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Advanced Anesthesia 2 > Oral Maxillofacial Trauma & Local Anesthetics - Quiz 5 > Flashcards

Oral Maxillofacial Trauma & Local Anesthetics - Quiz 5 Flashcards

(65 cards)

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1
Q

Which Facial Fracture is Triangular/Pyramidal in shape and affects the Nose and Palate?

A

Lefort II

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2
Q

Which type of Facial Fracture affects the entire face and completely separates the Midfacial Skeleton from the Cranial Base?

A

Lefort III

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3
Q

Which type of Facial Fracture affects just the Palate?

A

Lefort I

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4
Q

What is a concern while Intubating if a Lefort II or III is suspected?

A

Possible Intracranial Placement of ETT

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5
Q

Label the 7 Parts of the Mandible.

A
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6
Q

What are the Anesthetic Considerations regarding Facial Fractures?

A

Pretreat Edema w/ Steroids

Difficult/Bloody Airway

Awake Extubation

MUST have Wire Cutter/Scissors

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7
Q

What med can be given to help with Nasal Intubation?

A

Phenylephrine

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8
Q

A Left Enantiomer is denoted with an ___ for _______ and a Right Enantiomer is denoted with an __ for _______

A

A Left Enantiomer is denoted with an “s” for SINISTER and a Right Enantiomer is denoted with an “r” for RECTUS

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9
Q

Which Local Anesthetics are Pure Isomers?

A

Ropivacaine (s)

&

Levobupivacaine (s)

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10
Q

What are the advantages of using Local Anesthetics that are S Enantiomers?

A

S Enantiomers are LESS Neuro & Cardio-toxic

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11
Q

How do Local Anesthetics work?

A

Stops Na+ Ions from going through Sodium Channels

Slows Depolarization

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12
Q

Local Anesthetics do not alter _____ or _____ potentials

A

Local Anesthetics does not alter RESTING MEMBRANE or THRESHOLD potentials

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13
Q

How do Local Anesthetics affect nerves with more activity and firing?

A

Faster Blockade d/t more frequently activated-open state

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14
Q

Local Anesthetics have a much lower affinity for ________ than they do Sodium Channels

A

Local Anesthetics have a much lower affinity for POTASSIUM ION CHANNELS than they do Sodium Channels

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15
Q

What Increases the Minimum Local Anesthetic Concentration (Cm) to produce a conduction block?

A

Larger Nerve Diameter

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16
Q

What factors Decrease Minimum Local Anesthetic Concentration?

A

Higher Frequency Nerves

&

Higher pH

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17
Q

How does the Minimum Local Anesthetic Concentration compare between Motor & Sensory Nerves?

A

Minimum concentration is 2X more for Motor than Sensory Nerves - easier to block Sensory Nerves

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18
Q

How do Epidurals & Spinals affect Local Anesthetic Minimum Concentration?

A

No effect on Minimum Concentration, but requires less amount d/t direct nerve access

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19
Q

Local anesthetics must block at least ______ Nodes of Ranvier, preferably ____ Nodes

A

Local anesthetics must block at least TWO Nodes of Ranvier, preferably THREE Nodes

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20
Q

What is the Order of Blockade for Nerve Fibers

A
  1. B Fibers
  2. C & A-Delta Fibers
  3. A-Gamma Fibers
  4. A-Beta Fibers
  5. A-Alpha Fibers
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21
Q

What does the blocking of B Fibers affect?

A

Preganglionic Sympathetic Efferents

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22
Q

What does the blocking of C & A-Delta Fibers affect?

A

Pain

Temperature

Touch

Postganglionic Sympathetic Neurons

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23
Q

What are the function of A-Gamma fibers?

A

Efferent to Muscle Spindles

Muscle Tone

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24
Q

What is the function of A-Beta Fibers?

