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Anesthesia based on Nebuchanedzzer II > Anatomy > Flashcards

Anatomy Flashcards

1
Q

The axillary brachial plexus block targets the brachial plexus at the level of the branches, and provides anesthesia to which nerves?

A

Median n.
Radial n.
Ulnar n.
some Musculocutaneous n. (but is often missed bc it branches off plexus prior to the other nerves)

*block is named after the approach, but doesn’t actually include axillary n.

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2
Q

The musculocutaneous n. is most commonly visualized between which two muscles?

A

Biceps

Coracobrachialis

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3
Q

Which nerve blocks do not cover the medial upper arm, so additional coverage of the intercostobrachial n may need to be performed?

A 
Axillary brachial plexus block
or
Supraclavicular brachial plexus block
or 
Infraclavicular brachial plexus block

*intercostobrachial is not a branch of the brachial plexus

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4
Q

How to perform intercostobrachial n block

A

subQ injection of local anesthetic just distal to axilla.

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5
Q

How to perform U/S guided interscalene block (shoulder and upper arm)

A

U/S placed at level of cricoid cartilage, Identify carotid artery, move probe laterally and posteriorly, the roots of the brachial plexus is found between the ANTERIOR and MIDDLE scalene muscles.

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6
Q

With the interscalene brachial plexus block, the ____ n is frequently spared.

A

Ulnar n.

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7
Q

The lumbar plexus block, aka psoas compartment block, covers which nerves?
Spares which nerves?

A

Femoral,
lateral femoral cutaneous,
obturator

Spares sciatic n.

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8
Q

Sciatic n. is responsible for innervation of which muscles?

A

Gastrocnemius
Soleus
Plantaris
Digital flexors

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9
Q

How to perform lumbar plexus block

A

Pt is in lateral decubitus position

Needle is inserted at L4 transverse process

Once contacted, needle is redirected in cephalad manner and advanced until stimulation of quadriceps femoris occurs (knee extension)

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10
Q

Femoral n innervates which muscles? What are their actions?

A

Iliopsoas
- Hip flexion

Quadriceps femoris
- Extension of lower leg at knee

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11
Q

In adults, the conus medullaris ends at ____ and the dural sac terminates at _____

A

L1-L2

S1-S2

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12
Q

In infants, the conus medullaris ends at ____ and the dural sac terminates at _____

A

L3-L4

S3-S4

*shifted down one interspace than adults

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13
Q

Transtracheal injection of lidocaine, blocks ____ nerve, which anesthetizes sensation to _____, and motor function of ______, during awake intubations

A

recurrent laryngeal n.

s) - vocal cords and trachea
(m) - laryngeal muscles (EXCEPT cricothyroid m

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14
Q

In pts with complex regional pain syndrome (CRPS) of the lower extremity, a _____ block may offer significant relief

A

Lumbar sympathetic plexus block

- located at anterolateral aspect of lumbar vertebral bodies (L1-L5)

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15
Q

The _____ n. alone innervates the pharynx, and can be anesthetized by injecting LA at the _______ through the peri-oral approach, which will help prevent the gag reflex

A

glossopharyngeal n (CN IX)

base of each of the anterior tonsillar pillars (palatoglossal fold)

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16
Q

The internal (sensory) branch of the superior laryngeal n. innervates the mucosa from the _________ to the _______.

It can be blocked by injecting LA at ______

A

epiglottis
vocal cords

Greater cornu of hyoid bone
Superior cornu of thyroid cartilage

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17
Q

The transtracheal block, will anesthetize the ______ nerves, which provides motor innervation to ______

A

recurrent laryngeal n.

all intrinsic muscles in the larynx

  • posterior cricoarytenoids (vocal cord abduction)
  • lateral cricoarytenoids (vocal cord adduction)
  • thyroarytenoids (vocal cord relaxation)
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18
Q

A (meningocele / myelomeningocele) is associated with a tethered spinal cord, hydrocephalus and a latex allergy

A

myelomeningocele

*tethered spinal cord is a relative contraindication to neuraxial anesthesia d/t high potential for spinal cord injury

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19
Q

a ______ is where the meninges alone protrude through the defect in the vertebral column

A

meningocele

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20
Q

a ______ is where the meninges, nerve roots, and CSF, protrude through the defect in the vertebral column

A

myelomeningocele

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21
Q

Medial to lateral, what are the neurovascular structures in the antecubital fossa?

A

Median n, brachial a, radial n.

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22
Q

Subclavian vein central line

- approach and landmarks?

A

Insert needle 1 cm below mid-clavicle angled towards sternal notch

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23
Q

L IJ central line has higher risk of what?

A
  1. Pneumothorax (high-riding cupola of L lung)

2. Thoracic duct cannulation

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24
Q

Femoral vein central line

- approach and landmarks?

A

palpate femoral artery,

insert needle medial to artery and 1-2cm below inguinal ligament

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25
Q

Supraclavicular approach to central line placement

- approach and landmarks?

