Regional

Question 1

Complications of deep and superficial plexus blocks?

Answer 1

Mostly r/t the deep:
- epidural and subarachnoid injx
- phrenic nerve blockade
- intravasc injx into vertebral art
- RLN blockade
- Horner’s syndrome (ptosis, miosis, anhidrosis)

Superficial:
- LA toxicity, bleeding, infx (nothing special)

Question 2

What kind of regional anesthesia could you perform for a CEA?

Answer 2

• deep and superficial cervical plexus blocks to anesthetize C2-C4 dermatomes
• superficial: 10cc along post border of SCM
• deep: draw a line from mastoid process to Chassaignac’s tubercle (lat side, transverse process of C6) at the level of cricoid cartilage. C2 palpated 1cm caudad to mastoid, then C3 and C4 TPs 1/5cm intervals down from there. Inject at all 3 spots!

Question 3

Mech behind LAs affects on the heart?

Answer 3

• inh voltage-gated Na channels –>
  1) slowed conduction
  2) dec rate of depol
  3) dose dep reduction in cardiac contractility
  4) dec spontaneous PM activity in the SA node
  5) low dose –> vasoconstriction, high dose –> vasodilation

Question 4

Would you delay vascular surgery if traumatic epidural placement w/heme return?

Answer 4

• No bc vasc sx only needs 5000-10000U of heparin, insufficient evidence to support delaying
• Still, should delay removal of catheter until LE motor fxn returned to nl, make pt aware of sxs of epidural hematoma, and have q1h neuro checks

Question 5

How to perform celiac plexus block?

Answer 5

• pt in prone position
• needle inserted at L1 level, 5-7cm lateral to midline
• advanced under fluoro to lie ant to vert body
• test block w/LA
• if good relief, use alcohol/phenol to perform neurolytic block