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List 2 purposes of regional anesthesia
- - block pain perception
- - sometimes block motor activityat a targeted anatomical area
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List the 3 membranes around the spinal cord
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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
-
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
- airway management
- hypotension - IV fluids, vasopressors
- arrhythmias - meds/ cardioversion
- seizures - meds
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