Nerve Injury Prevention and Anesthesia Techniques
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Questions and Answers

Which prep solution results in fewer incidences of nerve injuries because it creates a durable bacterial barrier?

  • Hydrogen peroxide
  • Isopropyl alcohol
  • Povidone-iodine
  • Chlorhexidine gluconate (CHG) (correct)
  • What is the gold standard treatment for a postdural puncture headache?

  • Epidural blood patch (correct)
  • Acetaminophen
  • Caffeine
  • IV fluids
  • Which local anesthetic is associated with TENS and CES when injected intrathecally via a microcatheter?

  • Bupivacaine
  • Lidocaine (correct)
  • Ropivacaine
  • Chloroprocaine
  • What are two qualities of needles that cause a PDPH?

    <p>Cutting needle and larger size (A)</p> Signup and view all the answers

    What nerves innervate the diaphragm and comprise the phrenic nerve?

    <p>C3-C5 (B)</p> Signup and view all the answers

    What respiratory muscles are impaired from a high thoracic epidural?

    <p>External and internal intercostals, abdominal muscles (B)</p> Signup and view all the answers

    What are the 3 meningeal layers from superficial to deep?

    <p>Dura, arachnoid, pia (B)</p> Signup and view all the answers

    What meningeal layer adheres to the spinal cord?

    <p>Pia (B)</p> Signup and view all the answers

    What meningeal layer limits movement of drugs in and out of the CSF?

    <p>Arachnoid (C)</p> Signup and view all the answers

    Why does autonomic blockade occur in neuraxial anesthesia?

    <p>Due to blocked transmission of B fibers (D)</p> Signup and view all the answers

    What causes nausea and vomiting after neuraxial anesthesia?

    <p>All of the above (D)</p> Signup and view all the answers

    What are two factors that increase the spread of epidural anesthesia?

    <p>Pregnancy and old age (B)</p> Signup and view all the answers

    What hydrophilic drug can cause delayed respiratory depression when administered neuraxially?

    <p>Morphine (B)</p> Signup and view all the answers

    What factors determine the spread of local anesthetics in spinal anesthesia?

    <p>Baricity and patient position (C)</p> Signup and view all the answers

    What is a characteristic of a patient that contraindicates neuraxial techniques?

    <p>Taking long-acting antithrombotic or antiplatelet medication (D)</p> Signup and view all the answers

    What are absolute contraindications to neuraxial anesthesia?

    <p>All of the above (D)</p> Signup and view all the answers

    What are relative contraindications to neuraxial anesthesia? select all that apply

    <p>Peripheral neuropathy (A), Spine surgery (B), Aortic stenosis (D), History of Spina bifida (C), Hypovolemia (@)</p> Signup and view all the answers

    What is the first-line medication to administer when a patient codes after administration of a local anesthetic?

    <p>Epinephrine (D)</p> Signup and view all the answers

    What type of local anesthetics are more ionized in acidic environments?

    <p>Basic drugs (A)</p> Signup and view all the answers

    What types of channels do local anesthetics affect?

    <p>Sodium, potassium, calcium, and GPCR (C)</p> Signup and view all the answers

    How do nerve bundles appear in the periphery on ultrasound?

    <p>Hyperechoic (C)</p> Signup and view all the answers

    What are risk factors for nerve injuries associated with regional anesthesia?

    <p>All of the above (D)</p> Signup and view all the answers

    What innervates the lateral rectus muscle?

    <p>Abducens nerve (CN VI) (D)</p> Signup and view all the answers

    What innervates the superior oblique muscle?

    <p>Trochlear nerve (CN IV) (D)</p> Signup and view all the answers

    What are the efferent and afferent branches of the oculocardiac reflex?

    <p>Efferent = Vagus (CN X), Afferent = Ophthalmic division of Trigeminal (CN V1) (B)</p> Signup and view all the answers

    What type of eye protection is used for argon lasers?

    <p>Orange (A)</p> Signup and view all the answers

    What type of eye protection is used for Nd:YAG lasers?

    <p>Green (B)</p> Signup and view all the answers

    What types of masks should be used whenever lasers are used in the OR?

    <p>N-95 (A)</p> Signup and view all the answers

    What are the standard OR fire precautions?

