Local Anesthetic Part 2 Flashcards
(98 cards)
1
Q
Average pKa is ___ with LA.
A
8
2
Q
_______ increases the % of lipid soluble or non-ionized form LAs.
A
Alkalinization
3
Q
Benefit of Alkalinization of LA solutions:
* _________ onset of action: Peripheral and epidural blocks by 3 to 5 mins.
* Enhances the ________
* Increase the _______ (i.e., epidural)
A
- Faster
- depth
- spread
4
Q
Dexmedetomidine IV
Increased duration of:
* Both _____ and ______ blocks
* First analgesic request after _______ anesthesia
A
- motor and sensory
- spinal
5
Q
Magnesium:
Increased ________ with SAB with or without opioids
A
- duration
6
Q
Clonidine & Ketamine:
___________ regional anesthesia prolonged duration
A
- pediatric
7
Q
Dexamethasone:
__________ duration either ____ or mixed with LA.
A
- Increased
- IV
8
Q
Combination of Chloroprocaine & Bupivacaine:
* Produce a _______ onset and ___________.
A
- rapid
- tachyphylaxis
9
Q
__ ml of 8.4% Sodium Bicarb can be added to ___ ml of LA.
A
- 1 ml
- 30 ml
10
Q
When you combine LA’s, their ______ effectives are additive.
A
toxic
11
Q
Toxic Plasma Concentration of Lidocaine
A
> 5
12
Q
Toxic Plasma Concentration of Prilocaine
A
> 5
13
Q
Toxic Plasma Concentration of Mepivacaine
A
> 3
14
Q
Toxic Plasma Concentration of Ropivacaine
A
> 4
15
Q
The duration of action of a LA is _______ to the time the drug is in conctact with _______ fibers.
A
- proportional
- nerve
16
Q
Vasodilator and LA:
* 1. The duration of action of a LA is _____________ to the time the drug is in contact with nerve fibers.
2. Produce vasoconstriction.
3. ________ neuronal uptake of LA
4. α-adrenergic effects may have some degree of analgesia
5. No effect on ________ rate of LA
6. Enhanced cardiac _________ with inhaled anesthetics
7. Systemic absorption causes _______ and _________.
A
- proportional
- increased
- onset
- irritability
- HTN and Tachycardia
17
Q
Epinephrine ___ mg or Phenylephrine __ mg is used with Bupivacaine or Lidocaine SAB.
A
- 0.2 mg
- 2 mg
18
Q
LA 25% = ______mgs/mL
A
2.5
19
Q
LA 0.5% = ____ mgs/mL
A
- 5
20
Q
LA 1% = ___ mgs/mL
A
- 10
21
Q
LA 2% = ____ mgs/mL
A
- 20
22
Q
LA 4% = ____ mgs/mL
A
- 40
23
Q
Pharmacokinetics of LA:
* _____________ of LA Solutions
* Adjuvant ________ with LAs
* ___________ LAs
* __________ Use
A
- Alkalinization
- Mixed
- Combining
- Vasoconstrictor
24
Q
LA Uses:
* Topical
* _________ Infiltration
* _________ N. Block
* Intravenous
* Epidural
* Spinal
* Tumescent __________.
A
- Local
- Peripheral
- Liposuction
25
Max Lidocaine single dose is ____ mg or ____ mg with Epi
* 300
* 500
26
Max Bupivacaine single dose is ____ mg or ____ mg with Epi
* 175
* 225
27
Topical Anesthesia is applies to the ______ membrane of the nose, mouth, __________ tree, esophagus or ______ tract.
* mucous
* tracheobronchial
* GU
28
Topical Anesthesa:
_______ (4% to 10%) > __________ (1% to 2%) or Lidocaine (2% to 4%)
* Cocaine
* Tetracaine
29
Cocaine is used for _________ vasoconstriction. It decreases _____ loss and _______ surgical visualization.
* localized
* blood
* improves
30
Lidocaine works great with ______ anesthesia. Inhalation does not alter ______ resistance, but causes __________.
* surface
* airway
* vasodilation
31
_______ and _________ are ineffective as topical anesthesia d/t quick onset and offset.
* Procaine
* Chloroprocaine
32
Eutectic Mixture of LA consists of Lidocaine ____ % and ______ 2.5% = 5% LA.
* 2.5%
* Prilocaine
33
Eutectic Micture of Lidocaine 2.5% and Prilocaine 2.5% dose is __ to __gms/____ cm2 area.
* 1 to 2 grm
* 10 cm 2
34
Eutectic Mixture of Lidocaine 2.5% and Prilociaine 2.5% onset of action is ______ mins.