A

Lateral border of Sternocleidomastoid at its insertion point on clavicle

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26
Q

The MEDIAL lower leg is innervated by the _____ n., which is a branch of the femoral n.

A

saphenous

medial crural

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27
Q

The sciatic n innervates the LATERAL lower leg and the skin of the foot through its 2 branches: ____ and ____

A

common peroneal
and
tibial n.

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28
Q

The ______ n. provides sensory innervation to the lateral posterior portion of the leg.

A

Sural n (S1-2)

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29
Q

The tibial n. is a branch of the ______ n. and provides sensory innervation to the _____

A

sciatic n.

heel and plantar regions of the foot

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30
Q

How long do you have to wait to perform neuraxial anesthesia if the pt is on:

  • Therapeutic LMWH
  • Prophylactic LMWH
A
  • Therapeutic LMWH: 24h after last dose

- Prophylactic LMWH: 12h after last dose

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31
Q

When performing caudal epidural, ______ is the structure that is transversed just prior to the epidural space.

A

Sacrococcygeal ligament

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32
Q

3 landmarks for caudal block

A 
2 PSIS and 
sacral hiatus (directly superior to coccyx)
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33
Q

Sciatic n. block is performed between which 2 bony landmarks?

A

Greater trochanter and ischial tuberosity

gluteal approach

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34
Q

The LATERAL lower leg is innervated by the _____ n. and the MEDIAL lower leg is ______,

A

sciatic.

saphenous

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35
Q

The sciatic n. block provides anesthesia to which n?

A

sciatic n and its two components

  • Tibial .
  • Common peroneal
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36
Q

The common peroneal n. is a branch of the ______ n. and provides sensory innervation to the _____

A

sciatic

lateral lower leg

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37
Q

Infraclavicular n. block traverses the pec major and minor (NOT serratus anterior bc the lung is immediately deep to it) and targets _____

A

the brachial plexus at the level of the cords

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38
Q

Advantage of infraclavicular block over axillary block?

Disadvantage?

A

Includes the musculocutaneous and axillary n.

Higher risk of pneumothorax

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39
Q

Pts with (low/high) baseline vagal tone at increased risk of bradycardia and cardiac arrest.

A

high

  • they would have lower resting baseline HR
  • baseline ANS favors parasympathetics
  • benefit from pretreatment with antimuscarinic (glycopyrolate or atropine)
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40
Q

Motor stimulation with ____mA is associated with intraneural injection

A

< 0.2

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41
Q

Benefits to retrobulbar blocks as opposed to peribulbar block?

Cons?

A
  1. Requires less LA
  2. Denser block

_____

  1. Higher risk of:
    - intravascular and intradural injection
    - retrobulbar hematoma
    - penetration of globe
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42
Q

Femoral n. block: contraction of the _____ m. indicates correct placement of the needle

A

quadriceps (posterior division - main trunk of leg)

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43
Q

The lumbar plexus block aka the psoas compartment block is primarily used for femoral shaft and neck fractures, as it covers which key nerves?

A

femoral n.
obturator n.
LFCN
genitofemoral n.

*spares the sciatic n.

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44
Q

Which lung lobe is most prone to collecting secretions in the supine pt?

A

R lower lobe - posterior segment

most inferoposterior

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45
Q

The R coronary artery supplies which walls of the heart?

A

Inferior and inferoseptal walls of the LV

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46
Q

When is coronary circulation described as R or L dominant?

A

Right:
- If Posterior descending a. arises from RCA

Left:
- If Posterior descending a. arises from LCx

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47
Q

The lateral femoral cutaneous n contains fibers from the _____ n roots, and provides sensory innervation to the anterolateral thigh down to the knee

A

L2-L4

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48
Q

Femoral triangle to the adductor canal

A

Anteromedial wall: sartorius, posterior wall

Posterior wall: adductor longus and adductor magnus

Lateral wall: vastus medialis
(counterintuitive)

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49
Q

2/3 of the blood from the bronchial circulation drains into the ______, and 1/3 drains into the _____

A

Pulmonary vein

RV through pleurohilar veins or Pulmonary arteries

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50
Q

The R bronchial tree gets its circulation from _______, and the L bronchial tree gets it from ______

A

R: intercostal arteries

L: Bronchial circ arising Directly from aorta

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51
Q

Superficial cervical plexus block procedure are often used for carotid endarterectomy. How is it performed?

A

insert needle over posterior border of SCM and injecting LA along C2-C4 nerve roots.

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52
Q

The ______ is the fusion of the C7-T1 cervical sympathetic ganglia and lies on the anterior surface of the C7 vertebral body.

A

Stellate ganglion

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53
Q

What level is the stellate ganglion block performed?

A

C6 at Chassaignac tubercle

close proximity to the ganglion, which lies anterior to C7

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54
Q

How do you perform stellate ganglion block?

