Exam II: Specialty

Question 1

While topical anesthesia may be sufficient for certain eye procedures, the necessity of ___ of the extraocular muscles and eye lid may necessitate further anesthesia.

Answer 1

motionlessness (akinesia)

Question 2

Avoiding general anesthesia may be valuable in certain scenarios therefore demonstrating the value of a regional technique to accomplish ___ and ___ ___ of the eye structures.

Answer 2

sensory, motor blockade

Question 3

Knowledge of ___, surgeon preference, and ___ is important for deciding on the approach for ophthalmic anesthesia.

Answer 3

surgical field requirements, risk-benefit analysis

Question 4

Toleration of the placement of the block and ability to tolerate the surgery using ___anesthesia should be considered.

Answer 4

regional

Question 5

The use of sedation may result in satisfactory anxiolysis, but ___ ___should always be available, and caution is warranted when patients are at risk for airway support.

Answer 5

general anesthesia

Question 6

The necessity of ___ ___may be affected by manipulation of the airway in the presence of sedation, such as patients with sleep apnea.

Answer 6

eye akinesia

Question 7

One method of ___ is the application of local anesthetics to the surface of the eye.

Answer 7

analgesia

Question 8

For many procedures, this (application of LA to eye surface) is adequate with or without ___.

Answer 8

sedation

Question 9

Absence of ___ ___and speed of delivery make this very popular.
[Topical]

Answer 9

invasive injections

Question 10

An application of ___ ___ is generally adequate for short procedures.
[Topical]

Answer 10

2% lidocaine

Question 11

The ___or compartment ____ to the eye is the target of some blockades, but depositing local anesthetics outside of the cone adjacent to the cone and around the sclera can be a less invasive and adequate source of analgesia and in sufficient volumes, produce ____.

Answer 11

cone, posterior, akinesia

Question 12

One example is the Sub-Tenon block where a specific cannula is introduced just ____ to the sclera and allowed to track ___.

Answer 12

external, posteriorly

Question 13

The tenon capsule is a fascial layer that encapsulates the ___and produces the ____ for the Sub-Tenon block.

Answer 13

sclera, “container”

Question 14

__-__ml is allowed to fill the space.
[Sub-Tenon]

Answer 14

3-5

Question 15

As opposed to entry into the posterior vault/ cone, ___blocks deposit the LA into the tissue around the eye.

Answer 15

peri-bulbar

Question 16

This decreases the chance that it fully covers all ___ muscles; owing to the partitions created ___ around the eye.
[Peri-bulbar]

Answer 16

extraocular, circumferentially

Question 17

Larger volumes___ may be used or additional injections into the non-anesthetized quadrant can be completed to achieve akinesia.

[Peri-bulbar]

Answer 17

5-8ml

Question 18

These blocks are achieved by similar approach to the retrobulbar in that an___ ___ 4-5 o’clock position for right eye or 7-8 o’clock for the left eye is used to advance through the conjunctiva

[Per-bulbar]

Answer 18

inferior lateral

Question 19

A ___ direction is used until the mid-point of the globe is reached and then injection is given.
[Peri-bulbar]

Answer 19

caudal

Question 20

This approach decreases the chance of ___ and ___compartment trauma, but increases the chance of failed akinesia on first injection.
[Peri-bulbar]

Answer 20

globe, posterior

Question 21

A combination of ___ ___ and ___ ___ injections may produce desirable affect.
[Peri-bulbar]

Answer 21

superior lateral, inferior lateral

Question 22

The retrobulbar block and several similar injection techniques, are accomplished through the injection of LA into the compartment directly ___ to the globe of the eye (muscle cone/ retrobulbar space).

Answer 22

posterior

Question 23

Concurrent blockade of cranial nerves ___, ___, ___, ____, ___ accomplish the desired sensory and motor effects as the LA diffuses into the compartment nerves.

Answer 23

III, IV, V, VI, VII

Question 24

The procedure is accomplished by injection of LA ___of ___% preservative free lidocaine after topical skin cleansing.
[Retrobulbar]

Answer 24

2-4ml , 1-2

Question 25

___ may be administered prior to the block [Retrobulbar]

Answer 25

Anxiolysis

Question 25

___ may be administered prior to the block [Retrobulbar]

Answer 25

Anxiolysis

Question 26

Topical LA in the ___ is effective prior to injection [Retrobulbar]

Answer 26

conjunctiva

Question 27

The use of a ___ needle is ideal as this prevents over-insertion. [Retrobulbar]

Answer 27

1”

Question 28

Use of a block needle with ___ tip may also reduce traumatic effects. [Retrobulbar]

Answer 28

blunted

Question 29

Needle depth should be to a maximum of ___. [Retrobulbar]

Answer 29

1”

