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Anesthesia Foundations II Exam 2 > Truncal Blocks (week 6) > Flashcards

Truncal Blocks (week 6) Flashcards

1
Q

What are the absolute contraindications to regional anesthesia?

A
  • patient refusal
  • uncorrected coagulation deficiencies
  • infection at the block site

Nagelhout, pg. 1141

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2
Q

In addition to potentially spreading or seeding the infection, why else should regional anesthesia not be performed when there is an active infection at the site?

A
  • acidic environment will reduce effectiveness of the block

Nagelhout, pg. 1141

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3
Q

Allergies to which class of local anesthetic are more common?

A
  • Ester

ONE EYED ESTER IS A NASTAY BITCH

Nagelhout, pg. 1141

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4
Q

What is the double crush phenomenon as it relates to regional anesthesia?

A
  • The theory that patients with preexisting neurologic disease may experience permanent injury following a second insult

Nagelhout, pg. 1141, 1143

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5
Q

Why are allergies to ester local anesthetics more common?

A
  • The metabolite paraaminobenzoic acid (PABA) is a known allergen

Nagelhout, pg. 1141

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6
Q

Name the truncal blocks that can be utilized for surgeries in the chest/thorax area

A
  • PECS I/II
  • Paravertebral
  • Intercostal
  • Erector spinae

Nagelhout, pg. 1142 - Fig. 50.1

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7
Q

Name the truncal blocks that be utilized for surgeries in the abdominal/back areas

A
  • Transversus Abdominis
  • Quadratus Lumborum
  • Erector Spinae

Nagelhout, pg. 1142 - Fig. 50.1

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8
Q

Documented complications associated with regional anesthesia include:
* _________
* ________
* _________
* __________
* _________

A
  • direct/indirect nerve injury
  • local anesthetic systemic toxicity (LAST) events
  • vascular injury
  • hematoma
  • infection

Nagelhout, pg. 1142

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9
Q

While the overall incidence of severe or permanent peripheral nerve injury (PNI) following a block is extremely low, it is not uncommon in the early postoperative period for as many as 15% of patients to complain of _____________

A
  • paresthesia

aka postoperative neurologic symptoms (PONS)

Nagelhout, pg. 1142

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10
Q

True or false:

The lack of motor response when using a peripheral nerve stimulator is the best way to guarantee that intraneural needle placement has not occured, thus avoiding direct nerve injury

A
  • False - lack of motor response does NOT guarantee that intraneural needle placement has not occured

Nagelhout, pg. 1142

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11
Q

True or false:

All local anesthetics used in clinically relevant concentrations are potentially neurotoxic

A
  • True story

Nagelhout, pg. 1141

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12
Q

Indirect nerve injury refers to nerve injury occuring from local anesthetic toxicity, ____________, or _____________

A
  • ischemia
  • inflammation

Nagelhout, pg. 1142

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13
Q

All patients receiving peripheral blocks should have ____________, and blocks should be performed only in areas where ________________ are immediately available

A
  • functional IVs
  • patient monitoring, equipment, and drugs to treat LAST

Nagelhout, pg. 1143

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14
Q

Selection of local anesthetic is dependent on what 3 things?

A
  • onset
  • duration
  • desired density (pain management vs primary anesthetic)

Nagelhout, pg. 1143

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15
Q

In general, the highest concentrations of local anesthetic in the blood are found after _____________ blockade

A
  • intercostal

Nagelhout, pg. 1143

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16
Q

The type of local anesthesia may have a role in the development of neurotoxicity, with _________ being more toxic than ___________

A
  • esters
  • amides

Degree of neurotoxicity is dose dependent

Nagelhout, pg. 1143

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17
Q

How long does Exparel provide pain relief?

A

Up to 72 hrs

Nagelhout 7th, Ch. 50, pg. 1143

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18
Q

What is the maximum dose of Exparel?

A

266mg

Nagelhout 7th, Ch. 50, pg. 1143

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19
Q

What is the unique characteristic of Exparel that allows for such a long duration of action?

A
  • DepoFoam

basically an extended release “capsule”

Nagelhout, pg. 1143

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20
Q

Because of its delayed onset, it is not uncommon to mix Exparel with _________ to reduce the onset effect time of the block

A
  • standard bupivacaine

Nagelhout, pg. 1143

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21
Q

Exparel should not be adminstered for at least ___________ following any injection of lidocaine

A
  • 20 minutes

Nagelhout, pg. 1143

22
Q

Other formulations of bupivacaine should not be given for at least ___________ after a procedure using Exparel

A
  • 96 hours

Nagelhout, pg. 1143

23
Q

Why is it essential for a topical antiseptic to dry before an injection of Exparel?

