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Chapter 23. Epidural Anesthesia and Analgesia
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Which is not a potential benefit of epidural anesthesia in patients undergoing total hip arthroplasty?
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A. Reduction in operative time
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B. Reduced deep vein thrombosis (DVT)
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D. Less postoperative cognitive dysfunction
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E. Less perioperative hypotension
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E is correct. Hypotension is a common side effect of epidural anesthesia due to sympathectomy.
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A, B, C, and D are incorrect. Studies have proven turnover and operative time is faster when the patient receives neuraxial anesthesia (option A). Other benefits of epidural anesthesia for total hip arthroplasty include a lower incidence of postoperative DVT (option B), a shorter hospital stay (option C), and less postoperative cognitive dysfunction (option D).
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Which statement is correct regarding epidural analgesia and anesthesia for lower limb vascular surgery?
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A. It should not be used due to the need for perioperative anticoagulation.
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B. Only mixtures with epinephrine may be used.
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C. It should not be used due to the frequent comorbidities of peripheral arterial occlusive disease (PAOD) patients.
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D. It improves graft patency.
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E. General anesthesia (GA) is superior in most large studies.
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D is correct. Evidence suggests epidural anesthesia promotes graft patency.
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A is incorrect. Perioperative anticoagulation is needed in many vascular procedures; however, the perioperative dosing regimen usually does not augment the risk of epidural hematoma.
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B is incorrect. Epinephrine is used to prolong the block, uptake occurs but is unlikely to result in clinical significant vasopressive or inotropic effect.
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C is incorrect. Avoiding GA is beneficial in the majority of patients with comorbidities such as coronary artery disease.
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E is incorrect. Conflicting evidence exists on this matter; however, most studies suggest a better outcome with neuraxial anesthesia.
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A patient undergoing cystectomy requires a block up to which sensory level to attain adequate analgesia?
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A is correct. T4. The bladder is innervated by T9–T10, but the incision and traction on the viscera requires a sensory level block until level T4.
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