- sometimes block motor activityat a targeted anatomical area
List the 3 membranes around the spinal cord
pia mater
arachnoid
dura
Which space contains Nerve roots and CSF?
a) epidural space
b) subarachnoid space?
b
Which space contains nerves, fat, lymphatic vessels and veins?
a) epidural space
b) subarachnoid space?
a)
List 3 types of nerve fibres in spinal nerves
sensory
motor
autonomic
The following sites are common for what type of regional anesthesia?
eye; tympanic membrane, upper airways
topical
List a complication to watch for with topical anesthesia to the eye
- if blink reflex is absent, eye patch may be necessary to prevent corneal abrasions
List a complication to watch for with topical anesthesia to the throat
- loss of protective reflexes eg gag, cough
- watch for signs of ineffective airway clearance
Topical anesthesia to which area increases the risk of systemic uptake and toxicity due to being highly vascular?
nasopharynx
What type of block injects local anesthetic into the subcutaneous tissue?
local infiltration
Which nerve fibres are blocked in local infiltration?
Sensory
Which nerve fibre(s) is affected in conduction or nerve blocks
sensory and motor
List common areas for conduction/nerve blocks
retrobulbar
ankle block
brachial plexus (interscalene block)
intercostal
ilioinguinal or iliohypogastric
penile
List 2 complications of retrobulbar block
retrobulbar hemorrhage
bradycardia caused by activation of the oculocardiac reflex
toxicity
perforation of globe
accidental anesthesia of the brainstem - resp arrest/unconsciousness
The following are complications of what type of block?
- accidental vertebral artery injection
- seizures
- cardiac arrest
- phrenic nerve block leading to resp failure
- recurrent laryngeal nerve block - hoarseness
- pneumothorax
brachial plexus interscalene block
The following are complications of what type of block?
- vascular injection
- pneumothorax
intercostal nerve block
The following are complications of what type of block
- femoral nerve block
- hematoma
ilioinguinal nerve block
What is the maximum inflation time for the tourniquet in a bier block?
1.5 hrs
At what point in a bier block does the greatest risk of local anesthetic toxicity occur?
during deflation of tourniquet. Done slowly and intermittently
The following are important to assess in what type of block?
- S & S of systemic anesthetic toxicity
- CSM in affected limb
-bier block
List 5 signs of central nervous system local anesthetic toxicity
metallic taste
numbness in tongue
ringing in ears
slurred speech
confusion
nausea
excitation
muscle twitching
seizures
lightheadedness
decreased LOC
List 5 signs of respiratory and cardiovascular system local anesthetic toxicity
difficulty breathing
apnea
resp depression or arrest
decreased CO
hypotension
arrthymias
increased pr and qrs complex duration
List 5 MILD signs of local anesthetic toxicity
anxiety
restlessness
numb tongue
tinnitus
lightheadedness
drowsiness
disorientation
increased PR/QRS intervals
hypotention
decreased CO
List 5 SEVERE signs of local anesthetic toxicity
muscle twitching
tremors of face and extremities
seizures
unconsciousness
resp arrest
marked hypotension and decreased CO
dramatic increases in PR/QRS
arrhythmias like AV block, bradycardia asystole
List treatment for MILD local anesthetic toxicity
document and report symptoms
monitor
may not need treatment
List treatment for SEVERE local anesthetic toxicity