Question 84 of 100
(demo test)
Product Demo for COA Exam Questions
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You are setting up a tray for removal of a small eyelid growth in the office. The surgeon asks for lidocaine with epinephrine rather than plain lidocaine. The patient hears this and asks you what the epinephrine is for. What does adding epinephrine to the anesthetic do?
Epinephrine makes the numbing last longer and reduces bleeding at the surgical site. Lidocaine is the most common injected anesthetic, which means numbing medicine, for minor office surgery. It comes in several strengths, and it comes with or without epinephrine. Epinephrine constricts blood vessels, that is, it narrows them. Narrow vessels carry the lidocaine away more slowly, so the block lasts longer. Narrow vessels also leak less blood, which gives the surgeon a clearer view of the eyelid tissue.
Know your own part in this. An ophthalmic assistant may instill topical anesthetic drops, but only a physician or a nurse may give an injection. Common topical agents are proparacaine, tetracaine, and lidocaine drops, and lidocaine also comes as a gel. A drop first is kind practice, because it dulls the sting of the antiseptic prep. Warn the patient about what the injection feels like. The needle stick can hurt, and the medicine usually burns as it spreads into tissue. A patient who expects that will hold still. You can also help by steadying the head, holding a hand, and repeating the direction the surgeon wants the patient to look. Allergic and sensitivity reactions to anesthetics are rare, but they happen. For that reason, do not leave a patient alone for more than a moment after any medication is given.
Remember the trade-off in one line: plain lidocaine numbs, and lidocaine with epinephrine numbs longer and bleeds less. Preparing and explaining office anesthetics belongs to the COA content area on surgical assisting.
Incorrect Answers
- A. Epinephrine is not added for speed of onset. It changes how long the numbing lasts, not how fast it starts.
- B. The injection still burns as it goes in. Epinephrine does not stop that sting, so warn the patient first.
- C. Epinephrine has no antiseptic action. The skin still needs a full povidone-iodine prep before cutting.
Testing Pearls
- Lidocaine is the usual injected anesthetic for minor surgery in the office.
- Epinephrine prolongs the block and limits bleeding by narrowing vessels.
- Assistants may give drops; only a physician or nurse gives injections.
- Topical agents include proparacaine, tetracaine, and lidocaine.
- Stay with the patient after any medicine, because reactions are rare but real.
References
- American Academy of Ophthalmology. Ophthalmic Medical Assisting: An Independent Study Course. Chapter 17, Minor Surgical Assisting in the Office.
