CAA CAA Anesthesia Techniques & Airway Management 2 — Questions and Answers
Question 1: For a spinal anesthetic, hyperbaric bupivacaine is prepared by mixing bupivacaine with:
- Normal saline
- Dextrose 8% (Correct answer)
- Sterile water
- Epinephrine
Correct answer: Dextrose 8%
Hyperbaric bupivacaine is mixed with 8% dextrose, making it denser than CSF so it spreads dependent to patient positioning (e.g., toward the sacrum in a sitting patient).
Question 2: Which dermatome level of spinal block is needed for a Cesarean delivery under neuraxial anesthesia?
- T10
- T4 (Correct answer)
- L1
- S2
Correct answer: T4
A T4 sensory level (nipple line) is required for Cesarean section to cover peritoneal traction and uterine manipulation without patient discomfort.
Question 3: Total spinal anesthesia is a life-threatening complication characterized by:
- Local anesthetic toxicity causing seizures only
- Respiratory arrest and profound hypotension from cephalad spread of spinal block (Correct answer)
- Excessive epidural dosing causing epidural hematoma
- Spinal cord infarction from vasoconstrictor use
Correct answer: Respiratory arrest and profound hypotension from cephalad spread of spinal block
Total spinal occurs when local anesthetic spreads cephalad to the cervical cord and brainstem, causing apnea, loss of consciousness, and cardiovascular collapse.
Question 4: During an epidural technique, the loss-of-resistance (LOR) method identifies the epidural space by:
- Feeling a 'pop' as the needle passes through the ligamentum flavum and resistance to saline injection suddenly disappears (Correct answer)
- Observing free flow of CSF through the needle hub
- Noting patient pain with injection confirming nerve proximity
- Aspirating blood confirming intravascular placement
Correct answer: Feeling a 'pop' as the needle passes through the ligamentum flavum and resistance to saline injection suddenly disappears
Loss of resistance occurs as the epidural needle tip exits the dense ligamentum flavum into the negative-pressure epidural space, allowing free injection of saline or air.
Question 5: The test dose for an epidural catheter contains epinephrine 15 mcg to detect:
- Subarachnoid catheter placement
- Intravascular catheter placement (Correct answer)
- Subdural catheter placement
- Air embolism
Correct answer: Intravascular catheter placement
Intravascular injection of epinephrine 15 mcg causes a transient heart rate increase of ≥20 bpm within 1 minute, indicating inadvertent IV catheter placement.
Question 6: Brachial plexus nerve blocks performed at the interscalene level are MOST appropriate for surgery on the:
- Hand and wrist
- Elbow and forearm
- Shoulder and proximal humerus (Correct answer)
- Fingers and thumb
Correct answer: Shoulder and proximal humerus
Interscalene blocks target the C5–C7 nerve roots of the brachial plexus at the level of the neck, providing excellent anesthesia for shoulder and proximal arm surgery.
CAA CAA Anesthesia Techniques & Airway Management 2
For a spinal anesthetic, hyperbaric bupivacaine is prepared by mixing bupivacaine with: