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Principles of Anesthesia I (Summer 2024: Cooper) > Exam 1 Spinal & Epidural Neuraxial Anesthesia [6/03/24] > Flashcards

Exam 1 Spinal & Epidural Neuraxial Anesthesia [6/03/24] Flashcards

(60 cards)

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1
Q

What is the preservative found in Amide LA’s?

A

Methylparaben

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2
Q

True or False:
If someone has an ester allergy, they will most likely have an amide allergy?

A

False
There is no cross-sensitivity between esters and amides.

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3
Q

What two components of a LA determine its onset of action?

A
  1. pKa
  2. Concentration
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4
Q

What component of a LA determines its potency?

A

Lipid solubility

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5
Q

The protein binding % of a LA determines its ___.

A

Duration of Action

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6
Q

Factors Influencing Vascular Uptake and Plasma Concentration of Local Anesthetics include:

STAMP

A

Site of Injection
Tissue Blood Flow
Addition of Vasoconstrictor
Metabolism
Physiochemical Properties

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7
Q

Which LA do we NOT want to use in a Bier Block?

A

Bupivicaine

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8
Q

Which type of LA baracity is good for Hip Replacements per Dr. Tubog?

A

Isobaric

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9
Q

List examples of Hyperbaric LA solutions:

A

Bupivicaine 0.75% in 8.25% Dextrose
Lidocaine 5% in 7.5% Dextrose
Tetracaine 0.5% in 5% Dextrose
Procaine 10% in water

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10
Q

What is the baracity of Bupivicaine 0.3% in water?

A

Hypobaric

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11
Q

The 4 isobaric solutions listed in class are all mixed with what additive?

A

Saline

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12
Q

What is the only LA mixture (per the powerpoint slides) that is combined with water but is not a hypobaric solution?

A

Procaine 10% in water = Hyperbaric

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13
Q

High and Low (Peak and Trough) dermatome points in a SAB?

A

High: C3 and L3
Low: T6 and S2

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14
Q

SAB Dosing Table

A
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15
Q

T4 and T10 doses of Bupivicaine and Levobupivicaine:

A

T10: 10-15 mg
T4: 12-20 mg

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16
Q

T4 and T10 doses of Ropivicaine:

A

T10: 12-18 mg
T4: 18-25 mg

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17
Q

T4 and T10 doses of 2-Chloroprocaine:

A

T10: 30-40 mg
T4: 40-60 mg

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18
Q

T4 and T10 doses of Tetracaine:

A

T10: 6-10 mg
T4: 12-16 mg

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19
Q

In an epidural, while ensuring incremental dosing of 5 mls, we should be avoiding these 3 negative outcomes.

A
  1. Accidental “High Spinal”
  2. Hypotension from Rapid autonomic blockade
  3. LAST
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20
Q

Most common concentration of 2-Chloroprocaine for surgical anesthesia?
Why is this important?

A

3%

Higher concentration = faster onset

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21
Q

Adding NaHCO3 increases these 4 things:

A
  1. pH of LA
  2. Concentration of Non-ionized form
  3. Rate of diffusion
  4. Speed of the onset of the block

Alkalinization

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22
Q

The ___ of the LA is crucial for determining how high the anesthetic block reaches.

A

Volume

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23
Q

What is the initial dose of an epidural?
What about the top-up dose?

A

Initial: 1-2 ml/segment
Top-Up: 50-75% of initial dose

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24
Q

What aspect of a LA determines how strong/dense the block is?

