32

sterile water, lighter glucose, heavier

Question 33

Complications of neuraxial anesthesia:

Answer 33

* High neural block * CARDIAC ARREST * Urinary retention * Inadvertent total spinal anesthesia * POSTDURAL PUNCTURE HEADACHE when dura is breached due to decrease pressure of CSF. * neuro injury

Question 34

Postdural puncture headache Treatment?

Answer 34

* onset 12 hours to several days after * lie down, in the dark * drink lots of Mt. Dew (caffeine stimulates CSF production) * Conservative--NSAIDS, Tylenol, fluid, caffeine * EPIDURAL BLOOD PATCH

Question 35

Caudal anesthesia

Answer 35

Sacral hiatus creased by unfused s4-5 common in kids for procedures below diaphragm

Question 36

Place epidural at \_\_\_-\_\_\_\_.

Answer 36

L3 - L4