    <p>Let prep dry for at least 3 minutes (C)</p> Signup and view all the answers

    What are the high-risk OR fire precautions?

    <p>All of the above (D)</p> Signup and view all the answers

    When should a tonsillectomy or bilateral myringotomy with tubes (BMT) be postponed?

    <p>If the patient has active chest symptoms (e.g., fever and rhonchi) (C)</p> Signup and view all the answers

    When should you preoxygenate with FiO2 less than 30% during a tracheostomy procedure?

    <p>If the surgeon is using electrocautery to enter the trachea (B)</p> Signup and view all the answers

    When should you remove the endotracheal tube (ETT) during a tracheostomy procedure?

    <p>After the surgeon connects the tracheostomy tube to the anesthesia circuit (C)</p> Signup and view all the answers

    When should the ETT cuff be deflated during a tracheostomy?

    <p>Prior to tracheal transection (A)</p> Signup and view all the answers

    When would you extubate deep?

    <p>When you want to avoid bucking (D)</p> Signup and view all the answers

    What are the first signs that neuraxial anesthesia is positioned appropriately?

    <p>Hypotension due to sympathectomy (A)</p> Signup and view all the answers

    What type of eye protection is used for CO₂ lasers?

    <p>Clear (B)</p> Signup and view all the answers

    Flashcards

    Chlorhexidine gluconate (CHG)

    A prep solution that reduces nerve injuries by providing a durable bacterial barrier.

    Epidural blood patch

    The gold standard treatment for a postdural puncture headache.

    Lidocaine

    The local anesthetic associated with TENS and CES via microcatheter injection.

    Cutting needle

    A needle type that, along with size, can cause a postdural puncture headache.

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    Phrenic nerve

    Nerves C3-C5 innervate the diaphragm.

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    High thoracic epidural effects

    Can impair external and internal intercostal muscles and abdominal muscles.

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    Hypotension

    One of the first signs of appropriate neuraxial anesthesia positioning.

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    Meningeal layers

    The three layers from superficial to deep: Dura, Arachnoid, Pia.

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    Pia mater

    The meningeal layer that adheres to the spinal cord.

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    Arachnoid mater

    The meningeal layer that limits drug movement in and out of the CSF.

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    Autonomic blockade

    Occurs in neuraxial anesthesia due to blocked transmission of B fibers.

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    Neuraxial nausea triggers

    Caused by anxiety, hypotension, or opioid stimulation of the CTZ.

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    Factors increasing epidural spread

    Pregnancy and old age are factors that enhance spread.

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    Morphine respiratory depression

    Can cause delayed respiratory depression when administered neuraxially.

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    Local anesthetics spread determinants

    Baricity and patient position are key factors for spinal anesthesia.

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    Neuraxial contraindications

    Taking long-acting antithrombotic medication is a significant contraindication.

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    Absolute contraindications to neuraxial anesthesia

    Patient refusal, infection at the injection site, increased intracranial pressure.

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    Relative contraindications to neuraxial anesthesia

    Spine surgery is a relative contraindication.

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    Coding patient after local anesthetic

    First-line medication is epinephrine.

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    Basic drugs in acidic environments

    These anesthetics are more ionized in acidic conditions.

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    Channels affected by local anesthetics

    Affects sodium, potassium, calcium, and GPCR channels.

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    Ultrasound appearance of nerve bundles

    Bundles appear hyperechoic on ultrasound.

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    Risk factors for nerve injuries

    Includes diabetes, obesity, and male gender.

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    Argon laser eye protection

    Use orange eye protection for argon lasers.

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    Nd:YAG laser eye protection

    Use green eye protection for Nd:YAG lasers.

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    CO₂ laser eye protection

    Clear eye protection is required for CO₂ lasers.

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    N-95 masks

    Should be used whenever lasers are utilized in the OR.

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    OR fire precautions

    Let prep dry for at least 3 minutes to prevent fire hazards.

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    High-risk OR fire precautions

    Includes stopping supplemental oxygen before electrocautery.

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    Tonsillectomy postponement

    Should be postponed if the patient has active chest symptoms.

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    Preoxygenation with electrocautery

    Use FiO₂ less than 30% if electrocautery is involved.