A

Afferent from Skin & Joints

Tactile

Propioception

Touch Pressure

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25
What is the Function of A-Alpha Fibers?
**Efferent to Muscles** Motor & Propioception
26
What is the Order of Blockade for Nerve _Functions_?
**ATP - TP - MVP** Autonomic, Temperature, Pain Touch & Pressure Motor, Vibration, Proprioception
27
What happens if B, C, and small/medium A Fibers are blocked, but NOT Large A Fibers?
Sympathectomy Loss of Temp & Pain Sensation Preserved Motor & Proprioception
28
What form is required to cross the Lipid Bilayer regarding pK?
Unionized, therefore Local Anesthetics closer to Physiologic pH have FASTER onset
29
Which particular Local Anesthetic does NOT ionize based on pH and has an Unknown mechanism?
Benzocaine - Weak Acid - pKA 3.5
30
A ________ pH Lessens sting of Local Infiltration
A **HIGHER** pH Lessens sting of Local Infiltration
31
How is Local Anesthetics Distrubuted throughout the body?
Lungs 1st High Perfused Tissues 2nd (Heart, Brain, Kidneys) Low Perfused Tissue 3rd (Muscle & Fat)
32
Which type of Local Anesthetics are more widely distributed throughout the body?
Amides
33
Which Local Anesthetic has a higher chance to Crossing Placenta: Lidocaine, Bupivacaine, or Ropivacaine?
Lidocaine since it's NOT as protein-bound
34
What happens when Local Anesthetics cross the placenta?
Local becomes more Ionized & cant get back out = Fetal Local Toxicity from Ion Trapping
35
The Potency of Local Anesthetics is related to \_\_\_\_\_\_\_\_, while the Onset is more related to \_\_\_\_\_\_
The Potency of Local Anesthetics is related to **LIPID SOLUBILITY**, while the Onset is more related to **IONIZATION**
36
How does Protein-Binding of Local Anesthetics affect Duration of Action?
More Protein-Binding = Stronger Attachment & Longer Duration
37
Which Amide is the fastest to be Metabolized?
Prilocaine
38
Which Amides are the slowest to be Metabolized?
Etidocaine Bupivacaine Ropivacaine
39
How are Amides metabolized versus Esters?
**Amides** = Hepatic Clearance **Esters** = Plasma Cholinesterase
40
Which Ester is the fastest to be metabolized?
Chloroprocaine
41
Which Ester is the slowest to be metabolized?
Tetracaine
42
What Ester metabolite can cause allergic reactions?
Paraaminobenzoic Acid (PABA)
43
Which local injection site has little to no cholinesterase?
CSF - must wait for systemic absorption for hydrolysis
44
What can Inhibit the activity of Plasma Cholinesterase?
Liver Disease Increased BUN Parturients Chemotherapy
45
What is the function of Epinephrine with Local Anesthetics?
Test Dose Limits Systemic Absorption Prolongs Lidocaine by 1/3 **No effect on Onset**
46
Which two Local Anesthetics have ZERO Vasodilator Activity?
Cocaine & Ropivacaine
47
How does Clonidine affect Local Anesthetics?
Enhance Neuraxial Anesthesia & Increase Duration
48
The Effects of Mixing Local Anesthetics are _______ and NOT \_\_\_\_\_\_\_
The Effects of Mixing Local Anesthetics are **ADDITIVE** and NOT **SYNERGISTIC**
49
What is the Max Dose of Lidocaine?
300 mg
50
What is the Max dose of Ropivacaine?
200 mg
51
What is the Max dose of Bupivacaine?
175 mg
52
What are symptoms of Systemic Local Anesthetic Toxicity w/ Plasma Lidocaine levels of 5-10 mcg/mL?
Circumoral Numbness Tinnitus Twitching Hypotension Myocardial Depression
53
What are symptoms of Systemic Local Anesthetic Toxicity w/ Plasma Lidocaine levels of 10-15 mcg/mL?
Seizures & Loss of Consciousness
54
What are symptoms of Systemic Local Anesthetic Toxicity w/ Plasma Lidocaine levels of 15 - 25 mcg/mL?
Apnea & Coma
55
What are symptoms of Systemic Local Anesthetic Toxicity w/ Plasma Lidocaine levels \> 25 mcg/mL?
CV Collapse
56
What are the systemic levels related to blood flow of tissue from fastest to slowest for Local Anesthetics?
**In Time I Can Please Everyone But Suzi and Sally** IV Tracheal Intercostal Caudal Paracervical Epidural Brachial Plexus Subarachnoid Subq
57
What is the risk involved with Intrathecal Lidocaine?
Transient Neuro Symptoms (Back, Butt & Thigh Pain) Cauda Equina Syndrome Anterior Spinal Artery Syndrome
58
What is Cauda Equina Syndrome?
**Neurotoxicity r/t Lidocaine** Lumbosacral Plexus Injury Bowel & Bladder Dysfunction Paraplegia
59
What happens with Anterior Spinal Artery Syndrome?
Lower Extremity Paresis & Sensory Deficit
60
It takes 3x more in Plasma Local Anesthetic Concentration to see Cardiotoxicty versus CNS, except when using which Local Anesthetic?
Bupivacaine 8-10 mcg/mL - will see CV symptoms before CNS
61
What happens with Cardiotoxicity r/t to Local Anesthetics?
Profound Hypotension & Myocardial Depression
62
What should be done first for treating Local Anesthetic Toxicity?
Manage Airway & Supress Seizures
63
Regarding Local Anesthetic Toxicity, which meds should be avoided when managing Arrhythmias?
Vasopressin B-Blockers CC-Blockers Reduce Epi to \< 1mcg/kg
64
What can be given for CV Collapse related to Local Anesthetics?
20% Lipid Emulsion
65
Which Local Anesthetics is Methemoglobinemia associated with?
Prilocaine \> 8mg/kg Lidocaine Benzocaine Cetacaine

Advanced Anesthesia 2 (8 decks)

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