A

Concentration

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25
What are some positive outcomes to adding adjuncts to neuraxial anesthesia?
* Postoperative Analgesia * Extends Duration * Improves the density of the block
26
Which of the following drugs has been PROVEN to be the safest adjunct for neuraxial anesthesia? A. Neostigmine B. Ketamine C. Versed D. Clonidine E. Magnesium
D. Clonidine Rationale: All of the other drugs are still listed as "Investigative agents" and need to be further studied in order to be validated.
27
True or False: Vasopressors improve the density, duration and analgesia in neuraxial anesthesia?
FALSE Vasopressors extend the duration ONLY. Alpha-2 agonists improve the density, duration and analgesia in neuraxial anesthesia
28
Neuraxial Opioids target what area?
Substantia Gelatinosa of the dorsal horn (Lamina 2)
29
Do neuraxial opioids diffuse into the general circulation?
Yes: provides a more broad pain relief.
30
Examples of Hydrophilic Neuraxial anesthesia opioid adjuncts:
Morphine Hydromorphone Meperidine
31
Examples of Lipophilic Neuraxial anesthesia opiod adjuncts:
Fentanyl Sufentanil
32
When comparing hydrophilic opioids to lipophilic opioids, describe the duration and spread:
Duration is longer in hydrophilic and spreads more widely in a rostral manner
33
Is the onset longer or shorter in Hydrophilic opioids? What about systemic absorption?
Longer Less systemic absorption
34
Intrathecal, Epidural, and epidural infusion doses for Sufentanil
* Intrathecal: 5-10 mcg * Epidural: 25-50 mcg * Infusion: 10-20 mcg/hr
35
Intrathecal, Epidural, and epidural infusion doses for Fentanyl
* Intrathecal: 10-20 mcg * Epidural: 50-100 mcg * Infusion: 25-100 mcg/hr
36
Intrathecal, Epidural, and epidural infusion doses for Hydromorphone
Intrathecal: N/A Epidural: 0.5-1 mg Infusion: 0.1-0.2 mg/hr
37
Intrathecal, Epidural, and epidural infusion doses for Meperidine
Intrathecal: 10 mg Epidural: 25-50 mg Infusion: 10-60 mg/hr
38
Intrathecal, Epidural, and epidural infusion doses for Morphine
* Intrathecal: 0.25-0.3 mg * Epidural: 2-5 mg * Infusion: 0.1-1 mg/hr
39
Occurrence of pruritis after giving an opioid adjunct in neuraxial anesthesia:
30-100% of the time
40
Prophylactic measures to try and prevent pruritis.
* Minimize morphine dose < 300 mcg * Zofran * Nubain
41
How long does the addition of A2 agonists extend the sensory and motor blockade?
Approximately 1 hour
42
Doses of Precedex and Clonidine as neuraxial adjuncts:
Precedex: 3 mcg Clonidine: 15-45 mcg
43
Which of the following LA, when a vasoconstrictor is added as an adjunct, would cause the most profound increase in duration? Lidocaine Tetracaine Bupivicaine
Tetracaine
44
What is the most worrysome risk of performing neuraxial anesthesia on a patient taking anticoagulants?
Epidural Hematoma
45
Symptoms of an Epidural Hematoma:
Lower extremity weakness, numbness Lower back pain Bowel/Bladder dysfunction
46
Treatment for Epidural Hematoma:
Surgical decompression **within 8 hrs**
47
With which patient population (taking anticoagulants) is neuraxial anesthesia a big challenge?
Patients with Cardiac Stents
48
What are the guidelines for holding ASA in High Risk, Intermediate Risk, Low Risk and central neuraxial cases?
High/Intermediate: Hold 4-6 days Low: No hold Central: No additional precautions
49
How long should we hold NSAIDs for High risk procedures?
Hold for 5 half-lives
50
Place these types of surgeries in either a Low, Intermediate or High cardiac risk level: Prostate Surgery Cataract Surgery Breast Surgeries Open Aortic Surgery Orthopedic Surgery Head and Neck Surgery Peripheral Vascular Surgery Endoscopic Procedures Intra-thoracic/Intra-abdominal Surgeries
Prostate Surgery **(Intermediate)** Cataract Surgery **(Low)** Breast Surgeries **(Low)** Open Aortic Surgery **(High)** Orthopedic Surgery **(Intermediate)** Head and Neck Surgery **(Intermediate)** Peripheral Vascular Surgery **(High)** Endoscopic Procedures **(Low)** Intra-thoracic/abdominal **(Intermediate)**
51
How long should we hold Tirofiban/Eptifibatide prior to performing regional anesthesia? What about abciximab?
4-8 hrs 24-48 hrs
52
Hold time for Plavix, Prasugrel, Ticlopidine prior to Regional Anesthesia:
Plavix: 5-7 days Prasugrel: 7-10 days Ticlopidine: 10 days
53
Unfractionated Heparin will inhibit which factors?
2, 9, 10, 11, 12
54
Hold times for Low, High and Therapeutic doses of UFH?
Low (< 5,000 U): 4-6 hrs High (5-20,000 U): 12 hrs Therapeutic (> 20,000 U): 24 hrs
55
Why might we insist on a PLT level prior to central neuraxial block?
If the patient has been on UFH for > 4 days
56
LMWH will inhibit which factor?
Xa
57
Hold times of medications (for regional anesthesia) in patients on therapeutic or prophylactic doses of LMWH:
Prophylactic: 12 hrs Therapeutic: 24 hrs
58
How long should Warfarin be held prior to regional anesthesia?
Hold for 5 days, verify a normal INR (<1.5)
59
The use of which type of anticoagulants are an absolute contraindication to neuraxial anesthesia?
Thrombolytic Agents (t-PA, streptokinase, urokinase)
60
Hold time for direct oral anticoagulants prior to regional anesthesia: (Apixiban, Xarelto, Pradaxa, etc...)
DC at least 72 hrs prior to procedure

Principles of Anesthesia I (Summer 2024: Cooper) (18 decks)

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