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REGIONAL ANESTHESIA Flashcards

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1
Q

Membrane
• 90% of lipids
• 10% protein

A
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2
Q

Negative resting potential

A

-70 to -90 mV

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3
Q

Classification of
Regional Anesthesia:

I. _____ – skin or mucous membrane

II. _____ – incision site / tissue to be cut (e.g. sebaceous cyst)

III. _____ – around tissue to be cut (e.g. breast mass)

IV. _____ (Bier Block)

V. _____ BLOCK – along nerve or course of nerves
A. Peripheral Nerve Blocks
B. Central Blocks

A

I. TOPICAL – skin or mucous membrane

II. INFILTRATION – incision site / tissue to be cut (e.g. sebaceous cyst)

III. FIELD BLOCK – around tissue to be cut (e.g. breast mass)

IV. INTRAVENOUS REGIONAL (Bier Block)

V. CONDUCTION BLOCK – along nerve or course of nerves
A. Peripheral Nerve Blocks
B. Central Blocks

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4
Q

CONDUCTION BLOCK types

A

A. Peripheral Nerve Blocks
B. Central Blocks

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5
Q

Incision site like sebaceous cyst anesthesia used

A

Infiltration

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6
Q

around tissue to be cut like breast mass anesthesia used

A

Field block

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7
Q

INTRAVENOUS REGIONAL ANESTHESIA aka.

A

Bier Block

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8
Q

Branches of trigeminal nerve

A

(ophthalmic, maxillary, mandibular)

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9
Q

CERVICAL PLEXUS BLOCK
• Anterior rami of _____ spinal nerve roots

A

C1-C4

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10
Q

BRACHIAL PLEXUS BLOCK
• Anterior rami of ____ spinal nerve roots

A

C4-T2

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11
Q

Major Peripheral Branches a. Axiliary N – __
b. Musculocutaneous – __
c. Radial – __
d. Median – __
e. Ulnar – __

A

Major Peripheral Branches
a. Axiliary N – shoulder abduction
b. Musculocutaneous – elbow flexion
c. Radial – elbow, wrist, and finger extensions
d. Median – wrist and finger flexion
e. Ulnar – wrist and finger flexion

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12
Q

operations of upper extremity anesthesia used

A

BRACHIAL PLEXUS BLOCK

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13
Q

__ provides alternatives to general anesthesia

A

Neuraxial anesthesia

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14
Q

__ pass freely in and out
__ barred outside

A

Channels guarded by “gates”
• K+ pass freely in and out
• Na+ barred outside

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15
Q

Nerve stimulation

A

o Gates open
o Na+ rushing in
o Shifting of polarity
o Depolarization

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16
Q

INTERCOSTAL NERVE BLOCK
• Anterior rami of __ eleven spinal nerves • At inferior surface of ribs

A

1st

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17
Q

COMPLICATIONS OF INTERCOSTAL NERVE BLOCK

A

Pneumothorax

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18
Q

ANKLE BLOCK

• Blocks five nerves supplying foot
1-5

A

a. Deep peroneal
b. Superficial peroneal
c. Saphenous
d. Posterior tibial
e. Sural

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19
Q

ANKLE BLOCK
• Precaution
• Avoid __ to reduce risk of ischemia

A

epinephrine

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20
Q

PUDENDAL NERVE BLOCK
• sacral plexus __-__

A

(S2 – S3 – S4)

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21
Q

Fan-shaped injection at the base blocks dorsal and ventral branches

A

DORSAL PENILE BLOCK

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22
Q

Local anesthetic deposited at sub arachnoid space

A

SPINAL ANESTHESIA

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23
Q

Drugs Used in Spinal Anesthesia

A

• Tetracaine
• Lidocaine
• Bupivacaine
T L B

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24
Q

Factors Determining Level of Anesthesia (in spinal anesthesia)

A

• volume of solution
• concentration
• barbotage
• speed of injection
• patient position
• specific gravity of solution
• site of injection
• height of patient
• increasedintra-abdominalpressure

