Anesthesia

Question 1

Types of anesthesia

Answer 1

1. General
2. Sedation
3. Regional

Question 2

General anesthesia:

1. Suppression of what activity?
2. How does it affect the patient? 2

Answer 2

1. Suppression of activity in the CNS
2. • Unconsciousness and
   • total lack of sensation

Question 3

Sedation anesthesia

What is it?

Answer 3

Inhibition of transmission of nerve impulses between higher and lower centers of the brain inhibition of anxiety and memory

Question 4

What is regional anesthesia?

Answer 4

Regional : use of local anesthetics to make a portion of the body insensate by blocking transmission of nerve impulses between a part of the body and the spinal cord

Question 5

Peripheral regional anesthesia

1. Inhibits what?
2. What are a type of this?
3. Central regional anesthesia is what?

Answer 5

Peripheral
1. Inhibits sensory perception within a specific location
2 .Nerve blocks

Central
3. Local anesthetic delivered around the spinal cord and removes sensation of the body below the level of the block (spinal and epidural)

Question 6

Endpoints of Anesthesia? 5

Answer 6

1. Analgesia
2. Hypnosis
3. Amnesia
4. Hemodynamic Stability
5. Immobility

Question 7

What helps us accomplish the following anesthesia endpoints:

1. Analgesia? 4
2. Hypnosis? 3
3. Amnesia? 1
4. Hemodynamic Stability? 2
5. Immobility? 1

Answer 7

1. • Opiates
   • Local anesthetics
   • Ketamine
   • NSAIDs
2. • Barbiturates
   • Propofol
   • Etomidate
3. Benzodiazepines
4. • Beta-blockers
   • Sympathomimetics
5. Muscle relaxants

Question 8

Risks of anesthesia

4

Answer 8

1. Death
2. Myocardial infarction
3. Pulmonary embolism
4. Post operative nausea and vomiting

Question 9

ASA Classification

The higher the ASA class = what?

Answer 9

increased likelihood of surgical or anesthetic complications

Question 10

Regional anesthesia/Local anesthesia

is what?

Answer 10

Pain blocked from a part of the body using local anesthetics

Question 11

Types of regional anesthesia

6

Answer 11

1. Infiltrative
2. Peripheral nerve block
3. IV regional anesthesia
4. Central nerve blockade
5. Topical anesthesia
6. Tumescent anesthesia

Question 12

Describe the Types of regional anesthesia:

1. Infiltrative?
2. Peripheral nerve block?
3. IV regional anesthesia (aka Bier block)?

Answer 12

1. Infiltrative
   - Local anesthetic injected in a small area to stop sensation
2. Peripheral nerve block
   - Local anesthetic injected near a nerve that provides sensation to a portion of the body
3. IV regional anesthesia (aka Bier block)
   - Dilute local anesthetic infused to a limb through a vein with a tourniquet placed to prevent the drug from diffusing out of the limb

Question 13

Describe the Types of regional anesthesia:

1. Central nerve block? (two kinds?)
2. Topical Anesthesia?
3. Tumescent anestheisa?

Answer 13

1. Central nerve blockade
   -Infusion or injection of local anesthetic in or around a portion of the CNS
   (Spinal (intrathecal) and epidural)
2. Topical anesthesia
   - Special formulation that diffuses through the skin or mucous membranes (EMLA patches)
3. Tumescent anesthesia
   - Large amount of dilute local anesthesia infilatrated into the subcutaneous tissue used in liposuction

Question 14

Neuroaxial anesthesia

1. Indications?2
2. Contraindications? 3

Answer 14

1. Indications:
   - Surgery or pain
   - Appropriate distribution
2. Contraindications:
   - Patient refusal
   - Infection
   - Coagulopathy

Question 15

Benefits of spinal anesthesia

4

Answer 15

1. Decreased surgical time by 12%
2. 25% less blood loss
3. 50% less intraoperative transfusion requirements
4. May decrease the incidence of DVT or PE

Question 16

Benefits of epidural anesthesia and analgesia

6

Answer 16

1. Less blood loss
2. Reduced platelet aggregation
3. Reduced stress response to surgery
4. Decreased incidence of DVT
5. Improved graft patency after LE revascularization
6. Patients with combined (general and epidural) for aortic surgery had lower incidence of death and major perioperative complications

Question 17

Neuroaxial anesthesia compications? 2

-most common?

Answer 17

1. Most common is a post procedural headache

2. Spinal hematoma or abscess

Question 18

Compare the following with Spinal and Epidural Anesthesia:

1. Location of injection?
2. Specific levels?
3. Injection vs. catheter?

Answer 18

Spinal
1.  Lumbar region only
(below L2)
2. No
3. Many times just a one time dose

Epidural

1. Anywhere along the spine
2. Chest, abdomen, pelvis, legs
3. Often a catheter is left in place for multiple injections

Question 19

How would you accomplish nerve localization for a regional block? 3

Answer 19

1. Paresthesia
2. Nerve stimulation
3. US

Question 20

Common brachial plexus blocks? 3

Answer 20

1. Interscalene
2. Supraclavicular
3. Axillary

Question 21

Digital block

1. What needle?
2. What should you use?

Answer 21

1. 1.5 inch 25ga needle
2. 1-2ml local anesthetic/side
   No epinephrine!**

Question 22

List the following meds in order of short duration to long duration (and fast onset to slow)? 7

Answer 22

1. Procaine
2. Chloroprocaine
3. Lidocaine
4. Mepivacaine
5. Ropivicaine
6. Bupivacaine
7. Tretracaine

Question 23

1. What are the short acting esters? 2
2. What are the long actin esters?
3. What are the intermediate amides? 2
4. What are the long acting amides? 2

Answer 23

1. • Procaine (Novacaine)
   • 2-Chloroprocaine
2. Tetracaine
3. • Lidocaine (Xylocaine)
   • Mepivacaine
4. -Bupivacaine
   (Sensorcaine, Marcaine)
   -Ropivacaine (Naropin)

Question 24

Differential blocks? 2

Answer 24

1. Bupivacaine

2. Lidocaine

Question 25

Why Add Epinephrine to LAs? | 4

Answer 25

1. Prolong surgical anesthesia time 2. Decrease peak serum levels 3. Intravascular marker 4. Decrease surgical site bleeding

Question 26

1. When not to add epinephrine? | 2. Four areas?

Answer 26

1. When the vasoconstrictive properties of epinephrine may compromise tissue perfusion (e. g. “end” arteries): Fingers/toes Penis Ear/nose Skin flaps

Question 27

Treatment of local anesthetic toxicity | 5

Answer 27

1. Stop injection 2. Call for help 3. Supportive care (ABCs) 4. 20% Intralipid 1.5ml/kg IV bolus 0.25ml/kg/min May repeat bolus (1-2X) 5. Cardiopulmonary bypass