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LA and Regionals Test

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1.
What is a high spinal?
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2.
When is the cell membrane refractory?
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3.
What separates the benzene ring from the tertiary amine?
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4.
What state do the molecules need to be in to cross the membrane?
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5.
Chemistry of LA:
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6.
Pontocaine/tetracaine dose:
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7.
Cuff time:
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8.
What does lowering the threshold potential do to the cell?
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9.
What types of needles are used for spinals?
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10.
Bier Block:
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11.
Drugs used for epidurals:
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12.
What is Methemoglobinemia?
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13.
What drugs are used for Caudals?
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14.
***What is the dose per segment?
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15.
Controversial contraindications:
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16.
***Key landmarks L4-5:
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17.
What follows the nerve impules?
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18.
Tourniquet use:
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19.
What is the epidural test dose?
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20.
What are some of the complications of spinals and epidurals?
A.
Always inflate upper portion prior to surgery. Use 250mmHg for upper ext. and 300-350mmHg for lower extremity - may need higher pressure for HTN
B.
Normal Hb has iron in the ferrous state (Fe2+), Met-Hb has iron in the ferric state (Fe3+)
C.
Minumum of 20 minutes - if less then have to let cuff down slowly to prevent LA toxicity. Maximum 1.5-2 hours.
D.
It opens the Na channels and massive amounts of Na ions enter the cell - as the interior of the cell becomes more (+) action potential develops.
E.
IV regional anesthetic on upper or lower extremity.
F.
Unionized. The closer the pKa is to physiological pH the higher the concentration of nonionized that will cross the cell membrane.
G.
At superior iliac crest.
H.
1-2cc per dermatome.
I.
ALL have a lipophilic portion (benzene ring), and a hydrophilic portion (tertiary amine).
J.
During repolarization.
K.
Chloroprocaine 2-3%, Lidocaine 1-2%, Mepivicaine 1-2%, Bupivicaine 0.25-0.75%, Ropivicaine 0.1-0.5%
L.
It increases the nerves permeability for Na influx - which lowers the voltage difference until threshold potential occurs.
M.
Quinke (flat), Sprotte, whitacre (pencil point).
N.
Prior back sx, communication issues, complicated sx.
O.
Either an ester or amide linkage.
P.
3cc's of 1.5% lidocaine with EPI 1/200K = Lido 45mg and EPI 15mcg.
Q.
Above T4 decreases HR, tingling of the fingers - C8=middle, C7=pointer, C6=thumbs
R.
Hypotension, N&V (treat hypotension), PDPH (post dura puncture headache or wet tap)
S.
Bupivicaine, Ropivicaine, Opioids, Lidocaine s EPI
T.
Max: 3mg/kg DOA: 90m-6h
Type the Answer that corresponds to the displayed Question.
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21.
How far do you insert epidural catheter?
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22.
By pseudocholinesterase - bi-product of some are PABA so if pts. are allergic it is to the PABA bi-product
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23.
Max: 12mg/kg DOA: 30-60m DOA with epi: 30-90m
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24.
Onset of action
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25.
Lidocaine (xylocaine), Mepivicaine (carbocaine), Ropivicaine, Bupivicaine (marcaine), Etidocaine (duranest 1%) - they all have 2 I's in their name but know both names.
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26.
Lidocaine 0.5% without EPI, 40-50cc = 200-250mg then remove IV.
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27.
Block Na channels by binding directly to intracellular voltage dependent Na channels - cell cannot depolarize due to blocking Na influx.
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28.
Max: 4mg/kg (3-5) Max with EPI: 7mg/kg DOA: 30-120m DOA with EPI: 120-360m
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29.
All LA have a pKa 7.6-9.4 except benzocaine. Assume environment has pH of 7.4 unless told otherwise. Less than 50% of LA are in unionized form.
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30.
the pH at which the specific drug is 50% in the ionized and 50% in the unionized state. The ratio varies with the pH of the environment.

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