New York, NY: McGrawHill Medical; 2006. pp. New York, NY: McGrawHill Medical; 2006. p. 245. Philadelphia, PA: Lippincott Williams & Wilkins; 2008. p. 392. New York, NY: McGrawHill Medical; 2006. p. 272. Direct light reflex b. Cardioaccelerator reflex c. Vasomotor reflex d. Pupillary reflex Q24 Regarding the performance of stellate ganglion block, which one of the following statements is incorrect? A31 A In general, central nervous system (CNS) signs are first to manifest, followed by cardiovascular system (CVS) signs. 4th ed. A45 C Diabetic neuropathies are thought to result from microvascular injury involving vasa nervorum, and macrovascular processes of neuronal ischaemia and infarction. 3rd ed. Clinically, bupivacaine (higher lipid solubility) has a slower onset than lignocaine (less lipid-soluble). Infraclavicular blocks are large-volume blocks (40 mL) and a lower success rate is reported with lower volumes. Cousins MJ, Bridenbaugh PO, Carr DB, et al. Cousins and Bridenbaughs Neural Blockade in Clinical Anesthesia and Pain Medicine. 1st ed. a. The hyperglycaemic response following surgery is prevented by regional anaesthesia b. Cousins and Bridenbaughs Neural Blockade in Clinical Anesthesia and Pain Medicine. 1301. A9 D TABLE 8.3 Recommendations to reduce the chance of nerve damage during a peripheral nerve block (PNB) Equipment: Short-bevel/Tuohy needle less likely to enter nerves than long-bevel Use correct-length needles Use pressure indicators (B-smart) Accurate peripheral nervous system Right probe for the given block (e.g. Philadelphia, PA: Lippincott Williams & Wilkins; 2008. p. 218. No single manoeuvre can anaesthetise the entire airway c. Mandibular branches of trigeminal need not be blocked d. Facial nerve need not be blocked Q112 Regarding anaesthesia of nasal cavity, which of the following statements is correct? Cousins and Bridenbaughs Neural Blockade in Clinical Anesthesia and Pain Medicine. The spinous processes are interconnected by the interspinous ligaments. Associated with higher than recommended pressures. Block Table A.2 Volumes for lower limb used (approximate guides) Traditional peripheral nervous system blocks (mL) Lumbar plexus 40 Femoral 2030 Fascia iliaca/femoral three-inone 30 Obturator block 1015 Lateral femoral cutaneous nerve block 10 Sciatic block proximal 3040 Ultrasound-guided blocks (mL) 1020 Popliteal block 25 Saphenous block 10 Ankle block Up to 25 Overall, ultrasound guidance reduces total volume needed to block any nerve. Nerves running in the TAP lateral to the anterior axillary line, on the other hand, originate from segmental nerves T9 L1. TABLE 7.18 Difference between opioid tolerance and opioid-induced hyperalgesia Opioid tolerance Opioid-induced hyperalgesia Due to decreased analgesic potency Due to increased sensitivity (hyperalgesia) Down-regulation of anti-nociceptive system Rightward shift of dose-response curve Up-regulation of pro-nociceptive system Downward shift of dose-response curve Responds to dose increase Responds to dose decrease Sensory testing reveals no hyperalgesia Sensory testing reveals hyperalgesia Silverman SM. There is a possibility of depositing metallic debris in the intrathecal space with NTN technique due to friction between the needles. Philadelphia, PA: Lippincott Williams & Wilkins; 2008. p. 8. 1st ed. Both the tip and the shaft were conductive, causing current dispersion and lower accuracy. Textbook of Regional Anesthesia and Acute Pain Management. Therefore, hypothyroid patients with neuropathy are at higher risk of neurological damage following regional anaesthesia. MCQs in Regional Anaesthesia and Pain Therapy (Masterpass) (EPUB) Cousins and Bridenbaughs Neural Blockade in Clinical Anesthesia and Pain Medicine. A23 D C7: vertebrae prominens T3: spine of scapula T7: inferior angle of scapula L4: line connecting iliac crest S2: line connecting posterior inferior iliac spine. It is unlicensed for intrathecal use but is commonly used. 2004;101:A899. At SMU, we're all about small classes and personalized education. The pharmacological and clinical effects of LAs are the result of the drug absorption and its disposition b. