CPAN - Regional Anesthesia
What is the primary purpose of regional anesthesia? Correct Answer - To
produce loss of sensation and/or motor function in a specific extremity/area
of the body.
How does regional anesthesia affect the patient's cognitive abilities and
protective reflexes? Correct Answer - It does not alter cognitive abilities
or affect the patient's protective reflexes.
In what situations might regional anesthesia be preferred over general
anesthesia? Correct Answer - When maintenance of consciousness is
desired.
What are some benefits of Regional Anesthesia? Correct Answer -
Provides postoperative analgesia at the operative site, decreases the stress
response to surgery, and reduces hypotension and tachycardia.
How does Regional Anesthesia impact airway management? Correct
Answer - It allows for the avoidance of endotracheal intubation in patients
with difficult airways or reactive airway disease.
What are the effects of Regional Anesthesia on general anesthesia? Correct
Answer - It diminishes the side effects of general anesthesia such as
nausea/vomiting, unintended sedation, and respiratory depression. It also
reduces the number/amount of medications required to induce and maintain
general anesthesia.
What are some additional benefits of Regional Anesthesia? Correct Answer
- It expedites earlier discharge from post-anesthesia care, decreases the
incidence of complications like deep vein thrombosis, pulmonary embolism,
transfusion requirements, pneumonia, myocardial infarction, and renal
failure. It also has a positive effect on postoperative cognitive function and
enhances the return of gastrointestinal motility.
Why is regional anesthesia not practical for every surgical procedure?
Correct Answer - Insertion of block requires high level training and technical
expertise on part of anesthesia care provider
,What is a requirement for a patient to undergo regional anesthesia? Correct
Answer - The patient must be cooperative; may not be appropriate for
confused or combative patients
What are some concerns regarding the use of regional anesthesia? Correct
Answer - Patient may not like the feeling of numbness and loss of control,
single dose blocks have limited duration, risks of nerve injury, nerve trauma,
and local anesthetic toxicity
Topical Anesthesia Correct Answer - -applied directly to skin or mucous
membrane
-concerns about systemic absorption increase when applied in highly vascular
areas, esp tracheobronchial tree
-provides effected but short duration of analgesia; onset of action to mucous
membranes: 5-10 mins
-onset of action for application to skin is 30-60 mins with limited depth of
penetration
Local Infiltration Correct Answer - -local anesthetic injected directly into
the tissue at incision or puncture site
-designed to produce sensory blockade in specific/designated area which
blocks transmission of sensory impulses
-loal anesthetics containing epinephrine should not be injected into confined
areas such as fingers, toes, ears, nose and penis. Vasoconstrction in these
areas can cause tissue death and gangrene
Intravenous regional (bier block) Correct Answer - -injection of large
volumes of local anesthetic IV in specific extremity while circulation of
extremity is occluded by tourniquet
-rapid onset of sensory blockade, profound muscle relaxation
-duration is related to tourniquet inflation time
-there is risk of local anesthetic toxicity when tourniquet released
-after circulation restored there is no analgesia
Peripheral nerve blockade (site specific to block conduction) Correct
Answer - -injection of local anesthetic into or around specific nerve or nerve
group (plexus) to provide sensory and/or motor blockade
-onset is rapid with most local anesthetics choice of medication determined by
desired duration of action
, -increased risk of systemic toxicity with absorption of excessive doses;
epinephrine-containing solutions may delay systemic absorption thus
decreases risk of toxicity.
-Epinephrine is widely used as an additive in local anesthetics (typically in
concentrations of 1:100,000) to improve the depth and duration of the
anesthesia, as well as to reduce bleeding in the operative field. Epinephrine
counteracts the anesthetic's localized vasodilator effects in subcutaneous and
submucosal vessels, thereby reducing the risk of anesthetic toxicity by
decreasing the rate of systemic absorption from the site of injection
Sympathetic blockade Correct Answer - -injection of local anesthetic into
or around sympathetic nerves or ganlions to diagnose chronic pain
syndromes or provide vascular, visceral, or neurpathic pain relief
-common sites - stellate ganglion, celiac plexus, and lumbar sympathetic nerve
What is Neuraxial blockade? Correct Answer - It includes spinal
anesthesia and epidural anesthesia.
How does spinal anesthesia work? Correct Answer - Anesthetic solution is
injected into the intrathecal space, mixing with CSF to act directly on nerve
roots and part of the spinal cord.
Why is spinal anesthesia usually performed below L1-L2? Correct Answer -
To avoid damage to the spinal cord.
What is Epidural anesthesia? Correct Answer - It involves the injection of
dilute concentrations of local anesthetic or local with opioid into the epidural
space.
What is the difference in sympathetic blockade effect between spinal and
epidural blocks? Correct Answer - Sympathetic blockade effect is less with
intrathecal (spinal) block compared to epidural block.
What are the increased chances of systemic toxicity associated with epidural
anesthesia? Correct Answer - Epidural anesthesia has increased chances
of systemic toxicity due to a greater amount of drug being administered and
absorbed systemically.