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25
Position in spinal anesthesia
Lateral decubitus – knees flexed to chest chin put down on chest (nose-to-knee)
26
Puncture Sites in spinal anesthesia
• Interspaces between L2-L3, L3-:4, L4-L5 • Line joining highest points of iliac crests • crosses either body of L4 or interspace • between L4-L5
27
DELAYED COMPLICATIONS – leak of CSF
Headache
28
Levels of Spinal Anesthesia – Dermatomes Involved ____ - sensory loss involves lowers lumbar and sacral segments.
Saddle Block
29
Levels of Spinal Anesthesia – Dermatomes Involved __ – level of umbilicus (T10) lower thoracic lumbars and sacrals
Low Spinal
30
Levels of Spinal Anesthesia – Dermatomes Involved __ – costal margin (T6) lower thoracic lumbars and sacrals
Mid-Spinal
31
Levels of Spinal Anesthesia – Dermatomes Involved __ – nipple line (T4) thoracic segments (T4 – T12) lumbars and sacrals
High Spinal
32
Distance from skin to epidural space – __
4-5 cm
33
Position of epidural anesthesia
Position • Cervical epidural – sitting (C7) • Thoracic epidural (T7) • Lumbar epidural (L1-L2, L2-L3, L3-L4, L4-L5)
34
Method of Identifying Epidural Space
Principle: negative pressure in space
35
Drop of saline at hub of epidural needle is sucked in once it enters space
Hanging Drop
36
Central neuraxial block
Epidural anesthesia
37
LA injected into the epidural space in the sacral canal through sacral hiatus
CAUDAL ANESTHESIA
38
Caudal anesthesia blocks lumbosacral plexus ____ and coccygeal plexus ___
lumbosacral plexus (T12, L1-5, S1-3) and coccygeal plexus (S4-5, coccygeal nerves)
39
In caudal anesthesia __mL of lidocaine is used in the technique
15-20 mL
40
Reversible inhibition of sensory nerve impulse conduction
Local Anesthetics
41
• Prevent transmission of information to the CNS • No loss of consciousness
Local Anesthetics
42
NON PHARMACOLOGIC FACTORS INFLUENCING ACTIVITY OF LOCAL ANESTHETICS 1-5
1. Dosage 2. Addition of vasoconstrictor 3. Site of injection 4. Additives 5. Mixture of LA
43
In Spinal anesthesia, lack of _____ around spinal cord are responsible for the rapid onset
nerve sheath
44
Local anesthetic additive that increase pH near pKA more ionized faster entry faster onset
NaHCO3
45
Clinically Useful Local Anesthesia
AMINO-ESTERS Ester link between aromatic and main portion of the molecule AMINO-AMIDES Amide linkages
46
Local Anesthetics Classification Amides
Lidocaine, Bupivacaine, Ropivacaine, Levobupivacaine
47
Local Anesthetics Classification Esters
Procaine, Chloroprocaine, Cocaine, Tetracaine
48
Local Anesthetics Mechanism of Action
blocks voltage-sensitive Na+ ion channels in neuronal membrane \/ prevent Na+ influx (Depolarization) \/ prevent transmission of nerve impulses
49
Low anesthetic potency & short duration of action
procaine & chloroprocaine
50
Intermediate anesthetic potency & duration of action
lidocaine, mepivacaine & prilocaine
51
High anesthetic potency and prolonged duration of action
tetracaine, bupivacaine : racemic and levobupivacaine, ropivacaine, ethidocaine
52
decreases max rate of depolarization w/o altering RMP
LIDOCAINE
53
local anesthetic used in regional anesthesia for over 3 decades
BUPIVACAINE
54
- good motor/sensory block - less associated with tachyphylaxis - potential for cardiotoxicity and CNS toxicity
BUPIVACAINE
55
Mechanism: depresses the rapid phase of Depolarization (V max)
BUPIVACAINE
56
compounds made up of same atoms connected by the same sequence of bonds with different 3D structure
Stereoisomers
57
pairs of stereoisomers that, in their 3D projection, are related to each other as an object to its mirror image, and thus are not superimposable
Enantiomers
58
(+) enantiomer that rotates polarized light to the right
Dextrorotation
59
(-) enantiomer that rotates polarized light to the left
Levorotation
60
equal amounts of enantiomers in a chiral compound
RACEMIC MIXTURES
61
Comparative effect of racemic bupivacaine, levobupivacaine & ropivacaine on isolated rabbit heart.
D-Bupivacaine
62
Methemoglobinemia
PRILOCAINE
63
requires __mg Prilocaine to produce clinical level of Methemoglobenemia
600
64
requires 600mg Prilocaine to produce clinical level of Methemoglobenemia Reversed with _____
Methylene blue
65
EXTRAVASCULAR INJECTION BLOOD CONCENTRATION Depends on:
• Absorption • Tissue Redistribution • Metabolism • Excretion
66
Factors Affecting Absorption
• Site of injection – more blood supply > absorption • Choice of Drugs – characteristics of the drug may affect absorption • Dosage • Addition of Epinephrine – depends on the sensitivity of the vessels at the site of injection and local anesthesia itself
67
Central nerve blocks
A. Spinal anesthesia B. Epidural anesthesia C. Caudal anesthesia

ANESTHESIA (2 decks)

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