Regional Anesthesia Techniques Flashcards
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Read the first 7 Regional Anesthesia Techniques flashcards as text
Which of the following local anesthetics is MOST associated with methemoglobinemia as a toxic side effect?
Answer: Prilocaine
Prilocaine's metabolite o-toluidine oxidizes hemoglobin to methemoglobin, making it the local anesthetic most associated with clinically significant methemoglobinemia.
In a serratus anterior plane (SAP) block, the local anesthetic is injected to achieve analgesia for which area?
Answer: Lateral thorax and breast (T2-T9 dermatomes)
The SAP block anesthetizes the long thoracic nerve and lateral cutaneous branches of T2-T9, providing analgesia for the lateral chest wall and breast.
When performing a caudal epidural block in a pediatric patient, which structure is the primary landmark for needle entry?
Answer: Sacral hiatus bounded by the sacral cornua
The sacral hiatus, identified by the sacral cornua as bony lateral landmarks, is the entry point for caudal epidural block in pediatric patients.
What is the MOST appropriate initial treatment for local anesthetic systemic toxicity (LAST) presenting with ventricular fibrillation refractory to standard ACLS?
Answer: 20% lipid emulsion (Intralipid) bolus 1.5 mL/kg IV
ASRA guidelines recommend 20% lipid emulsion as first-line rescue therapy for refractory LAST-induced cardiac arrest, acting as a lipid sink to sequester local anesthetic.
In a continuous thoracic paravertebral block catheter, the local anesthetic spreads primarily to block which nerves?
Answer: Ipsilateral spinal nerve roots at multiple dermatomal levels
Thoracic paravertebral block produces ipsilateral somatic and sympathetic blockade by depositing local anesthetic adjacent to the spinal nerve roots as they exit the intervertebral foramina.
A patient develops profound bradycardia (HR 32) during a high spinal anesthetic. After atropine 0.5 mg with no response, what is the NEXT best treatment?
Answer: Epinephrine 10-100 mcg IV titrated
When atropine fails for high spinal bradycardia, small IV doses of epinephrine (10-100 mcg) address both the chronotropic and inotropic deficits caused by sympathectomy.
Which drug-drug interaction is MOST clinically significant when administering ropivacaine to a patient on fluvoxamine (a CYP1A2 inhibitor)?
Answer: Reduced ropivacaine clearance leading to elevated plasma levels
Ropivacaine is primarily metabolized by CYP1A2; fluvoxamine inhibition of this enzyme significantly reduces clearance, leading to prolonged elevated plasma concentrations and toxicity risk.