exam 2 Flashcards by Grace Prinsell

eye procedures

NEVER insert more than ___ inch

use a ________ needle

1 inch

blunt needle

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eye surgery
true or false

GA should always be available
Always have a clinician (eye surgeon) available when block is being performed!

it CAN be the sole anesthetic

true

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topical is _______ only

NO akinesia

sensory

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LA applied outside/adjacent/posterior vault of cone + around the sclera

Tenon capsule is fascial layer that encapsulates the sclera, it produces a “container” for the block
(similar to TAP) block

sub-tenon

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eye
Sensory (analgesia) + akinesia (with LARGE doses)

sub-tenon

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eye
sensory only

topical

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eye
Sensory (analgesia) + akinesia (must be done on BOTH sides)

peri-bulbar

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eye
Sensory (analgesia) + akinesia/motor

retro-bulbar

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true or false

PERI-bulbar is SAFER and MORE common

true

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what direction should needle go with PERIbulbar block
when advancing through CONJUNCTIVA

________, ________

inferior, lateral

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peri-bulbar

R eye = ___-___ o clock
L eye = ___-___ o clock

R = 4-5
L = 7-8

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what direction should needle go with PERIbulbar block
UNTIL THE MIDPOINT of eye (halfway)
_________ direction

caudal/posterior

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eye
LA deposited directly posterior to the globe (muscle cone space)

retro-bulbar

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what 5 nerves does RETRO-bulbar block*

CN 3-7

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eye
have patient look at the ________

needle
or
straight ahead

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retro-bulbar

1st: __________ approach
2nd: _________ approach
3rd: once halfway, ___________ approach

1st: inferior/caudal/downward

2nd: parallel

3rd: superior, once halfway

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eye
which block do you use a smaller volume due to risk for compartment syndrome

retro-bulbar

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4 complications of eye blocks

IV injection (seizure)
hemorhagic injury
globe injury
vagal (bradycardia)

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true or false

airway block requires combo of 3 blocks

true

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what are 4 adjunct drugs for airway blocks

antisialagogue

aspiration prophylaxis
(non-particulate + reglan)

anxiolysis

amnesia

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indication for airway block

difficult airway

burn, contracture, spondylitis

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most superficial airway nerve

glossopharyngeal (CN 9)

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3 areas of sensation for glossopharyngeal (CN 9)

1) posterior tongue

2) pharynx

3) portions of soft palate + epiglottis

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3 areas of innervation for SUPERIOR laryngeal nerve*

1) larynx

2) POSTERIOR epiglottis

3) cricothyroid muscle

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3 areas of innervation for RECURRENT laryngeal nerve*

1) BELOW vocal cords 2) muscles of larynx (except cricothyroid) 3) deep to the trachea

SUPERIOR laryngeal nerve identify _______ bone inject ________ and __________ to the most lateral portion of bone

hyoid bone lateral, inferior

RECURRENT laryngeal use a _____________ injection through the _______________ membrane

trans-tracheal injection through the cricothyroid membrane

best formulation for LA topical

paste

true or false airway giving ONLY topical LA for airway is NOT sufficient for scope down the throat

true

digital block 2 nerves lie to the _________/_________ side

ventral/forward side

2 types of approaches for digital block

bilateral injections trans-thecal (single injection into callous/flexor sheath )

ligaments run ____________/________

longitudinal/vertical

connects transverse process + spinous process*

lamina

connects transverse process + vertebral body*

pedicle

intrathecal/subdural =

spinal block

what type of approach should you use for THORACIC

paramedian

what type of ANGLE should you use for THORACIC

cephalad (toward the head)

true or false termination of the spinal cord is NOT abrupt

true

epidural space is located where

posterior to the dura anterior to the ligamentum flavum

epidural space is ___cm deep for MIDLINE approach only

5cm deep do not go deeper! L&D is deeper

epidural space* widest = __________ narrow = ___________

widest = posterior/midline narrow = anterior/inward

INWARD curvature

lordosis

where is lordosis located

cervical lumbar

OUTWARD curvature

kyphosis

where is kyphosis located

thoracic

kyphosis results in _________ leaning position

forward-leaning

lordosis results in __________-direct spine

posterior-directed

how should a person sit for lumbar placement

kyphosis (opposite of normal)

true or false PALPATION of landmarks should occur PRIOR to site preparation/cleaning

true

CONTRAindications to central blocks

neuromuscular dx (MS, MG, increased ICP) cardiac frailty unable to tolerate aortic valve stenosis, HOCM, IHSS

3 types of patients that should NOT receive central block this is due to dependence on SVR

aortic valve stenosis hypertrophic obstructive cardiomyopathy (HOCM) idiopathic hypertrophic subaortic stenosis (IHSS)

true or false CPR will NOT be effective with patients with HOCM, IHSS, aortic valve stenosis

true

true or false with coagulopathy, NO standard is recognized

true

cause of total spinal

injected medications block nerves high into the thoracic or even cervical levels

symptoms of total spinal

PNS symptoms brady, hypotension, vascular collapse/dilation apnea loss of motor function loss of consciousness loss of airway