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008. A46 B Christmas tree appearance is normally seen on injection of contrast in the caudal space. Hadzic A. Epidural stimulation (Tsui test): the placement of wired epidural catheters threaded into epidural space can be confirmed by electrical stimulation between 1 and 10 mA. Since it is a neuropathic pain, it is treated first with antidepressants (tricyclic antidepressants like amitryptyline) followed by anticonvulsants (gabapentin). Lignocaine is more dependent on hepatic blood flow, which is increased in pregnancy. 15+ Anesthesia Books for Free! [PDF] - InfoBooks.org The risk of post-operative apnoea is 5% if the gA is < 35 weeks and pcA is < 48 weeks, and risk of 1% if gA 35 weeks and pCA 54 weeks. This causes dorsiflexion upon stimulation. Type I error occurs by rejecting the null hypothesis when it is true c. Type II error occurs by missing a true difference between the groups d. Power of the study is the probability of occurrence of type II error Answers A1 A Numerical data (obtained from measurements) TABLE 9.1 Types of statistical data Continuous: can take any value in a given range (e.g. Disease or drugs may reduce membrane excitability, resulting in lower action potential amplitude, slower rate of impulse depolarisation and slower conduction velocity. There is limited cephalad spread c. The size of interverterbral foramina decreases with age d. All of the above Q31 Which of the following does not represent the pharmacokinetic differences of epidurally administered local anaesthetic in children when compared with adults? New York, NY: Springer; 2007. p. 66. a. It provides sympathetic supply to abdominal organs b. FIGURE 7.4 Projections of sympathetic nervous system Harold E. Clinical Anatomy for Medical Students and Junior Doctors. A Practical Approach to Regional Anesthesia. Caudal block results in blockage of S2S4 contribution to parasympathetic system, affecting the bladder and the bowel distal to the colonic splenic flexure. Additionally, the Fibromyalgia Impact Questionnaire is used to assess the impact of pain on a patients life. Textbook of Regional Anesthesia and Acute Pain Management. More recently, ultrasound-guided techniques of TAP block have been described. Cetacaine spray (mix of 14% benzocaine and 2% tetracaine): more toxicity. 4th ed. It can be performed bilaterally, since it does not cause hemidiaphragmatic paresis. Ultrasound guidance speeds the execution and improves the quality of supraclavicular block. It lies anterior to aorta at T12L1 level c. Block is performed mainly to block the sympathetic fibres d. It receives parasympathetic supply through the vagus Q27 Regarding the performance of coeliac ganglion block, which of the following is true? FIGURE 2.4 Systemic disposition of local anaesthetic Property Lipophilicity TABLE 2.5 Factors affecting systemic disposition of local anaesthetics Effect Clinical relevance Systemic absorption of longer-acting, more lipophilic agents is slower Lignocaine absorption is faster, but bupivacaine is absorbed slowly into the circulation Site of Anatomical features such as vasularity Intravascular > intrapleural > intercostal > administration and presence of tissues and fat that can caudal > epidural > brachial plexus > bind LA influences disposition femoro-sciatic > subcutaneous > intraarticular > spinal Dosage All other factors being constant, dose is C max dose given; therefore, the primary determinant of peak increased C max plasma concentrations after any route of injection Speed of injection Accidental intravenous administration Dose fractionation may allow early of LA may result in higher peak detection of systemic toxicity (C max) with higher speed of injection Vasocontrictor Decrease rate of systemic absorption by Decreased C max reducing uptake Depot formulations Slow the release of local anaesthetic and hence its absorption Decreased C max Cousins MJ, Bridenbaugh PO, Carr DB, et al. 2005; 30(1): 435. 