36 Questions
What is a possible reason for intravascular injection to go unnoticed?
The infusion is running at a low enough level
What is a contraindication for planned surgery?
All of the above
What is a key to preventing systemic toxicity?
Giving a test dose
What is a possible cause of back pain following anesthesia?
Needle trauma
What is the primary concern with bupivacaine?
It has a narrow margin of safety
What is the recommended management for subarachnoid injection?
Support of ventilation and intubation as needed
Why is ropivacaine considered advantageous for epidural anesthesia?
It has a lower cardiotoxic potential
What is the incidence of post-dural puncture headache following dural puncture with a large diameter epidural needle?
Up to 50%
What should be done if resistance is encountered when advancing the epidural catheter?
Withdraw the catheter and reposition the needle
When advancing the epidural catheter, what indicates that you are in the wrong place?
Resistance is encountered
What should be attached to the catheter once it is in position and the needle is withdrawn?
A hub
Which of the following is not a possible malposition location for the catheter?
Peritoneal
What is recommended to improve adhesion when securing the catheter?
Benzoin or mastisol
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
What potential risk is associated with a meningeal hole made by the spinal needle?
High concentrations of epidural drugs reaching the subarachnoid space
What does the term 'loss of resistance technique' relate to in epidural procedures?
Identifying the epidural space
What is required after the catheter is threaded to a depth of 6 cm during an epidural procedure?
Aspirating for heme or CSF
How is the potential outcome of regional anesthesia or analgesia measured?
By improvement in postoperative pain relief
Which antiseptic is mentioned for use in the sterile prep and drape process?
Betadine
What is the concentration of xylocaine used with epinephrine for the test dose?
1.5% with epinephrine 1/200,000
What is one of the primary factors affecting the physiologic effects of spinal and epidural anesthesia?
The height of the block and subsequent sympathectomy
Which factor is less significant in determining block height with epidural anesthesia compared to spinal anesthesia?
Patient positioning
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
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
Which procedure is typically performed in the prone position using a pillow under the iliac crests?
Caudal epidural in adults
What is a key element for the success of an epidural procedure?
Patient positioning
Which type of epidural administration produces a blood level almost equivalent to an IV dose?
Epidural fentanyl
In epidural anesthesia, what can excessive blood levels of local anesthetic potentially result in?
Toxic effects
Which treatment is definitive for a condition that typically resolves in several days with conservative treatment?
Epidural blood patch
What is a potential cause of neurologic injury mentioned in the content?
Direct needle trauma
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
Which rate is correct for the incidence of epidural hematoma from 1993-1998 in the U.S. post-op epidurals?
1/3,100
What significantly affects the outcome of a neurosurgical emergency like an epidural hematoma?
Early detection
What is a controversy involved with placing an epidural in anesthetized patients?
It is less safe due to lack of patient feedback
What concern is associated with the value of epinephrine in the test dose during labor?
Heart rate change might not be notable
What is the question raised about local anesthetics in the context of CSEA potential risk?
Do they reach the subarachnoid space?
This quiz covers the physiological effects of epidural anesthesia, including differences from spinal anesthesia, required dosage, and sympathectomy.
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