Physiologic Effects of Epidural Anesthesia
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Questions and Answers

What is a possible reason for intravascular injection to go unnoticed?

  • The infusion is running at a low enough level (correct)
  • The anesthesiologist is inexperienced
  • The patient is under general anesthesia
  • A high dose of anesthesia is used

What is a contraindication for planned surgery?

  • Patient refusal
  • Coagulopathy
  • Previous spinal anesthesia
  • All of the above (correct)

What is a key to preventing systemic toxicity?

  • Injecting the anesthesia rapidly
  • Using a large dose of anesthesia
  • Using a specific type of anesthesia
  • Giving a test dose (correct)

What is a possible cause of back pain following anesthesia?

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

What is the primary concern with bupivacaine?

<p>It has a narrow margin of safety (C)</p> Signup and view all the answers

What is the recommended management for subarachnoid injection?

<p>Support of ventilation and intubation as needed (A)</p> Signup and view all the answers

Why is ropivacaine considered advantageous for epidural anesthesia?

<p>It has a lower cardiotoxic potential (A)</p> Signup and view all the answers

What is the incidence of post-dural puncture headache following dural puncture with a large diameter epidural needle?

<p>Up to 50% (A)</p> Signup and view all the answers

What should be done if resistance is encountered when advancing the epidural catheter?

<p>Withdraw the catheter and reposition the needle (C)</p> Signup and view all the answers

When advancing the epidural catheter, what indicates that you are in the wrong place?

<p>Resistance is encountered (B)</p> Signup and view all the answers

What should be attached to the catheter once it is in position and the needle is withdrawn?

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

Which of the following is not a possible malposition location for the catheter?

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

What is recommended to improve adhesion when securing the catheter?

<p>Benzoin or mastisol (B)</p> Signup and view all the answers

What should be done if the catheter has advanced any distance out the end of the needle but not far enough?

<p>Remove the needle and catheter as a unit and start over (A)</p> Signup and view all the answers

What potential risk is associated with a meningeal hole made by the spinal needle?

<p>High concentrations of epidural drugs reaching the subarachnoid space (B)</p> Signup and view all the answers

What does the term 'loss of resistance technique' relate to in epidural procedures?

<p>Identifying the epidural space (D)</p> Signup and view all the answers

What is required after the catheter is threaded to a depth of 6 cm during an epidural procedure?

<p>Aspirating for heme or CSF (C)</p> Signup and view all the answers

How is the potential outcome of regional anesthesia or analgesia measured?

<p>By improvement in postoperative pain relief (A)</p> Signup and view all the answers

Which antiseptic is mentioned for use in the sterile prep and drape process?

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

What is the concentration of xylocaine used with epinephrine for the test dose?

<p>1.5% with epinephrine 1/200,000 (D)</p> Signup and view all the answers

What is one of the primary factors affecting the physiologic effects of spinal and epidural anesthesia?

<p>The height of the block and subsequent sympathectomy (C)</p> Signup and view all the answers

Which factor is less significant in determining block height with epidural anesthesia compared to spinal anesthesia?

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

What is a risk associated with the larger volume and dosage of drugs required for epidural anesthesia?

<p>Increased local anesthetic blood levels potentially leading to toxicity (A)</p> Signup and view all the answers

What is a common outcome of maintaining a patient in the lateral decubitis position after epidural dosing?

<p>A somewhat better block on the 'down' side (A)</p> Signup and view all the answers

Which procedure is typically performed in the prone position using a pillow under the iliac crests?

<p>Caudal epidural in adults (A)</p> Signup and view all the answers

What is a key element for the success of an epidural procedure?

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

Which type of epidural administration produces a blood level almost equivalent to an IV dose?

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

In epidural anesthesia, what can excessive blood levels of local anesthetic potentially result in?

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

Which treatment is definitive for a condition that typically resolves in several days with conservative treatment?

<p>Epidural blood patch (B)</p> Signup and view all the answers

What is a potential cause of neurologic injury mentioned in the content?

<p>Direct needle trauma (A)</p> Signup and view all the answers

What is the indicated action if a labor nurse is unable to remove the epidural catheter shortly after delivery?

<p>Send the patient for an MRI (B)</p> Signup and view all the answers

Which rate is correct for the incidence of epidural hematoma from 1993-1998 in the U.S. post-op epidurals?

<p>1/3,100 (D)</p> Signup and view all the answers

What significantly affects the outcome of a neurosurgical emergency like an epidural hematoma?

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

What is a controversy involved with placing an epidural in anesthetized patients?

<p>It is less safe due to lack of patient feedback (D)</p> Signup and view all the answers

What concern is associated with the value of epinephrine in the test dose during labor?

<p>Heart rate change might not be notable (B)</p> Signup and view all the answers

What is the question raised about local anesthetics in the context of CSEA potential risk?

<p>Do they reach the subarachnoid space? (D)</p> Signup and view all the answers

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