45 mins
35
Eutectic Mixture used for skin grafting needs to set for ___ hours before the procedure?
2
36
Eutectic Mixture needs to occur ___ mins before the following procedures:
* Cautery of genital warts
* venipuncture, lumbar puncture
* Arterial connulation (Nitroglycernine)
* Myringotomy
* 10 mins
37
Topical Anesthesia EMLA:
* caution with _________.
* ______ recommended for skin wounds
* C/I with _____ allergies
* methemoglobinemia
* NOT
* amide
38
Other EMLA Preparations are:
* Amethocaine (EMLA-like)
* Tetracaine __% Gel
* ____________ 7%
* Tetracaine __%
* 4% Gel
* Lidocaine
* 7%
39
Lidocaine can be used on nasal trumpets, but not LMA because
* Nasal trumpets are rubber
* LMAs are silicone and Lido breaks down silicone.
40
Local Infiltration Extravascular placement of LA is through ________ injection.
subcutaneous
41
Local Infiltration for Inguinal Operative Site:
* _______ 1% to 2%
* ____________ 0.25%
* _______________ 0.25%
* Lidocaine
* Ropivacaine
* Bupivacaine
42
Duration of a Local Infiltration can be doubled by adding Epi 1: ___________
* 200,000
43
Epi is C/I for Local Infiltration involving what (4) body parts? And Why?
* fingers
* toes
* ears
* nose
* penis
* Vasoconstriction, ischemia, necrosis
44
Peripheral Nerve blocks are achieved by LA being injected into tissue surrounding _______ peripheral nerves or nerve _______.
* individual
* plexus
45
Peripheral Nerve Block MOA is the diffussion from ____ mantle to central _______ of nerve along a _________ gradient.
* outer
* core
* concentration
46
Peripheral Nerve Block:
* Onset: _______ affected first, then _______.
* Ending: ______ Comes back first and then ______
* proximal
* distal
* proximal
* diastal
47
Peripheral Nerve Blocks: Smallest ________ and _____ fibers first, and then larger _______ and proprioceptive axons.
* sensory
* ANS
* motor
48
For Peripheral Nerve blocks, OOA is dependent on the LA ___.
* pK
49
Peripheral Nerve blocks:
* Lidocaine OOA _____ mins
* Bupivacaine OOA _____ mins
* 3
* 15
50
Peripheral Nerve Blocks _________ depends on the dose of LA
* Bupivacaine w/ Epi/fentanyl/clondine lasts __ to __ hours.
* duration
* 12
* 18
51
Peripheral Continuous Infusion Blocks:
* improved ___ control, less _______ and greater satisfaction
* _______ are used.
* pain
* nausea
* additives
52
Examples of Perpheral Nerve Blocks are
* Interscalene
* Axillary
* Femoral
* Sciatic
53
Peripheral Nerve Blocks: Nerve Stimulation
* mA __ - ___
* Pinpoint _____.
* 0.1 - 1
* needles
54
Peripheral Nerve: Ultrasound-guided
* ___- plane vs ___ - ___ -plane
* In - plane
* Out-of Plane
55
An August Bier Block is an example of a ____ Regional Anesthesia.
IV
56
A Bier Block is an ____ injection of LA into an extremity ______ from the rest of the systemic circulation with a _________.
* IV
* isolated
* tourniquet
57
For a IV Regional Anesthesia, the sensation and ___ tone dependent on the __________.
* muscle
* tourniquet
58
IV Regional Anesthesia ester or amide LA can be used:
* Lidocaine __ Mepivacaine
* Most commonly used is __________.
* <
* Lidocaine
59
Steps for a Bier
* IV start
* _________
* ______ cuff
* LA injection
* IV D/C
* Exsanguination
* double
* LA Infection
60
Sequence of Blockade:
1. _____
2. _____
3. _____
1. SNS
2. Sensory
3. Motor
61
Segmental Block in Neuraxial Anesthesia
* Myelinated Preganglionic B fibers (________) (SNS)
* Myelinated __ (medium) and B fibers (faster) > Unmyelinated ___ fibers (small)
* ________ & Temperature (touch/pressure, proprioception, & motor): myelinated A-δ and unmyelinated C fibers
* fastest
* A
* C
* Pain
62
Spinal Anesthesia is Produced by direct injection of LA into ____________.
* _____ is confirmation
* ________ fibers: Principal site of action
* subarachnoid
* CSF
* Principle
63
Spinal Block sensory effect is on the same level of _______.
