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EHPLE Anesthesia study materials
EHPLE Anesthesia study resources

EHPLE Anesthesia: General and Regional Anesthesia Techniques

EHPLE Anesthesia · Work through your exam, one topic at a time.

All guide sections

General and Regional Anesthesia Techniques

What this domain tests

Technique items ask you to choose and execute anesthesia safely, including drug dosing, neuraxial contraindications, and complication management.

Core rules

  • General anesthesia triad: hypnosis, analgesia, immobility. Balanced anesthesia combines agents to reduce dose-related toxicity. MAC is the alveolar concentration preventing movement to a standard stimulus; MAC-awake is about 0.3-0.4 MAC.
  • TIVA: propofol and remifentanil; beware awareness with paralysis and no volatile monitoring; use processed EEG when deep neuromuscular blockade is used.
  • Neuraxial: spinal hypotension follows sympathectomy; treat with fluids and vasopressors. High block causes bradycardia and hypotension. Use left uterine displacement in pregnancy.
  • ASRA anticoagulation: stop prophylactic heparin 12 h; LMWH 12-24 h depending on dose; clopidogrel 5-7 days; DOACs 3-5 days; document.
  • LAST: stop injection, call for help, oxygenate, give benzodiazepine for seizures, start 20% lipid emulsion 1.5 mL/kg bolus then 0.25 mL/kg/min, and begin CPR if arrest occurs.
  • Specific blocks: interscalene causes phrenic palsy; supraclavicular risks pneumothorax; TAP does not cover visceral pain; adductor canal spares quadriceps strength.

Worked example

A 70 kg patient develops seizures and hypotension after 40 mL of 0.5% bupivacaine for a fascia iliaca block. Total dose is 200 mg, near the 2-2.5 mg/kg ceiling. Stop injection, secure the airway, give midazolam, start 20% lipid at 1.5 mL/kg = 105 mL bolus, then 0.25 mL/kg/min = 17.5 mL/min. The reasoning is that bupivacaine cardiotoxicity is treated with lipid sink and prolonged resuscitation, not a single defibrillation attempt.

Traps

Calculating local anesthetic dose in milliliters rather than milligrams and mg/kg; using an epinephrine-containing solution to exceed the ceiling; missing LAST because the block was peripheral; performing neuraxial anesthesia with a supratherapeutic INR; forgetting that spinal anesthesia can cause bradycardia.

Key points

  • MAC-awake is about 0.3-0.4 MAC.
  • LAST treatment is 20% lipid 1.5 mL/kg bolus then 0.25 mL/kg/min.
  • Interscalene block risks phrenic nerve palsy.
  • ASRA timing must be documented before neuraxial procedures.
  • High neuraxial block causes hypotension and bradycardia.