Term
| How should the eye be positioned during a retrobulbular block and why? |
|
Definition
| Direct stare gaze because this allows the vessels to relax and less tension is placed on the optic nerve |
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Term
| What kind of a block is a retrobulbular block? How much local should be administered? |
|
Definition
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Term
| To produce a fully immobile eye, what muscle must be blocked and what nerve innervates it? (This sounds too much like Gross!) |
|
Definition
| Obicularis oculi; facial nerve |
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Term
| What cranial nerves are anesthetized with a retrobulbular block? |
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Definition
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Term
| What type of "space" is local anesthetic administered to and why? |
|
Definition
| epidural; because the optic nerve is in the area and is an extension of the brain with meningeal covering |
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Term
| What are complications of retrobulbular blocks? |
|
Definition
stimulation of oculocardiac reflex
hemorrhage
puncture of globe with possible retinal detachment
central retinal artery occlusion
penetration of optic nerve
brain stem anesthesia = apnea
intraocular injection |
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Term
| Why should we not block the facial nerve as it exits the stylomastoid foramen? |
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Definition
| The vagus and glossopharyngeal nerves exit here as well and can become blocked (vocal cord paralysis, laryngospasm, dysphagia, respiratory distress) |
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Term
| Absolute contraindications to brachial plexus blocks are: |
|
Definition
patient refusal
infection at site
uncorrected coagulopathy |
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|
Term
| What are the symptoms of intravascular injection of lidocaine? |
|
Definition
Circumoral numbness
tinnitus
metallic taste in mouth
seizure, coma, death |
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Term
| What type of block is a brachial plexus block and what types of local are commonly used? |
|
Definition
Volume block
Lido/bupivicaine |
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Term
| When performing a brachial plexus block - at what point is the electric stimulator turned on and at what setting? |
|
Definition
When needle is under skin
2amps |
|
|
Term
| Why is the needle of the electrical stimulator covered in sheathing? |
|
Definition
| To tightly focus the electrical stimulation so that defined areas can be tested |
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Term
| What are the four approaches to brachial plexus blocks? |
|
Definition
axillary
interscalene
supraclavicular
infraclavicular |
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|
Term
| Review Brachial Plexus structure/anatomy |
|
Definition
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Term
| Injecting local into what compartment can numb the entire arm? What is this compartment formed by? |
|
Definition
| Interscalene space: scalene fascia (posterior fascia of the anterior scalene and the anterior fascia of the middle scalene) |
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