Regional Quiz #4 Flashcards Preview

2nd Quarter > Regional Quiz #4 > Flashcards

Flashcards in Regional Quiz #4 Deck (15):
1

What are the indications for Intravenous Regional Anesthesia(Bier Blocks)?

surgeries and manipulations of the extremities requiring anesthesia for up to an hour's duration. Many times done in the ER.

2

What procedures are IVRA(Bier Blocks) most suited for?

peripheral soft-tissue ganglionectomies, carpal tunnel releases, Dupuytren's contractors or reduction of fractures

3

What are some adjuvants to LA in Bier Blocks?

ketorolac
clonidine
fentanyl
pancuronium
rocuronium
sodium bicarbanate

4

What equipment is used for a Bier Block?

Local Anesthesia
7/8" rubber tourniquet
18, 20, 22 g IV catheter and hep lock
standard monitors and resuscitation equipment
double-bladder pnuematic tourniquet
4,5, or 6" Esmarch bandage
60 ml syringe

5

What is the technique for performing a Bier Block?

-Place double tourniquet on brachium of arm with padding(soft roll)
-Cuff A placed in Axilla or "Above"
-Cuff B placed "Below"
-Place angiocath as far distal as possible
-Elevate arm and wrap Esmarch tightly up to B cuff
-Inflate distal(B) cuff 100 torr above patients SBP. Then, inflate A cuff to same pressure
-Remove Esmarch and check for presence of a radial artery pulse
-wrap 7/8" tourniquet around distal forearm and inject chosen volume of LA and remove angiocatheter
-prep, drape, cut

6

What are some complications associated with a Bier Block?

1. Drug related(LA and Adjuvants)--->LAST or Sedation related(opioids)
2. Equipment related--->inadvertent deflation of cuff, cuff failure sudden increase in venous pressure

7

What are Patrick Moss' clinical pearls regarding a Bier Block?

1. attempt to administer at least 4 mg of Versed prior to deflation of cuffs
2. deflate cuffs in a tiered fashion(down 10 sec and up 10 sec then repeat a few times) This allows time to question patient for CNS symptoms of toxicity.
3. Never deflate tourniquet if time is under 20, 25 or 30 minutes(depending on the text)--->20 was in Bold
4. The solution he uses:30 ml of 1.5% mepivacaine + 20 ml of sterile water or saline yielding a final concentration of 0.9% Mepivacaine and total volume of 50ml

8

What are digital blocks used for?

Used as to provide anesthesia to the digits of the fingers and toes

9

Where are digital blocks utilized?

mostly used in ER, Primary Care Clinics and occasionally in the operating theater

10

What equipment is used to perform a digital block?

-sterile towels with 4X4
-10 ml syringe with desired LA
-25g 1.5" needle

11

What is the technique utilized when performing a digital block?

-26g needle inserted at a point on the dorsolateral aspect of the base of the finger and a small skin wheal is raised.
-then redirect needle anteriorly toward the base of the phalanx.
-2-3 ml of solution is injected along phalanx with an additional 1 ml as the needle is being withdrawn.
-Repeat on the other side

12

What are Pat's Pearls of wisdom concerning Digital Nerve Blocks?

-NO EPI!!!
-Max volume 4-5ml per digit(roughly 2ml/side)
-NO digital tourniquets(this means rubber bands too)
-Caution if patient has Raynaud's or Sickle Cell Disease when using tourniquets
-Do no use tourniquet if patient has peripheral vascular disease

13

What are three types of Ocular Regional Blocks?

1. Topical
2. Peribulbar
3. Retrobulbar

14

What is the Opthalmic Anatomy?

-6 extraocular muscles
-2 eyelid muscles(Levator and Orbicular)
-Cranial Nerves of Eye Function(II-optic, III-oculomotor, IV--trochlear, ***V-TRIGEMINAL***, VI-abducen, VII-FACIAL, ***X-VAGUS***

15

What are the possible complications of Ocular Regional Blocks?

-retrobulbar hemorrhage
-bleeding into the eye
-temporary loss of vision
-lens occluded by blood
-increases intraocular pressure
-intrarterial injection(MOST COMMON COMPLICATION)
-injection into optic nerve sheath
-***OCULOCARDIAC REFLEX(5 AND DIME)***