3 symptoms of horner syndrome

1. Ptosis 2. Miosis 3. Anhidrosis

post dural "spinal" headache is a result of a _______ puncture

dural puncture

___-___% of spinals cause post-dural headaches

1-2%

post-dural headache: by laying supine, the CSF pressure _________, this relieves the stretching

CSF pressure increases

2nd line treatment for postdural headache injection into __________ space with blood

epidural space

____ml blood patch, treatment is ___% successful

20 ml 90% successful

dermatome lateral portion of upper arm

dermatome prominent cervical spinous process

dermatome superior angle of the scapula and sternal notch

dermatome plane of Ludwig; carina; angle of Louis

dermatome base of the scapulae

dermatome xiphoid

dermatome umbilicus

T10

dermatome lateral portion of UPPER leg

dermatome MIDDLE portion of leg

dermatome superior aspect of the iliac crests

dermatome lateral portion of LOWER leg

motor blockade = ___ fiber

A fiber

sensory blockade = ___ fiber

C fiber

autonomic/sympathetic blockade = ___ fiber

B fiber

easiest to block

autonomic/sympathetic B fiber

hardest to block

motor blockade = A fiber

which blockade goes the furthest out

autonomic/sympathetic (B fiber)

Blocking ___ means it is a very dense block

what is usually identified first

sacrum

device ALLOWS for needle angle adjustment and multi-directional adjustments 3D slower

task-specific (Accuro)

device does NOT allow for needle angle adjustment DOES allow for depth of needle evaluation

standard ultrasound

true or false NEITHER device is set up for real time/live needle manipulation under ultrasound

true

type of needle for SPINAL

non-cutting needles "pencil point tips" cone-shaped tips

gauge for SPINAL needles

25 g

common length SPINAL needle

3.5in or 9cm

true or false baricity is ONLY applicable to SPINAL**

true

hyperbaric =

downward dextrose

hypobaric =

upward sterile water

4 biggest factors for affecting spread of SPINAL anesthesia

baricity gravity/positioning drug DOSE** site of injection

NARROW spine = _____ effect

narrow = LESS effect

topical lidocaine for spinal

spinal needle should be _________ or ____________

cephalad or horizontal

treatment for sympathectomy

volume challenge PRE-treatment pressors

cardioaccelerator blockade T__-T___

T1-T4

cardioaccelerator blockade treatment

volume loading BEFOREhand (1-2 L)

spinal is ___% of epidural dose

10%

bupivacaine dose ___% in _____% dextrose

.75% in 8.25% dextrose

bupivacaine ___-___ mg for perineum, lower limbs

4-10 mg

bupivacaine ___-___ mg for lower abdomen

12-14

bupivacaine ___-___ mg for upper abdomen

12-18

bupivacaine ALONE duration

1.5-2 hours

bupivacaine + epi duration

1.5-2.5 hours

fentanyl dose

10-25 mcg TOTAL 1-2 hour duration

epi dose

100-200 mcg TOTAL

true or false you CAN create a motor blockade with epidural

true

what type of needle is used for EPIDURAL

touhy "blunted AND curved"

true or false epidural: needle should remain shallow/PROXIMAL to the dura

true

needle GAUGE for epidural

16-18 g

epidural catheter advancement through needle should be ___-___cm

2-5cm

how do you know you are in the epidural space

loss of resistance hanging drop

hanging drop uses _______

saline

what is a risk with hanging drop with epidurals

dural puncture

true or false the NEEDLE must be removed 1st, then the catheter

true

test dosing occurs with epidural this is ___ml lidocaine, __% lidocaine, 1:_________ epi or ___mcg epi

3ml lidocaine 1.5% 1:200,000 or 15 mcg epi

what effects SPREAD**

volume

what effects DENSITY/FIBER TYPES**

concentration

1 ml per dermatome how many MLs would you need for T10-S5

13 ml

true or false Re-dosing of a catheter does NOT require an additional test dose, but should always be aspirated first

true

true or false gravity effects density

true

if catheter is stuck upon removal, what should you do

reposition the patient

true or false anticoagulation rules apply to catheter removal just as they do to catheter reinsertion

true

what is more dangerous, spinal or epidural

spinal

true or false caudal blocks are for peds and are NOT the sole anesthetic

true

caudal block is functionally the same as the __________ block

epidural block

caudal block approach the space through the ________ ________

sacral hiatus

caudal block sacral _______ = lateral sacral _______ = center

cornua = lateral hiatus = center

caudal block ____ gauge ____ degree angle CEPHALAD

22 gauge 45 degree angle

caudal block dose per kg ____-___ml/kg

0.5-1 ml/kg

what needle length for retrobulbar block

1 inch

toughy needle should be pointed ____

exam 2 Flashcards

(131 cards)