4th ed. Therefore, the device guides placement of the tip according to injection pressures. This means that non-noxious (sensory) input suppresses pain, or closes the gate to noxious input. A14 D TABLE 6.7 Local anaesthetic adjuvants for epidural in children Additives Characteristics Epidural opioids Avoided in day-case surgeries Side effects like nausea, vomiting, respiratory depression and urinary retention Clonidine 15 mcg/kg Side effects: hypotension and sedation Ventilatory response to increasing levels of carbon dioxide is blunted Ketamine 0.250.5 mg/kg Preservative-free solution must be used Its safety for epidural use is not established There are few animal studies suggesting neurotoxicity Side effects: psychomimetic effects Midazolam 0.05 mg/kg Preservative-free solution must be used Its safety for epidural use is not established Neostigmine 2 mcg/kg Preservative-free solution must be used Its safety for epidural use is not established Side effects: nausea and vomiting Note: the most common adjuvant used is epinephrine. Philadelphia, PA: Saunders; 2006. p. 24. Mulroy MF, Bernards CM, McDonald SB, et al. 1st ed. 4th ed. Higher doses according to weight c. Higher rate of continuous infusions d. Higher potential for toxicity Q32 Which of the following statements about paediatric epidurals is incorrect? Cocaine toxicity manifests as biphasic CNS effects (stimulation followed by depression), sympathetic stimulation, hyperthermia, pupillary dilatation and feeling of crawling insects on the skin. Higher-frequency beams experience more attenuation (directly proportional) and hence have lesser penetration. While the former is usually inhibitory, the latter is usually stimulatory. Anesth Analg. But clopidogrel and ticlopidine should be stopped 7 days and 10 days before spinal anaesthetic, respectively. Incidence increases with age, duration of diabetes and degree of hyperglycaemia. Two approaches to PNS-guided popliteal block are in vogue. a. a. Hadzic A, Vloka J, Hadzic N, et al. 1st ed. Nerves of T6T9 enter the TAP medial to the anterior axillary line. 4th ed. Cousins MJ, Bridenbaugh PO, Carr DB, et al. A Practical Approach to Regional Anesthesia. Magazine: MCQs in Regional Anaesthesia and Pain Therapy (Masterpass). Correct needle placement in the epidural space can be identified with a nerve stimulator (current 110 mA) and anal sphincter contraction as the end response. They act through peripheral opioid receptors modulating afferent nociceptive stimuli b. FIGURE 5.44 Maxillary block: needle direction Spread of local anaesthetic here may cause transient blindness. Textbook of Regional Anesthesia and Acute Pain Management. Needles with stylet are not useful b. Angiocaths are useful, as they help in locating intravascular placement c. An equilateral triangle is formed by joining the two posterior superior iliac spines, and sacral cornua d. Skin is punctured at an angle of 2030 for caudal block Q20 Which of the following statements about caudal block is incorrect? a. Endoneurium in the nerve fibres form the bloodnerve barrier b. Opiate receptors are distributed widely in the brain, spinal cord and peripheral tissues. 53646. Hence, the same dose as in adults will lead to a higher block. Onset is usually delayed (1248 hours) but can be seen up to 5 days after a procedure. After contacting the rib, a 1618-G Tuohy needle is walked off cephalad to the top edge of the rib, using a loss-of-resistance technique to enter the intrapleural space. Parecoxib: parenteral preparation. Cousins and Bridenbaughs Neural Blockade in Clinical Anesthesia and Pain Medicine. 1st ed. It is derived from posterior division of dorsal primary rami c. The posterior division passes deep to the adductor brevis but superficial to adductor magnus d. The anterior division passes superficial to the adductor longus and adductor magnus Q57 Regarding obturator nerve block, which of the following statements is false? Complications in Regional Anesthesia and Pain Medicine. Passes under the inguinal ligament medial to femoral artery c. Lies under fascia lata and fascia iliaca d. Saphenous nerve originates from anterior branch of FN and lies within adductor canal Q52 Regarding the various techniques of femoral nerve block, which of the following statements is correct?
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