ABA Clinical Procedures and Protocols 2 — Questions and Answers
Question 1: A patient undergoing awake fiberoptic intubation becomes increasingly agitated. Which airway topicalization technique provides the most reliable anesthesia of the glottis and subglottis?
- Nebulized lidocaine
- Transtracheal injection of lidocaine (Correct answer)
- Superior laryngeal nerve block alone
- Cocaine-soaked pledgets to the nares
Correct answer: Transtracheal injection of lidocaine
Transtracheal (cricothyroid) injection of lidocaine anesthetizes the subglottis and trachea most directly, providing reliable anesthesia below the cords.
Question 2: When performing a thoracic epidural for a patient with severe COPD scheduled for esophagectomy, at which interspace should the catheter tip ideally be positioned?
- T10–T11
- T6–T8 (Correct answer)
- T2–T4
- L1–L2
Correct answer: T6–T8
A T6–T8 thoracic epidural catheter tip provides analgesia covering the surgical dermatomes of esophagectomy while minimizing unnecessary rostral spread.
Question 3: During a Bier block (IVRA), the tourniquet must remain inflated for at least how long after local anesthetic injection to prevent systemic toxicity?
- 5 minutes
- 10 minutes
- 20 minutes (Correct answer)
- 30 minutes
Correct answer: 20 minutes
A minimum of 20 minutes allows sufficient local anesthetic tissue binding, reducing the risk of rapid systemic absorption upon tourniquet deflation.
Question 4: After successful placement of a femoral nerve block, the patient still reports pain along the medial thigh. Which nerve is most likely not anesthetized?
- Obturator nerve (Correct answer)
- Saphenous nerve
- Lateral femoral cutaneous nerve
- Ilioinguinal nerve
Correct answer: Obturator nerve
The obturator nerve innervates the medial thigh and is not reliably blocked with a standard femoral nerve block, requiring a separate obturator block.
Question 5: A patient receiving a continuous peripheral nerve block develops fever, erythema, and purulent discharge at the catheter site on postoperative day 3. What is the most appropriate next step?
- Increase local anesthetic infusion rate
- Add systemic antibiotics and continue the catheter
- Remove the catheter and culture the tip (Correct answer)
- Replace the catheter at the same site
Correct answer: Remove the catheter and culture the tip
Signs of catheter site infection mandate immediate removal of the catheter and culture of the tip to guide antibiotic therapy.
Question 6: Which landmark is used to identify the correct needle insertion point for a classic posterior approach to the sciatic nerve block (Labat technique)?
- Midpoint between the ASIS and pubic tubercle
- Midpoint of a line drawn from the posterior superior iliac spine to the greater trochanter (Correct answer)
- 2 cm below the midpoint of the inguinal ligament
- Midpoint between the ischial tuberosity and the femoral artery
Correct answer: Midpoint of a line drawn from the posterior superior iliac spine to the greater trochanter
The Labat technique uses the midpoint of the line between the PSIS and the greater trochanter, then drops a perpendicular line to locate the needle entry point.
Question 7: During neuraxial blockade, a 'wet tap' (dural puncture with an epidural needle) occurs. What is the most evidence-based treatment to reduce the incidence of postdural puncture headache?
- Immediate epidural blood patch
- Prophylactic epidural saline infusion
- Threading the epidural catheter intrathecally and converting to spinal anesthesia (Correct answer)
- Bed rest and aggressive IV hydration
Correct answer: Threading the epidural catheter intrathecally and converting to spinal anesthesia
Threading the catheter intrathecally and using it for intentional spinal anesthesia has the best evidence for reducing PDPH after accidental dural puncture with an epidural needle.
ABA Clinical Procedures and Protocols 2
A patient undergoing awake fiberoptic intubation becomes increasingly agitated.
Which airway topicalization technique provides the most reliable anesthesia of the glottis and subglottis?