IV Regional

Question 1

IV regional anesthesia is done after injecting local where?

Answer 1

venous system of an extremity that has been exsanguinated by the compression and isolated from the central circulation via tourniquet.

Question 2

True or false; IV regional blocks can be used as primary anesthesia?

Answer 2

True

Question 3

What is the time limit for IV regional?

Answer 3

1 hour or less

Question 4

Which has the greatest occurrence of complications, upper or lower extremity?

Answer 4

lower extremity

Question 5

Upper extremity IV regional is best suited for which operations?

Answer 5

soft tissue operations such as ganglionectomies, CTR, Dupuytren’s contractures, reductions of fractures.

Question 6

Manipulations of the ulnar, median, or radial nerves may require what in an addition to IV regional?

Answer 6

analgesics, sedation; usually a MAC or fentanyl/versed cases

Question 7

Indications for lower extremity IV regional techniques

Answer 7

excision of masses, digital nerve repair, phalangeal fractures, navicular excisions, orthopedic procedures

Question 8

Lower extremity IV regional techniques is associated with an increased risk of what?

Answer 8

compartment syndrome when treating tibial shaft fractures.

Question 9

Relative contraindications to IV regional?

Answer 9

crush injuries, inability to locate PIV, local skin infections, cellulitis, compound fractures, allergy to LA, severe vascular injury, PVD, sickle cell disease

Question 10

Only absolute contraindication to IV regional?

Answer 10

patient refusal

Question 11

What is the equipment necessary to perform IV regional?

Answer 11

LA, 18-20g IV, standard monitoring, functioning IV access, two pneumatic tourniquets, esmarch bandage, syringe

Question 12

First step in preparing patient for IV regional of upper extremity.

Answer 12

IV placement in hand or forearm (surgery on hand), Forearm or AC (if surgery on the elbow).

AC can be used if no access obtainable on hand (decreased effectiveness)

Question 13

First step in preparing patient for IV regional of lower extremity.

Answer 13

IV in lower leg, foot or ankle for surgery on leg/foot

Question 14

What could result in sickle cell disease?

Answer 14

acidosis, venous statis, sickle cell disease

Question 15

Esmarch bandage is applied when?

Answer 15

prior to axillary artery occlusion

Question 16

Which cuff is inflated first?

Answer 16

distal, then proximal

Question 17

Which cuff is deflated first?

Answer 17

distal; if pain inflate distal, deflate proximal

Question 18

If patient experiences tourniquet pain, waht should be the next action?

Answer 18

inflate distal, deflate proximal to cover TQ pain (will buy you 15-20 extra minutes)

Question 19

Axillary artery is occluded using what TQ pressure settings?

Answer 19

50-100mmHg above SBP (closer to 100 for LE)

Question 20

How many mLs of LA is infused in IV?

Answer 20

30-50mL

Question 21

LE requires how many mLs of LA?

Answer 21

100 mL

Question 22

What is the appropriate dosage for UE LA?

Answer 22

30-50 mL of 0.5% lidocaine (150-250mg);

12-15 mL of 2% lidocaine (24-30mg)

Question 23

What is appropriate dosages for LE LA?

Answer 23

50-100mL of 0.5% lidocaine (250-500mg)
15-30mL of 2% lidocaine (300-600mg)
MAX 300mg

Question 24

Other options for LA are available for IV regional?

Answer 24

Prilocaine 0.5% 40mL

Question 25

What are some additives of to IV regional LA?

Answer 25

Dexmedetomidine 0.5mcg/kg muscle relaxants Ketorolac 20-30mg (only drug that has showed any promise with blocks per Hadzic)

Question 26

What are some associated risks for IV regional?

Answer 26

excessive plasma concentrations, prilocaine = methemoglobin, ischemic pain from TQ

Question 27

Which block is associated with inadequate analgesia?

Answer 27

Lower; 100% incidence of local leakage under TQ

Question 28

TQ pain can result in what after 2 hours?

Answer 28

ischemic pain that results in HTN

Question 29

Use of procaine can result in what?

Answer 29

methemoglobinemia (occurs in about 4-8 hours after administration)

Question 30

Increased plasma concentrations of lidocaine are typically associated with what?

Answer 30

faulty tourniquet

Question 31

Increased plasma concentrations of lidocaine results in?

Answer 31

vasodilation, diminished cardiac contractility, hypotension

Question 32

There are typically no complications if TQ isn't deflated for at least ____?

Answer 32

20 minutes

Question 33

TQ deflation is associated with what risk?

Answer 33

LAST; ranges from tinnitus to seizure and cardiovascular collapse

Question 34

It is not unusual for a patient to experience what symptoms?

Answer 34

tinnitus, light-headedness, metal taste in the mouth

Question 35

methods to decrease the risk of LAST?

Answer 35

transfer pt to PACU with clamped distal TQ if surgery is very short (shouldn't be removed for 20 minutes) and deflate TQ in cyclic fashion, every 1-2 minutes, avoids one big LA washout

Question 36

Patients should be monitored for how long after deflation?

Answer 36

15 minutes