45. Neuroaxial anesthesia

Question 1

Distal end of spinal cord in adults and kids

Answer 1

Kids L3
Adults L1

Question 2

Layers of spinal cord from outside to inside

Answer 2

Dura – Arachnoid – Pia mater

Question 3

Vascularization of Pia / Arachnoid

Answer 3

Arachnoid. non vascular
Pia. Highly vascularized

Question 4

Most influence of spinal block level and recovery

Answer 4

CSF volume

Question 5

Epidural space characteristics

Answer 5

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

Question 6

Máximum thickness of lig. flavum

Answer 6

Thoracic lumbar. 5-6 mm

Question 7

Dural sac carachteristics

Answer 7

Ends at S2
Volume 10 - 27
Contain various plexuses

Question 8

Spinal artery syndrome

Answer 8

Loss of pain, strength, T
Proprioception and vibration Ok

Question 9

Blood supply to spinal cords

Answer 9

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.

Question 10

Order of fibers sensitivity to anesthesia

Answer 10

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

Question 11

Order of recovery after neuroaxial anesthesia

Answer 11

Motor – pinprick – Cold

Question 12

Block level for Cesarean and for TURP

Answer 12

Cesarean T4
TURP T10

Question 13

Is neuraxial safe in MS

Answer 13

Yes

Question 14

Procaine disadvantages

Answer 14

PONV
High failure rate

Question 15

Transient neurologic symptoms

Answer 15

Decrease with Chlorprocaine
Increase Lido 4%
Increase if Lithotomy position

Question 16

Bazold Jarish reflex after spinal

Answer 16

Decrease BP, HR

Question 17

Time to wait for neuraxial after eliquis

Answer 17

72h

Question 18

What can cause the use of chlorhexidine

Answer 18

Arachnoiditis

Question 19

Cauda equina syndrome

Answer 19

After spinal. No control of sphincters

Question 20

Types of needles

Answer 20

Pencil point : Whitacre / Spotte
Quince (cutting)

Question 21

Effect of saline in epidural space in Spinal

Answer 21

Increase height of Spinal

Question 22

Effect of slow injection in neuraxial

Answer 22

Increase the height of block

Question 23

Side effect of prilocain

Answer 23

Methemoglobinemia

Question 24

What affects the most the spinal

Answer 24

Baricity and dose (VxC)

Question 25

Lipophilic drugs in neroaxial

Answer 25

Increase onset, decrease duration Fentanyl lipophilic vs morphine hydrophilic

Question 26

when to use neuraxial in systemic infection

Answer 26

Safe after antibiotics and response

Question 27

Location of cardio accelerator fibers and effect of block

Answer 27

T1-T4 Bradicardia

Question 28

In epidural, at what level will sympathectomy occurs

Answer 28

At the same level of the motor block

Question 29

Lumbo sacral CSF pressure

Answer 29

15 cc H2O

Question 30

Thoracic epidural anesthesia and blood flow

Answer 30

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

Question 31

Blood patch

Answer 31

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

Question 32

Factors affecting epidural local anesthetic distribution and block height

Answer 32

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

Question 33

Local anesthetic with antagonist epidural effect of morphine

Answer 33

Chloroprocaine

Question 34

Action of epidural alpha 2

Answer 34

Increase duration of sensory and motor block

Question 35

PDPH symptoms

Answer 35

Headache Blindness Swallowing difficulty Convulsions

Question 36

Epidural space length

Answer 36

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

Question 37

Level of block compared to location of block in spinal

Answer 37

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

Question 38

Factors Affecting Local Anesthetic Distribution and Block Height in spinal

Answer 38

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