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REPRO > Anaatomy of Anaesthesia for Labour > Flashcards

Anaatomy of Anaesthesia for Labour Flashcards

1
Q

What motor functions are involved in the female reproductive system?

A
  • uterine cramping (menstruation)
  • uterine contraction (labour)
  • pelvic floor muscle contraction (during sneezing)
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2
Q

Sensory pains from the reproductive system?

A
  • pain from the adnexae, uterus, vagina, perineum
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3
Q

What separates the pelvis from the perineum?

A
  • Levator Ani Muscle
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4
Q

Structures in the pelvis?

A
  • body cavity (organs: uterus, bladder, rectum)

- sympathetic, parasympathetic and visceral afferent

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5
Q

Structures in the perineum?

A
  • body WALL

- somatic MOTOR and sensory

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6
Q

What motor function in the reproductive system is controlled hormonally?

A
  • uterine cramping and contraction
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7
Q

What are the sources of visceral afferent pains?

A

-pain from the adnexae, uterus, vagina (pelvic part)

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8
Q

What parts of the reproductive system are under somatic sensory ?

A
  • perineum part of the vagina

- pain from the perineum

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9
Q

How different is the sensory nerve supply between the superior aspect of the pelvic organs and the inferior aspect?

A
  • pelvic organs in contact with peritoneum: VISCERAL afferents (run alongside sympathetic fibres)
  • inferior aspect of pelvic organs: also VISCERAL afferent (runs along PARASYMPATH.)
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10
Q

Where does the sensory supply enter at the spinal cord in the superior aspect of the pelvic organs vs the inferior?

A
  • superior: T11-T12

- Inferior: S2-S4

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11
Q

Where is the pain perceived to be with regards to whether it’s the superior or inferior aspect of the pelvic organs?

A
  • Pain of the superior aspect: SUPRAPUBIC area

- pain from the inferior aspect: S2-S4 dermatome (perineum)

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12
Q

Distinct nerve supply for structures that cross over from the pelvis to the perineum.

A
  • above the L.ani: visceral afferents/parasympa/S2-S4

- Below the L.ani: somatic sensory / PUDENDAL nerve/ S2-S4 —–pain localized to perineum

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13
Q

Where do the sympathetics arise from in spinal cord?

A
  • sacral sympathetic trunks
  • T11-L2
  • Superior Hypogastric Plexus
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14
Q

Where do the parasympathetics arise from?

A
  • sacral outflow (S2-s4)
  • pelvic splanchnic nerves ; from spinal roots
  • —-mixes with sympathetics in the inferior hypogastric plexus
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15
Q

What pelvic organs touch the peritoneum?

Spinal cord levels?

A
  • uterine tubes
  • uterus- ovaries
  • —T11 -L2
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16
Q

INferior aspect, pelvic organs?

A
  • cervix

- superior vagina

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17
Q

Structures within the perineum somative nerve supply and to which spinal level?

A
  • Pudendal nerve back to S2-S4

- —–inferior vagina, perineal muscles, glands and skin

18
Q

Where is the spinal anaesthetic given at and when?

A
  • spinal block via Lumbar Puncture (anesthetisizes from waist down - intra+subperitoneal + somatic areas)
19
Q

When is the caudal epidural nerve block given?

A
  • anesthetisize areas innervated by the pudendal nerve + subperitoneal areas
20
Q

Pudendal nerve block is specifically to block

A

—pudendal nerve supply to the majority of the PERINEUM

21
Q

Site for injection of the spinal and epidural anaesthetic?

A
  • L3-L4 (L5)

TRANSVERSE line from the superior points of the iliac crests

22
Q

When does the spinal cord become the cauda equina?

A
  • L2
23
Q

When does the subarachnoid space end?

A

S2

24
Q

What does the epidural anaesthetic pass through?

A
  • supraspinous Ligament
  • interspinous ligament
  • ligamentum flavum
  • epidural space
25
Q

What does the spinal anaesthetic pass through?

A
  • supra->infra-spinous ligament
  • ligamentum flavum
  • epidural space
  • DURA mater
  • arachnoid mater
  • subarachnoid space
26
Q

Where does the sympathetic outflow originate from? And where do they exit from and travel to next?

A
  • the autonomic centres IN the brain

- —-sympathetic nerve sEXIT the spinal cord with T1-L2 spinal nerves> travels to the sympathetic chains

27
Q

Where does the sympathetic supply originate from below L2?

A
  • from L2 level via the sympathetic chain

- —distributes them via the Lumbar, Sacral and coccygeal spinal nerves

28
Q

Where are sympathetic nerves found?

A
  • in ALL spinal nerves and their named nerves (femoral, sciatic, obturator, pudendal)
29
Q

What does the sympathetic fibres supply ? Blockade of these sympathetic fibres?

A
  • -supplies all arterioles

- blockade of sympathetic tone > vasodilation of the lower limb arterioles

30
Q

What are signs of the spinal anaesthetic working ?

A
  • skin of lower limbs looks FLUSHED
  • WARM lower limbs
  • reduced sweating
31
Q

What is the risk of spinal anaesthesia?

A
  • HYPOTENSION
32
Q

What is the role of the pudendal nerve across the systems?

A
  • GI system
  • Renal System
  • role in MOTOR control of external anal and external urethral sphincters
33
Q

What is the course of the pudendal nerve ?

A
  • Exists pelvis via Greater Sciatic Foramen > passes POSTERIOR to sacrospinous ligament> RE-ENTERS pelvis via lesser sciatic foramen …
34
Q

And what is the course of the pudendal nerve once it has re-entered the pelvis?

A
  • travels in pudendal canal with the INTERNAL pudendal ARTERY and VEIN (and Nerve to obturator internus)….then branches out to supply perineal structures
35
Q

What makes up the pudendal canal ?

A
  • the passageway within the obturator fascia
36
Q

How is the pudendal nerve block administered?

A
  • via vaginal insertion; the ischial spine is palpated and used as a landmark to administer nerve block
37
Q

When is the pudendal nerve block performed?

A
  • during labour
    (forceps delivery/painful vaginal delivery)
  • episiotomy incision
  • Perineal suturing POST delivery (LA is injected along site of tear/episiotomy) to anesthetise branches.
38
Q

Can the pudendal nerve be damaged during labour? How?

A
  • brs. of the the nerve can be STRETCHED with resultant stretch of the nerve fibres
  • —fibres within the levator ani/ext. anal sphincter m. could be torn and as a result = muscle weakness
39
Q

Risk of multiple pregnancies?

A
  • weakened pelvic floor

- fecal incontinence

40
Q

What may occur with a perineal tear extending posteriorly?

A

—-may involve the external anal sphincter

41
Q

Where is the episiotomy conducted?

A
  • made into the fat filled ischioanal fossa

- –avoids the extension of the incision into the rectum

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