Question 30

Use of a blunt needle is preferred to a ___ needle [Retrobulbar]

Answer 30

sharp

Question 31

Finally needle angle should be initially ___, then ___ to the globe and only directed superiorly after passing the midpoint of the globe (~1/2”). [Retrobulbar]

Answer 31

downward, parallel

Question 32

Further, the patient should be directed to maintain gaze straight ahead or ideally toward the ___ such that the posterior structures of the eye are moved away from the needle’s path. [Retrobulbar]

Answer 32

needle

Question 33

Complications that can arise from these blocks include the following: ___causing seizures, ___ injury to posterior vasculature, ___injury, and significant ___ simulation. [Retrobulbar]

Answer 33

Intravascular injection, hemorrhagic, globe, vagal

Question 34

Particularly___ mediated bradycardia after the block should be anticipated and prepared for. [Retrobulbar]

Answer 34

vagal

Question 35

A clinician competent in ___ of the eye should be available when blocks are being performed. [Retrobulbar]

Answer 35

decompression

Question 36

Monitoring should be ___ to all other anesthetics. [Retrobulbar]

Answer 36

equivalent

Question 37

Primarily used to facilitate an ___ ___without sedation, regional techniques of the airway often require a ___ of blocks to sufficiently anesthetize the structures necessary to tolerate an intubation, classically by fiberoptic scope. [Airway blocks]

Answer 37

awake intubation, combination

Question 38

Regardless of the airway tool(s) used, the ___, upper airway, and ___must be considered. [Airway blocks]

Answer 38

tongue, vocal cords

Question 39

Glossopharyngeal nerve- (CN 9) controls sensation to the ___, ___, ___, ___.

Answer 39

posterior tongue, pharynx, portions of the soft palate and the epiglottis.

Question 40

This nerve is blocked through bilateral injection of LA (2ml of plain 1-2% lidocaine at the ____). [CN-IX]

Answer 40

base of each tonsillar pillar

Question 41

Alternatively, various forms of sprayed LA (topical benzocaine “Hurricane/ Cetacaine” Spray or atomized/ nebulized lidocaine) can be aerosolized into the ___ and ___.

Answer 41

oral cavity, posterior pharynx

Question 42

Superior laryngeal nerve- Derived from the Vagus (CN-10) innervates the ___ and ___ and controls the ____.

Answer 42

larynx and posterior epiglottis, cricothyroid muscle

Question 43

The SLN can be blocked by identifying the ___ bone and inject 2ml of lidocaine laterally and inferiorly to the most lateral portion.

Answer 43

hyoid

Question 44

Recurrent laryngeal nerve- controls sensation below the ___ and ___except the ___ muscle.

Answer 44

vocal cords and muscles of the larynx, cricothyroid

Question 45

This nerve can be blocked by using a ___-___injection through the cricothyroid membrane. [RLN]

Answer 45

trans-tracheal

Question 46

An IV catheter is placed into the space, aspirating to confirm air, then ___ml of ___% lidocaine is injected to produce a cough and aerosolization of the LA onto the cords and adjacent structures. [RLN]

Answer 46

2-3, 4

Question 47

Topical anesthesia can be provided through: (3).

Answer 47

nebulized LA, sprayed, or atomized formulations

Question 48

Typically, ___ is used. [Airway]

Answer 48

lidocaine

Question 49

Caution in toxic doses should be considered in relation to ___.

Answer 49

volume

Question 50

Because of the ease of nebulizing 4% lidocaine, it is often used to achieve a ___block, but ___ in the tracheal sites warrants careful attention to subsequent dosing respect to maximums.

Answer 50

fast, speed of uptake

Question 51

A key concept is ensuring all structures to be ___are addressed.

Answer 51

manipulated

Question 52

For example, if a nasal approach is used, additional topical should be applied by ___, ___ or ___supplement the oral cavity.

Answer 52

cotton swab, nebulizer, or atomizer to

Question 53

___ drugs for antisialagogue, aspiration prophylaxis, anxiolysis, and amnesia are usually helpful.

Answer 53

Adjunct

Question 54

Two nerves lie on either side of the finger, more to the ___side.

Answer 54

ventral

Question 55

Bilateral injections of ___ml is sufficient to provide blockage. [Digital Block]

Answer 55

2

Question 56

Lidocaine will function for ___hours while bupivacaine will last for as long as ___hours.

Answer 56

1-3, 12

Question 57

___ should not be added to digital blocks to reduce the risk of vascular ischemia.

Answer 57

Epinephrine

Question 58

A single injection along the ___ sheath identified by the “callous” in the palm of the hand.

Answer 58

flexor

Question 59

___ml injected here is possible for a bilateral block. [Digital Block]

Answer 59

2