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S5 - Regional/OB - Test 3 > Other Blocks (eye, airway, etc) > Flashcards

Other Blocks (eye, airway, etc) Flashcards

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
Q

What LA and volume are used for a Retrobulbar block

A

2-4ml of 1-2% preservative-free lidocaine after topical skin cleansing

26
Q

What would be v kind of you to give before an eye block

A

anxiolytic

27
Q

What length needle is used for retrobulbar blocks

A

1” blunt tip needle

28
Q

maximum needle depth for retrobulbar block

A

1” depth

29
Q

Describe the needle angle/approach for retrobulbar blocks

A

initially downward, then parallel to the globe and only directed superiorly after passing the midpoint of the globe

30
Q

how should the patient be instructed to direct their gaze during an eye block

A

straight ahead or towards the needle to ensure the optic nerve isn’t in the path of the needle

31
Q

Complications associated with eye blocks

A
  • seizures (injection in optic nerve sheath)
  • hemorrhagic injury to posterior vasculature
  • globe injury
  • significant vagal stimulation
32
Q

What complication should be anticipated and prepared for, for any eye block

A

vagal stimulation bradycardia

33
Q

who must be present during eye blocks

A

a clinician competent in decompression of the eye

34
Q

true/false: monitoring during eye blocks isn’t necessary

A

false duh

35
Q

is venous injection during eye blocks a serious complication?

A

no- intravascular injection isn’t dangerous, but the block won’t be effective

36
Q

airway blocks are primarily used for what

A

awake fiberoptic intubations without sedation

37
Q

controls sensation to the posterior tongue, pharynx, portions of the soft palate, and the epiglottis

A

glossopharyngeal CN IX

38
Q

How is the glossopharyngeal nerve blocked

A
  • blocked through bilateral injection of LA at the base of each tonsilar pillar
  • atomized LA into the oral cavity and posterior pharynx
39
Q

What LA and how much volume is used for glossopharyngeal blocks

A

2ml 1-2% lidocaine (bilaterally)

40
Q

innervates the larynx and posterior epiglottis and controls the cricothyroid muscle

A

superior laryngeal nerve- derived from the Vagus

41
Q

What is the landmark used for superior laryngeal block

A

hyoid bone

42
Q

where is LA injected for a SLN block in relation to the hyoid bone

A

inject 2ml laterally and inferiorly to the most lateral portion

43
Q

controls sensation below the vocal cords and muscles of the larynx except for the cricothyroid muscle

A

RLN

44
Q

How is the RLN blocked

A

trans-tracheal injection through the cricothyroid membrane

45
Q

after puncturing the cricothyroid membrane what is done to confirm placement before LA injection

A

aspirate for air

46
Q

what LA and how much volume is used in a RLN block

A

2-3ml of 4% lidocaine

47
Q

what response to trans-tracheal injection of LA is beneficial to help the spread

A

cough

48
Q

why is there a high risk of toxicity with nebulizing LA to the airway

A

the tracheal site has the fastest uptake

49
Q

What adjunct drugs should be considered before airway blocks

A
  • antisilalogogue
  • aspiration prophylaxis
  • anxiolysis and amnesia
50
Q

two nerves lie on either side of the finger more to the __ side

A

ventral

51
Q

volume used for digital block

A

2ml

52
Q

how long will a lidocaine digital block last

A

1-3hrs

53
Q

bupivacaine digital block will last as long as?

A

12hrs

54
Q

should you add epi to a digital block

A

no d/t risk of vascular ischemia

55
Q

where is LA injected for a digital block

A

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
Q

Volume used for caudal block

A

1 ml/kg

57
Q

is caudal block typically used as sole anesthetic?

A

No, more of an adjunct

58
Q

depth of needle for retrobulbar block before directing upward and medially

(note with block video he uploaded)

A

at least half

S5 - Regional/OB - Test 3 (4 decks)

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