A
  • antiseptic solutions may cause the liposomes to degrade, releasing toxic amounts of the drug into the plasma

Nagelhout, pg. 1143

24
Q

Following a peripheral nerve block, patients should be observed for at least _________ for potential signs of LAST or other adverse outcomes as blood levels peak

A
  • 30 minutes

Nagelhout, pg. 1144

25
What discharge information should patients be given after a peripheral nerve block regarding what to do/expect as the block starts to wear off?
* site may be numb for up to 72 hours * first sensations will be tingling in the area that was numb * being taking prescribed pain medication as soon as any feeling comes back ## Footnote Nagelhout, pg. 1144 - Box 50.1
26
You are performing a peripheral nerve block and utilizing a nerve stimulator - you have a setting of 0.1 mA and a motor response is elicited. Is this normal/expected? If not, explain why?
* The goal is to elicit a motor response with minimal amplitude - usually 0.3-0.5 mA * A setting less than 0.2 mA may indicate that the needle tip has penetrated the nerv'es epineurium - DO NOT PROCEED WITH INJECTION ## Footnote Nagelhout, pg. 1144
27
The number of cycles that occur in 1 second is called a __________
* Hertz, Jalen | as reference, humans can detect sound frequencies from 20 to 20,000 Hz ## Footnote Nagelhout, pg. 1145
28
In general, high frequency ultrasound (>7 MHz) creates _______ resolution images; these waves degrade/attenuate ___________ and can visualize structures up to depths of _________
* high * quickly * ≤ 4 cm ## Footnote Nagelhout, pg. 1145
29
Low frequency ultrasound (2-5 MHz) can image ________ structures with _________ resolution
* deeper * decreased ## Footnote Nagelhout, pg. 1145
30
The standardized propagation velocity of sound through tissue is approximately ____________
* 1540 m/second ## Footnote Nagelhout, pg. 1145
31
_________ of tissue describes it stiffness, or resistance against the propragation of sound
* impedance ## Footnote Nagelhout, pg. 1145
32
Differences in impedance along tissue borders results in:
* reflection * refraction * scattering * attenuation ## Footnote Nagelhout, pg. 1146
33
________ of an ultrasound wave is the basis of all diagnostic imaging and occurs when a sound contacts the borders of two tissues with difference densities (acoustic impedance)
* reflection | part of the beam continues through the tissue and part returns ## Footnote Nagelhout, pg. 1146
34
The amount of reflection of the US beam is proportional to the ____________
* difference of impedance between the two tissues ( equal impedance gives no echo, large difference gives large echo) ## Footnote Nagelhout, pg. 1146
35
Define refraction as it relates to ultrasound imaging
* the reflection of the ultrasound wave when it strikes at an oblique angle - the echoes do NOT return directly back to the transducer ## Footnote Nagelhout, pg. 1146
36
# True or false: Scattering occurs when the wave is smaller than the structure it contacts, generating a uniform, low amplitude reflection in all directions
* False - scattering occurs when the wave is GREATER than the structure it contacts ## Footnote Nagelhout, pg. 1146
37
What is an example of a hyperechoic structure? How might this appear on the ultrasound image?
* Bone, fascia, needles * bright/white ## Footnote Nagelhout, pg. 1147
38
What is the appearance of a hypoechoic structure on an ultrasound image?
* varying shades of gray ## Footnote Nagelhout, pg. 1147
39
Describe the appearance of nerves on an ultrasound image - why do they appear like this?
* They can be either hyper- or hypoechoic * It depends on their location in the body and the density of the surrounding structures ## Footnote Nagelhout, pg. 1147
40
Proximal nerves, such as the roots of the brachial plexus, are _______ dense than the surrounding connective tissue, making them appear ________echoic on ultrasound
* less * hypo ## Footnote Nagelhout, pg. 1147
41
Peripheral nerves, such as the tibial and peroneal nerves, are _______ dense than the surrounding connective tissue, making them appear ________echoic on ultrasound
* more * hyper ## Footnote Nagelhout, pg. 1147
42
What type of structure might appear anechoic on the ultrasound image?
* Fluid-filled (e.g. blood vessels & cysts) | They do not reflect sound waves ## Footnote Nagelhout, pg. 1147
43
In diagnostic imaging, Doppler is used to detect and measure __________
* blood flow ## Footnote Nagelhout, pg. 1147
44
Color-flow Doppler technology assigns a color to the blood flow based on ___________
* whether or not it is arterial or venous | NO STUPID IDIOT ITS BASED ON DIRECTION OF FLOW IN RELATION TO TRANSDUCER ## Footnote Nagelhout, pg. 1147
45
When Doppler ultrasound is oriented over a blood vessel so that blood is flowing toward the transducer it will result in a _____________ Doppler shift
* positive ## Footnote Nagelhout, pg. 1147
46
If blood is flowing away from the transducer, it will result in a ___________ Doppler shift
* negative ## Footnote Nagelhout, pg. 1147
47
In diagnostic ultrasound imaging, proper orientation is achieved when the orientation indicator is aligned to the provider's _________ side in a transverse view, or toward the patients _________ in a sagittal view
* left * head ## Footnote Nagelhout, pg. 1147
48
What is the appearance of the needle on the ultrasound image when using the in-plane approach?
* the entire length of the needle is visualized ## Footnote Nagelhout, pg. 1148
49
What is the appearance of the needle on the ultrasound image when using the out-of-plane approach?
* the cross section of the needle is seen as a hyperechoic dot where it crosses the plane
50
When utilizing a continuous catheter technique for peripheral nerve blocks, how far is the catheter threaded beyond the needle tip? What is the rationale for this length?
* 3-5 cm * insertions > 5 cm have been associated with catheter kinking/knotting ## Footnote Nagelhout, pg. 1175

Anesthesia Foundations II Exam 2 (6 decks)

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