What is the primary purpose of regional anesthesia? Correct Answer - To
produce loss of sensation and/or motor function in a specific extremity/area
of the body.
How does regional anesthesia affect the patient's cognitive abilities and
protective reflexes? Correct Answer - It does not alter cognitive abilities
or affect the patient's protective reflexes.
In what situations might regional anesthesia be preferred over general
anesthesia? Correct Answer - When maintenance of consciousness is
desired.
What are some benefits of Regional Anesthesia? Correct Answer -
Provides postoperative analgesia at the operative site, decreases the stress
response to surgery, and reduces hypotension and tachycardia.
How does Regional Anesthesia impact airway management? Correct
Answer - It allows for the avoidance of endotracheal intubation in patients
with difficult airways or reactive airway disease.
What are the effects of Regional Anesthesia on general anesthesia? Correct
Answer - It diminishes the side effects of general anesthesia such as
nausea/vomiting, unintended sedation, and respiratory depression. It also
reduces the number/amount of medications required to induce and maintain
general anesthesia.
What are some additional benefits of Regional Anesthesia? Correct Answer
- It expedites earlier discharge from post-anesthesia care, decreases the
incidence of complications like deep vein thrombosis, pulmonary embolism,
transfusion requirements, pneumonia, myocardial infarction, and renal
failure. It also has a positive effect on postoperative cognitive function and
enhances the return of gastrointestinal motility.
Why is regional anesthesia not practical for every surgical procedure?
Correct Answer - Insertion of block requires high level training and technical
expertise on part of anesthesia care provider
,What is a requirement for a patient to undergo regional anesthesia? Correct
Answer - The patient must be cooperative; may not be appropriate for
confused or combative patients
What are some concerns regarding the use of regional anesthesia? Correct
Answer - Patient may not like the feeling of numbness and loss of control,
single dose blocks have limited duration, risks of nerve injury, nerve trauma,
and local anesthetic toxicity
Topical Anesthesia Correct Answer - -applied directly to skin or mucous
membrane
-concerns about systemic absorption increase when applied in highly vascular
areas, esp tracheobronchial tree
-provides effected but short duration of analgesia; onset of action to mucous
membranes: 5-10 mins
-onset of action for application to skin is 30-60 mins with limited depth of
penetration
Local Infiltration Correct Answer - -local anesthetic injected directly into
the tissue at incision or puncture site
-designed to produce sensory blockade in specific/designated area which
blocks transmission of sensory impulses
-loal anesthetics containing epinephrine should not be injected into confined
areas such as fingers, toes, ears, nose and penis. Vasoconstrction in these
areas can cause tissue death and gangrene
Intravenous regional (bier block) Correct Answer - -injection of large
volumes of local anesthetic IV in specific extremity while circulation of
extremity is occluded by tourniquet
-rapid onset of sensory blockade, profound muscle relaxation
-duration is related to tourniquet inflation time
-there is risk of local anesthetic toxicity when tourniquet released
-after circulation restored there is no analgesia
Peripheral nerve blockade (site specific to block conduction) Correct
Answer - -injection of local anesthetic into or around specific nerve or nerve
group (plexus) to provide sensory and/or motor blockade
-onset is rapid with most local anesthetics choice of medication determined by
desired duration of action
, -increased risk of systemic toxicity with absorption of excessive doses;
epinephrine-containing solutions may delay systemic absorption thus
decreases risk of toxicity.
-Epinephrine is widely used as an additive in local anesthetics (typically in
concentrations of 1:100,000) to improve the depth and duration of the
anesthesia, as well as to reduce bleeding in the operative field. Epinephrine
counteracts the anesthetic's localized vasodilator effects in subcutaneous and
submucosal vessels, thereby reducing the risk of anesthetic toxicity by
decreasing the rate of systemic absorption from the site of injection
Sympathetic blockade Correct Answer - -injection of local anesthetic into
or around sympathetic nerves or ganlions to diagnose chronic pain
syndromes or provide vascular, visceral, or neurpathic pain relief
-common sites - stellate ganglion, celiac plexus, and lumbar sympathetic nerve
What is Neuraxial blockade? Correct Answer - It includes spinal
anesthesia and epidural anesthesia.
How does spinal anesthesia work? Correct Answer - Anesthetic solution is
injected into the intrathecal space, mixing with CSF to act directly on nerve
roots and part of the spinal cord.
Why is spinal anesthesia usually performed below L1-L2? Correct Answer -
To avoid damage to the spinal cord.
What is Epidural anesthesia? Correct Answer - It involves the injection of
dilute concentrations of local anesthetic or local with opioid into the epidural
space.
What is the difference in sympathetic blockade effect between spinal and
epidural blocks? Correct Answer - Sympathetic blockade effect is less with
intrathecal (spinal) block compared to epidural block.
What are the increased chances of systemic toxicity associated with epidural
anesthesia? Correct Answer - Epidural anesthesia has increased chances
of systemic toxicity due to a greater amount of drug being administered and
absorbed systemically.