* SNS effect is 2 spinal segments _________ of sensory
* Motor effect is 2 spinal segments _________ sensory
* denervation
* caudal
* below
64
Name the (5) LA for a Subarachnoid Block SAB
* Tetracaine
* Lidocaine
* Bupivacaine
* Ropivacaine
* Levobupivacaine
65
Subarachnoid Block (SAB) Dosages is according to:
* ________ of patient (vol of subarachnoid space)
* _________ level of anesthesia desired
* __________ of anesthesia desired
* Height
* Segmental
* Duration
66
For a Subarachnoid Block _______ is more important than ________________ of drug (%) or volume (mL) of solution injection.
* Dose
* Concentration
67
For a Subarachnoid with Bupivacaine 0.75%:
* ___ ft = 1 mL
* + ____ mL for every inch above for a total of __ cc. (1.5 hours to 2 hours)
* 5
* 0.1
* 2
68
SAB: The _____ _____ of LA is important in determining spread of the drug.
* Hyperbaric with __________ is additive
* ________ with distilled water as additive.
* Specific Gravity
* glucose
* Hypobaric
69
Hyperbaric:
* the specific gravity of LA is _____ than CSF.
* Glucose is additive
* Causes the LA to _______.
* greaters (>)
* Sinks
70
Hypobaric:
* Specific gravity of LA is _____ than CSF
* distilled water
* Causes the LA to _________
* less (<)
* float
71
Patient having surgery on right hip and you place the patient on their left side. A ________ additive is added to cause the LA to float up to the Right Hip.
Hypobaric
72
Most common Epidural LA is ________.
* Good _____ through tissues and safer.
* Lidocaine
* diffusion
73
Epidural:
* Levobupivacaine and __________
* less diffusion than bupivaine, but still with _____ and CNS toxicity.
* Ropivacaine
* Cardiac
74
Epidural:
* Onset: ___ to ____ minutes slow diffusion/delay
* Epi 1: 200,000 with bupivacaine: _____ advantage
* Great with loading dose and then _____ boluses.
* 15 to 30
* No
* intermittent
75
Epidurals for OB Labor and C-section:
* ________ placent barrier if not ionized
* Effect on fetus at ___ to ___ hours.
* __________ will cross more than bupivacaine
*Crosses
* 24 to 48 hours
* lidocaine
76
Epidural difference with SAB:
* ___ _______ zone of SNS, sensory, and motor blockade
* _____ dose required.
* No differential
* Large
77
Epidural: ___ are acceptable as additives to both Epidural & SAB synergistic.
* Opioids
78
Tumescent Liposuction: __ infiltration of large volumes (_L or more)
* SQ
* 5
79
Tumescent Liposuction Solutions:
* _____ Lidocaine (0.05 to 0.1%)
* Epinephrine 1: _______
* Diluted
* 100,000
80
Tumescent Liposuction causes taunt stretching of overlying ____ skin d/t large volume and _________ tumescent.
* Local anesthesia with _________ aspirates and _______ postoperative analgesia
* blanched
* vasoconstriction
* bloodless
* prolonged
81
Tumescent Liposuction:
* LA Plasma Peak is ___ to ___ hours s/p injection
* Where: thigh, _____, hips and _______.
* 12 to 14 hours
* abdomen
* buttocks
82
Tumescent Liposuction:
* Regional Anesthesia Lidocaine with Epi: __ mg/kg
* Highly __________ Lidocaine with Epi Tumescent: ___ to __ mg/kg
* 7
* diluted
* 35 to 55
83
Tissue Buffering System theory states that ___ gram of ___ tissue can absorb up to ___ mg of Lidocaine.
* 1
* SQ
* 1
84
Epinephrine:
1:200,000 Epi
* 5 mcg/mL
85
Epinephrine:
1: 500,000 Epi
* 2 mcgs/mL
86
Epinephrine:
1: 10,000 Epi
100 mcg/mL
87
Epinephrine:
1:1,000 Epi
1,000 mcg/mL or 1 mg/mL
88
A- alpha fibers sensitivity to LA
1
89
A- beta fibers sensitivity to LA
1
90
A- gamma fibers sensitivity to LA
1
91
A- Delta fibers sensitivity to LA
0.5
92
Beta fibers sensitivity to LA
0.25
93
C fibers sensitivity to LA
0.5
94
A- alpha: Function (2)
* Innervation of skeletal muscles
* Proprioception
95
A- Beta: Function (2)
* touch
* pressure
96
A- gamma: Function (1)
* Skeletal Muscle Tone
97
A- Delta: Function (3)
* Fast Pain
* Touch
* Temperature
98
C Fiber: Function (4)
* Slow Pain
* Touch
* Temperature
* Postganglionic sympathetic fibers
