31. Epidural Flashcards
epidural space
potential space between ligamentaum flavum and dura mater where fluids can collect
epidural space extends ______ to dural sheat
posterior
lateral
anterior
contents in epidural space
adipose
lymphatics
venous plexus
connective tissue
epidural indications
obstetric analgesia
surgical anesthesia
post-op pain control
chronic pain management
cervical epidrual
chronic pain steroid injections
thoracic epidural
post-op surgical pain
lumbar epidural
labor pain
caudal epidural
peds
how are epidurals controlled
LA dose
LA type
LA concentration
medication
location
dermatomes show
cutaneous sensory innervation
epidural CI: absolute
infection at site
pt refusal
coagulopathy
severe hypovolemia
incr ICP
aortic/mitral stenosis
sepsis
epidural CI: relative
neuro deficit
sepsis
mild stenosis
spinal deformity
what are we concerned about with anticoags and epidurals?
- START/RESTART anti-coag while catheter is in?
- time to DISCONTINUE anti-coag before REMOVAL of catheter
- wait time to RESUME anti-coag
rivaroxaban trade name
xarelto
apixaban
eliquis
clopidogrel trade name
plavix
low dose heparin SC trade name
enoxaparin
LMWH trade name
lovenox
rivaroxaban (xarelto): wait ____ hrs after catheter removal
6 hrs
rivaroxaban: wait ____ hrs before removing catheter
22-26 hrs
apixaban: wait ____ hrs after cathether removal
6 hrs
apixaban: wait ____ hrs before removing catheter
26-30 hrs
clopidogrel: wait ___ hrs after catheter removal
start immediately
clopidogrel is not recommended when
catheter in place
Low dose heparin: catheter can be removed when
4-6 hrs post dose
systemic heparin: remove catheter
1 hr prior to admin
or
wait 2-4 hrs after admin to remove
LMWH: 2x daily dose
4 hrs after catheter removal
can you give LMWH with catheter in?
no
LMWH: 1x daily
remove cather 12 hrs after last dose
hold next for 4 hrs post removal
Cephalad spinous process
C7
cather too far in
one sided block
test dose epidural
3mL of 1.5% lido with 1:200000 epi
initial dose epidural
5 mL
- 0.125% bupi
- 2mcg/mL fentanyl
susequent doses epidural
5 mL 0.25% bupivacaine
2 mL fentanyl
3 mL NS
what sensory level are epidural blocking
T10-L1
C section epidural dose
20 mL 2% lido w/5mcg epi
4 mL 4.2% bicarb
2mL fentanyl
** give 5-6 mL of mixture
C- section epidural moprhine dose
1.5-2mg in 10mL w/saline
hip/Lower extremity sx
ob anealgesiua
L2-5
colectomy
upper abdominal
T6-T8
throacic
T2-T6
best choice for pre-incision for post-op pain epidural
50-100 mg 1% lidocaine
+
50-100 mcg fentanyl
epidurals are ______ dose
volume dose
spinals are _____ dose
concentration dose
what makes PDPH better
laying down
PDPH duration
12-72 hrs
factors that incr risk of PDPH
younger
female
pregnant
connective tissue disorder
smaller habitus
prior PDPH
larger needle
provider inexperience
bevel lateral orientation
PDPH treatment: conservative
time
lay down
non-opioid analgeiscs
fluids
caffeine (300-500 mg)
PDPH treatment: invasive
blood patch
sphenopalantine block
limit caffein to ____ if breastfeeding a low birth weight or premie
200 mg
what % of pts respond to blood patch
90%
what % of pts respond to second blood patch
90% of remaining 10%
what drug is used for spehnopalantine block
4% lido
hematoma treatment
surgical decompression
hematoma occurence
immediate
abscess occurrence
5 days to weeks after insertion
how to prevent abscess
bacterial filter
less catherter manipulations
replace every 96 hrs
sheared catheters can cause
abscess
