Physiologic Effects of Epidural Anesthesia

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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?

Needle trauma (A) Signup and view all the answers

What is the primary concern with bupivacaine?

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

What is the recommended management for subarachnoid injection?

Support of ventilation and intubation as needed (A) Signup and view all the answers

Why is ropivacaine considered advantageous for epidural anesthesia?

It has a lower cardiotoxic potential (A) Signup and view all the answers

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

Up to 50% (A) Signup and view all the answers

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

Withdraw the catheter and reposition the needle (C) Signup and view all the answers

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

Resistance is encountered (B) Signup and view all the answers

What should be attached to the catheter once it is in position and the needle is withdrawn?

A hub (D) Signup and view all the answers

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

Peritoneal (B) Signup and view all the answers

What is recommended to improve adhesion when securing the catheter?

Benzoin or mastisol (B) 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?

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

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

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

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

Identifying the epidural space (D) Signup and view all the answers

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

Aspirating for heme or CSF (C) Signup and view all the answers

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

By improvement in postoperative pain relief (A) Signup and view all the answers

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

Betadine (A) Signup and view all the answers

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

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

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

The height of the block and subsequent sympathectomy (C) Signup and view all the answers

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

Patient positioning (C) Signup and view all the answers

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

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

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

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

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

Caudal epidural in adults (A) Signup and view all the answers

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

Patient positioning (B) Signup and view all the answers

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

Epidural fentanyl (A) Signup and view all the answers

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

Toxic effects (B) Signup and view all the answers

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

Epidural blood patch (B) Signup and view all the answers

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

Direct needle trauma (A) 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?

Send the patient for an MRI (B) 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?

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

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

Early detection (D) Signup and view all the answers

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

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

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

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

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

Do they reach the subarachnoid space? (D) Signup and view all the answers