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Questions and Answers
Which prep solution results in fewer incidences of nerve injuries because it creates a durable bacterial barrier?
Which prep solution results in fewer incidences of nerve injuries because it creates a durable bacterial barrier?
What is the gold standard treatment for a postdural puncture headache?
What is the gold standard treatment for a postdural puncture headache?
Which local anesthetic is associated with TENS and CES when injected intrathecally via a microcatheter?
Which local anesthetic is associated with TENS and CES when injected intrathecally via a microcatheter?
What are two qualities of needles that cause a PDPH?
What are two qualities of needles that cause a PDPH?
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What nerves innervate the diaphragm and comprise the phrenic nerve?
What nerves innervate the diaphragm and comprise the phrenic nerve?
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What respiratory muscles are impaired from a high thoracic epidural?
What respiratory muscles are impaired from a high thoracic epidural?
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What are the 3 meningeal layers from superficial to deep?
What are the 3 meningeal layers from superficial to deep?
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What meningeal layer adheres to the spinal cord?
What meningeal layer adheres to the spinal cord?
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What meningeal layer limits movement of drugs in and out of the CSF?
What meningeal layer limits movement of drugs in and out of the CSF?
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Why does autonomic blockade occur in neuraxial anesthesia?
Why does autonomic blockade occur in neuraxial anesthesia?
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What causes nausea and vomiting after neuraxial anesthesia?
What causes nausea and vomiting after neuraxial anesthesia?
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What are two factors that increase the spread of epidural anesthesia?
What are two factors that increase the spread of epidural anesthesia?
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What hydrophilic drug can cause delayed respiratory depression when administered neuraxially?
What hydrophilic drug can cause delayed respiratory depression when administered neuraxially?
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What factors determine the spread of local anesthetics in spinal anesthesia?
What factors determine the spread of local anesthetics in spinal anesthesia?
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What is a characteristic of a patient that contraindicates neuraxial techniques?
What is a characteristic of a patient that contraindicates neuraxial techniques?
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What are absolute contraindications to neuraxial anesthesia?
What are absolute contraindications to neuraxial anesthesia?
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What are relative contraindications to neuraxial anesthesia? select all that apply
What are relative contraindications to neuraxial anesthesia? select all that apply
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What is the first-line medication to administer when a patient codes after administration of a local anesthetic?
What is the first-line medication to administer when a patient codes after administration of a local anesthetic?
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What type of local anesthetics are more ionized in acidic environments?
What type of local anesthetics are more ionized in acidic environments?
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What types of channels do local anesthetics affect?
What types of channels do local anesthetics affect?
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How do nerve bundles appear in the periphery on ultrasound?
How do nerve bundles appear in the periphery on ultrasound?
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What are risk factors for nerve injuries associated with regional anesthesia?
What are risk factors for nerve injuries associated with regional anesthesia?
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What innervates the lateral rectus muscle?
What innervates the lateral rectus muscle?
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What innervates the superior oblique muscle?
What innervates the superior oblique muscle?
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What are the efferent and afferent branches of the oculocardiac reflex?
What are the efferent and afferent branches of the oculocardiac reflex?
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What type of eye protection is used for argon lasers?
What type of eye protection is used for argon lasers?
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What type of eye protection is used for Nd:YAG lasers?
What type of eye protection is used for Nd:YAG lasers?
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What types of masks should be used whenever lasers are used in the OR?
What types of masks should be used whenever lasers are used in the OR?
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What are the standard OR fire precautions?
What are the standard OR fire precautions?
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What are the high-risk OR fire precautions?
What are the high-risk OR fire precautions?
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When should a tonsillectomy or bilateral myringotomy with tubes (BMT) be postponed?
When should a tonsillectomy or bilateral myringotomy with tubes (BMT) be postponed?
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When should you preoxygenate with FiO2 less than 30% during a tracheostomy procedure?
When should you preoxygenate with FiO2 less than 30% during a tracheostomy procedure?
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When should you remove the endotracheal tube (ETT) during a tracheostomy procedure?
When should you remove the endotracheal tube (ETT) during a tracheostomy procedure?
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When should the ETT cuff be deflated during a tracheostomy?
When should the ETT cuff be deflated during a tracheostomy?
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When would you extubate deep?
When would you extubate deep?
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What are the first signs that neuraxial anesthesia is positioned appropriately?
What are the first signs that neuraxial anesthesia is positioned appropriately?
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What type of eye protection is used for CO₂ lasers?
What type of eye protection is used for CO₂ lasers?
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Flashcards
Chlorhexidine gluconate (CHG)
Chlorhexidine gluconate (CHG)
A prep solution that reduces nerve injuries by providing a durable bacterial barrier.
Epidural blood patch
Epidural blood patch
The gold standard treatment for a postdural puncture headache.
Lidocaine
Lidocaine
The local anesthetic associated with TENS and CES via microcatheter injection.
Cutting needle
Cutting needle
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Phrenic nerve
Phrenic nerve
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High thoracic epidural effects
High thoracic epidural effects
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Hypotension
Hypotension
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Meningeal layers
Meningeal layers
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Pia mater
Pia mater
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Arachnoid mater
Arachnoid mater
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Autonomic blockade
Autonomic blockade
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Neuraxial nausea triggers
Neuraxial nausea triggers
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Factors increasing epidural spread
Factors increasing epidural spread
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Morphine respiratory depression
Morphine respiratory depression
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Local anesthetics spread determinants
Local anesthetics spread determinants
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Neuraxial contraindications
Neuraxial contraindications
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Absolute contraindications to neuraxial anesthesia
Absolute contraindications to neuraxial anesthesia
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Relative contraindications to neuraxial anesthesia
Relative contraindications to neuraxial anesthesia
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Coding patient after local anesthetic
Coding patient after local anesthetic
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Basic drugs in acidic environments
Basic drugs in acidic environments
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Channels affected by local anesthetics
Channels affected by local anesthetics
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Ultrasound appearance of nerve bundles
Ultrasound appearance of nerve bundles
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Risk factors for nerve injuries
Risk factors for nerve injuries
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Argon laser eye protection
Argon laser eye protection
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Nd:YAG laser eye protection
Nd:YAG laser eye protection
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CO₂ laser eye protection
CO₂ laser eye protection
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N-95 masks
N-95 masks
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OR fire precautions
OR fire precautions
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High-risk OR fire precautions
High-risk OR fire precautions
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Tonsillectomy postponement
Tonsillectomy postponement
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Preoxygenation with electrocautery
Preoxygenation with electrocautery
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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.