Other Blocks (eye, airway, etc) Flashcards

(58 cards)

1
Q

Caudal blocks are limited to what population and why?

A

Pediatrics

anatomical structures are less reliable in adults

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2
Q

caudal blocks are functionally similar to what other block?

A

epidural blocks

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3
Q

caudal blocks are approached through what space

A

sacral hiatus

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4
Q

What are the target levels of anesthesia for caudal blocks

A
  • lower extremities
  • distal colon
  • urologic
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5
Q

What is responsible for the increased failure rate associated with caudal blocks

A

inadvertent extravasation of LA into other compartments

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6
Q

Identification of landmarks for caudal block

A

note the distal end of the coccyx, the sacral cornua on the lateral margins, and the sacral hiatus in the center

(this means nothing to me, going to try and find a better explanation)

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7
Q

What gauge needle for caudal block

A

22g

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8
Q

For caudal block what angle do you advance your needle and in what direction

A

advance at 45-degree angle cephalad until a pop and loss of resistance is achieved

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9
Q

At what point during caudal block can injection of LA occur

A

after pop and loss of resistance

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10
Q

Benefits of topical for eye procedures

A
  • you don’t have to get a needle stabbed in your eye
  • fast onset
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11
Q

What LA is of used for topical for eye procedures

A

2% lidocaine

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12
Q

Sub-Tenon block

A
  • depositing LA outside of the cone/posterior compartment and around the sclera
  • less-invasive block that can produce akinesia is sufficient volume is used
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13
Q

For a sub-tenon block achieving akinesia is dependent on what

A

volume

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14
Q

name of the fascial layer that encapsulates the sclera and produces the “container” for the sub-tenon block

A

tenon capsule

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15
Q

What volume is used to fill the tenon capsule

A

3-5ml

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16
Q

For a peri-bulbar block where is LA injected

A

into the tissue around the eye

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17
Q

With a peri-bulbar block is there an increased or decreased chance of fully covering all extraocular muscles

A

decreased

(vs. retrobulbar, I think? v unclear)

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18
Q

What volume is used for a peri-bulbar block

A

5-8ml

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19
Q

Peri-bulbar block approach

(going to try and find better explanation for this from a different source)

A
  • inferior lateral to advance through the conjunctiva
  • “4-5 o’clock” position for the right eye
  • “7-8 o’clock” for the left eye
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20
Q

What direction is used for a peri-bulbar block- cephalad or caudad?

A

caudal direction until the mid-point of the globe is reached, then injection is given

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21
Q

the caudal direction during a peri-bulbar block reduces the chances of what?

increased chance for?

A
  • reduces the likelihood of globe and posterior compartment trauma
  • increases the chance of failed akinesia on first injection
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22
Q

true/false: you can only perform peri-bulbar blocks with an inferior lateral injection

A

false: combining superior lateral and inferior lateral injections “may produce desirable affect”

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23
Q

injection of LA into the compartment directly posterior to the globe of the eye

A

retrobulbar block

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24
Q

what cranial nerves are blocked/targeted for retrobulbar blocks

A

CN III, IV, V, VI, VII

25
What LA and volume are used for a Retrobulbar block
2-4ml of 1-2% preservative-free lidocaine after topical skin cleansing
26
What would be v kind of you to give before an eye block
anxiolytic
27
What length needle is used for retrobulbar blocks
1" blunt tip needle
28
maximum needle depth for retrobulbar block
1" depth
29
Describe the needle angle/approach for retrobulbar blocks
initially downward, then parallel to the globe and only directed superiorly after passing the midpoint of the globe
30
how should the patient be instructed to direct their gaze during an eye block
straight ahead or towards the needle to ensure the optic nerve isn't in the path of the needle
31
Complications associated with eye blocks
* seizures (injection in optic nerve sheath) * hemorrhagic injury to posterior vasculature * globe injury * significant vagal stimulation
32
What complication should be anticipated and prepared for, for any eye block
vagal stimulation bradycardia
33
who must be present during eye blocks
a clinician competent in decompression of the eye
34
true/false: monitoring during eye blocks isn't necessary
false duh
35
is venous injection during eye blocks a serious complication?
no- intravascular injection isn't dangerous, but the block won't be effective
36
airway blocks are primarily used for what
awake fiberoptic intubations without sedation
37
controls sensation to the posterior tongue, pharynx, portions of the soft palate, and the epiglottis
glossopharyngeal CN IX
38
How is the glossopharyngeal nerve blocked
* blocked through bilateral injection of LA at the base of each tonsilar pillar * atomized LA into the oral cavity and posterior pharynx
39
What LA and how much volume is used for glossopharyngeal blocks
2ml 1-2% lidocaine (bilaterally)
40
innervates the larynx and posterior epiglottis and controls the cricothyroid muscle
superior laryngeal nerve- derived from the Vagus
41
What is the landmark used for superior laryngeal block
hyoid bone
42
where is LA injected for a SLN block in relation to the hyoid bone
inject 2ml laterally and inferiorly to the most lateral portion
43
controls sensation below the vocal cords and muscles of the larynx except for the cricothyroid muscle
RLN
44
How is the RLN blocked
trans-tracheal injection through the cricothyroid membrane
45
after puncturing the cricothyroid membrane what is done to confirm placement before LA injection
aspirate for air
46
what LA and how much volume is used in a RLN block
2-3ml of 4% lidocaine
47
what response to trans-tracheal injection of LA is beneficial to help the spread
cough
48
why is there a high risk of toxicity with nebulizing LA to the airway
the tracheal site has the fastest uptake
49
What adjunct drugs should be considered before airway blocks
* antisilalogogue * aspiration prophylaxis * anxiolysis and amnesia
50
two nerves lie on either side of the finger more to the __ side
ventral
51
volume used for digital block
2ml
52
how long will a lidocaine digital block last
1-3hrs
53
bupivacaine digital block will last as long as?
12hrs
54
should you add epi to a digital block
no d/t risk of vascular ischemia
55
where is LA injected for a digital block
single injection along the flexor sheath identified by the "callous" in the palm of the hand or bilateral injections of 2 mL for each nerve on the ventral part of the finger
56
Volume used for caudal block
1 ml/kg
57
is caudal block typically used as sole anesthetic?
No, more of an adjunct
58
depth of needle for retrobulbar block before directing upward and medially (note with block video he uploaded)
at least half