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Miller's Anesthesia > 45. Neuroaxial anesthesia > Flashcards

45. Neuroaxial anesthesia Flashcards

1
Q

Distal end of spinal cord in adults and kids

A

Kids L3
Adults L1

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2
Q

Layers of spinal cord from outside to inside

A

Dura – Arachnoid – Pia mater

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3
Q

Vascularization of Pia / Arachnoid

A

Arachnoid. non vascular
Pia. Highly vascularized

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4
Q

Most influence of spinal block level and recovery

A

CSF volume

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5
Q

Epidural space characteristics

A

Front post longitudinal lig.
Back. Lig. flavum
Side. pedicles + foramina
Include nerves lymph and vessels (Batson venous plexus)
Exists through intervertebral foramina

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6
Q

Máximum thickness of lig. flavum

A

Thoracic lumbar. 5-6 mm

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7
Q

Dural sac carachteristics

A

Ends at S2
Volume 10 - 27
Contain various plexuses

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8
Q

Spinal artery syndrome

A

Loss of pain, strength, T
Proprioception and vibration Ok

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9
Q

Blood supply to spinal cords

A
  1. Ant spinal a. Anterior. from vertebral a. 2/3.
  2. 2 Post spinal a. from cerebelar a. 1/3
    3, Segmental a. from intercostal / lumbar a.
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10
Q

Order of fibers sensitivity to anesthesia

A

B > C cold > A lambda Prick > A beta touch > A alpha motor
Smaller, no myelin, more sensible

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11
Q

Order of recovery after neuroaxial anesthesia

A

Motor – pinprick – Cold

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12
Q

Block level for Cesarean and for TURP

A

Cesarean T4
TURP T10

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13
Q

Is neuraxial safe in MS

A

Yes

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14
Q

Procaine disadvantages

A

PONV
High failure rate

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15
Q

Transient neurologic symptoms

A

Decrease with Chlorprocaine
Increase Lido 4%
Increase if Lithotomy position

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16
Q

Bazold Jarish reflex after spinal

A

Decrease BP, HR

17
Q

Time to wait for neuraxial after eliquis

A

72h

18
Q

What can cause the use of chlorhexidine

A

Arachnoiditis

19
Q

Cauda equina syndrome

A

After spinal. No control of sphincters

20
Q

Types of needles

A

Pencil point : Whitacre / Spotte
Quince (cutting)

21
Q

Effect of saline in epidural space in Spinal

A

Increase height of Spinal

22
Q

Effect of slow injection in neuraxial

A

Increase the height of block

23
Q

Side effect of prilocain

A

Methemoglobinemia

24
Q

What affects the most the spinal

A

Baricity and dose (VxC)

25
Q

Lipophilic drugs in neroaxial

A

Increase onset, decrease duration
Fentanyl lipophilic vs morphine hydrophilic

26
Q

when to use neuraxial in systemic infection

A

Safe after antibiotics and response

27
Q

Location of cardio accelerator fibers and effect of block

A

T1-T4
Bradicardia

28
Q

In epidural, at what level will sympathectomy occurs

A

At the same level of the motor block

29
Q

Lumbo sacral CSF pressure

A

15 cc H2O

30
Q

Thoracic epidural anesthesia and blood flow

A

Improves anastomotic mucosal blood flow if MAP is maintained.
Worsen local perfusion if blood flow os decreased

31
Q

Blood patch

A

15 - 20 cc
At the level of the Dural puncture or caudal

32
Q

Factors affecting epidural local anesthetic distribution and block height

A

Drug. Volume and dose
Patient. Elderly and pregnancy
Procedure. Level

33
Q

Local anesthetic with antagonist epidural effect of morphine

A

Chloroprocaine

34
Q

Action of epidural alpha 2

A

Increase duration of sensory and motor block

35
Q

PDPH symptoms

A

Headache
Blindness
Swallowing difficulty
Convulsions

36
Q

Epidural space length

A

Around the DURA is the epidural space which extends from the Foramen Magnum to the Sacral hiatus

37
Q

Level of block compared to location of block in spinal

A

Motor
Touch 0
Pinprick +2
Cold + 4
B. Sympathetic

38
Q

Factors Affecting Local Anesthetic Distribution and Block Height in spinal

A

Dose
Baricity
Volume
CSF volume
Advanced age
Pregnancy
Patient position
Epidural injection post spinal

Miller's Anesthesia (43 decks)

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