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    Study Notes

    Nerve Injury Prevention During Procedures

    • Chlorhexidine gluconate (CHG) reduces nerve injury by creating a strong bacterial barrier.

    Postdural Puncture Headache Treatment

    • Epidural blood patch is the gold standard treatment.

    Local Anesthetics and Procedures

    • Lidocaine is frequently used with transcutaneous electrical nerve stimulation (TENS) and continuous electrical stimulation (CES) when injected intrathecally.

    Qualities of Needles and PDPH

    • Cutting needles and larger sizes can cause postdural puncture headache (PDPH).

    Nerve Innervation of the Diaphragm

    • The phrenic nerve, formed by C3-C5 nerves, innervates the diaphragm.

    Respiratory Muscles and Epidural Anesthesia

    • High thoracic epidurals can impair the external intercostal, internal intercostal, and abdominal muscles.

    Proper Positioning of Neuraxial Anesthesia

    • Proper positioning signs are not detailed in this document.

    Meningeal Layers

    • The meninges are the dura mater, arachnoid mater, and pia mater. The pia mater adheres directly to the spinal cord. The arachnoid mater is important for limiting diffusion of drugs.

    Autonomic Blockade and Neuraxial Anesthesia

    • Neuraxial anesthesia blocks transmission of B fibers which are part of the autonomic nervous system.

    Causes of Nausea and Vomiting Post-Anesthesia

    • Nausea and vomiting after neuraxial anesthesia can be caused by anxiety, opioid stimulation of the chemoreceptor trigger zone(CTZ), and/or hypotension.

    Factors Increasing Epidural Spread

    • Pregnancy and older age increase the spread of epidural anesthesia.

    Medications and Delayed Respiratory Depression

    • Morphine can cause delayed respiratory depression when administered neuraxially.

    Local Anesthetic Spread Factors

    • A primary factor determining the spread of local anesthetics in spinal anesthesia is the baricity of the anesthetic and patient position.

    Absolute Contraindications to Neuraxial Anesthesia

    • Patient refusal and infection at the injection site are absolute contraindications to neuraxial anesthetic procedures. Increased intracranial pressure is also an absolute contraindication.

    Relative Contraindications to Neuraxial Anesthesia

    • Spine surgery is a relative contraindication to neuraxial procedures.

    First-Line Medication for Patient Code

    • Epinephrine is the first-line medication for treating a code after a local anesthetic.

    Local Anesthetic Ionization

    • Basic local anesthetics are more ionized in acidic environments.

    Types of Channels Affected by Local Anesthetics

    • Local anesthetics affect sodium, potassium, calcium, and GPCR channels.

    Appearance of Nerve Bundles on Ultrasound

    • Nerve bundles appear hyperechoic in ultrasound scans.

    Risk Factors for Regional Anesthesia Injuries

    • Diabetes, hypertension, and obesity are risk factors for nerve injuries associated with regional anesthesia.

    Lateral Rectus Muscle Innervation

    • The abducens nerve (CN VI) innervates the lateral rectus muscle.

    Superior Oblique Muscle Innervation

    • The trochlear nerve (CN IV) innervates the superior oblique muscle.

    Oculocardiac Reflex

    • The oculocardiac reflex involves the vagus nerve (CN X) and the ophthalmic branch of the trigeminal nerve (CN V1).

    Eye Protection for Lasers

    • Argon lasers require orange eye protection, Nd:YAG lasers need green, and CO2 lasers require clear eye protection.

    OR Fire Precautions

    • Never let preps dry for less than 3min. Use non-flammable materials in the OR.

    High-Risk OR Fire Precautions

    • Stop supplemental oxygen at least 1 minute before and during electrocautery.

    Postponing Tonsillectomy/Bilateral Myringotomy

    • Active chest symptoms (fever, rhonchi) are criteria for postponing the surgery.

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    Description

    This quiz focuses on the essential techniques for nerve injury prevention during medical procedures, including the use of antiseptics and local anesthetics. It covers important topics such as postdural puncture headache treatment and the anatomy of nerve innervation critical for anesthesia. Test your knowledge on these crucial aspects of patient care in anesthesia and management.

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