A
  1. Neck extension
  2. Locate cricoid cartilage (at C6)
  3. Run fingers laterally until you palpate anterior tubercle of C6 transverse process
  4. Push carotid a and jugular v laterally
  5. Insert 25g 1.5in needle until you reach bone and inject 5-10mL of LA
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55
Q

Benefits of TAP blocks

A

Limited side effects

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56
Q

Goal of TAP blocks

A

Block anterior rami of T7-L1

- Analgesia to skin, m, and parietal peritoneum of abd wall

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57
Q

(Cardiac MRI / 2-D ECHO) is best at determining ventricular EF.

A

Cardiac MRI

  • std error 5%
  • No radiation or contrast
  • Habitus is not an issue

(Echo std error 10%)

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58
Q

Femoral n. contains divisions of L ____. It courses through the _____ m. and then between the psoas and ilacus m., covered by the _______

A

L2, L3, L4

Psoas major m.

Fascia iliaca

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59
Q

The historical “three-in-one” block provides blockade of which n?

A

femoral n.
lateral femoral cutaneous n.
obturator n.

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60
Q

Femoral n, a, v, which is more lateral?

A

Lateral to medial:

Nerve -> arterty -> vein

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61
Q

Injecting LA at the greater cornu of the hyoid bone blocks which nerve?
- What sensory innerv. does it block?

A

Internal branch of the superior laryngeal n.
- sensory innervation to the base of the tongue, epiglottis, aryepiglottic folds and arytenoids

*can prevent laryngospasm

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62
Q

Transtracheal LA injection at the cricothyroid membrane blocks which n?

A

Recurrent laryngeal n.

- vocal cords ABduction and trachea

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63
Q

(Short axis / long axis) and towards the direction of flow is the best way to obtain red signal on color doppler US

A

Short axis

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64
Q

Mechanism of Intravenous regional anesthesia (ie: bier block)

A

Vascular supply of LA to the distal peripheral nerves contribute to anesthesia

65
Q

Which nerves are responsible for vocal cord adduction and abduction?

Vocal cord relaxation (LOWERS voice pitch)?

A

ADDuction:
- Lateral cricoarytenoids

ABduction:
- Posterior cricoarytenoids

Relaxation:
- Thyroarytenoid ms.

*All of these intrinsic muscles are supplied by the recurrent laryngeal nerves.

66
Q

Which n is responsible for elongating the vocal cords (tensor), and RAISING the pitch of the sound produced?
What is it innervated by?

A

cricothyroid m.
- innervated by the superior laryngeal n.

*Say “cricothyroid” in a high pitch every time to help remember

67
Q

How do you identify the vertebra prominens (C7) during placement of paravertebral catheters?

A

The most cephalad vertebra that remains IMMOBILE during neck flexion and extension

68
Q

The _____ provides sensation to the entire larynx above the glottis.

A

Internal branch of the superior laryngeal n

69
Q

Laryngospasm is mediated by the ______ n.

A

Internal branch of the superior laryngeal n

  • afferent limb
  • sensory
  • can do a superior laryngeal n block.

Recurrent Laryngeal n.

  • efferent limb
  • motor
  • can do a transtracheal block
70
Q

Superior laryngeal n.

- Which branch provides sensory and motor innervation?

A

Internal branch: sensory

External branch: motor

“SIME”

71
Q

What happens when the aCH receptor opens (aCH binds to both a-subunits)?

*The receptor opens when the ligand binds, not when depolarization happens!

A

Conformational change of ion channel ->

  • Influx of Calcium and Sodium.
  • Efflux of Potassium

=
Sodium current exceeds potassium current

72
Q

The _____ n. roots exit above the numbered pedicle.

The _____ n. roots exit below the same numbered pedicle.

A

cervical
(ie: C3 exits above C3 pedicle)

Lumbar
(ie: L4 exits below L4 pedicle)

73
Q

Where best to hear these murmurs?

  • AR:
  • AS:
  • MR:
  • MS:
  • MVP:
  • PDA:
  • VSD:
A
  • AR: 3rd/4th parasternal interspace
  • AS: 2nd parasternal interspace
  • MR: apex of heart into axilla (L of nipple)
  • MS: apex of heart into axilla
  • MVP: apex of heart
  • PDA: inferior-mid clavicle
  • VSD: LL sternal border
74
Q

Name that murmur:

  • Blowing, holosystolic murmur
  • Mid-diastolic murmur w/ opening snap
  • Late systolic click
A
  • Blowing, holosystolic murmur: MR
  • Mid-diastolic murmur w/ opening snap: MS
  • Late systolic click: MVP
75
Q

I regional or local anesthesia w/ no supplemental sedation, what is the required monitoring needed?

A

ventilation w/ only qualitative observation (ie. chest rise)

76
Q

Qualifying circumstances for billing unique clinical situations

A
  1. Extremes of age (< 1 or > 70)
  2. Use of deliberate total body hypothermia
  3. Controlled hypotension
  4. Emergency conditions

*invasive lines are eligible for additional billing, but isnt a qualifying circumstance

77
Q

The arteria radicularis magna aka the artery of Adamkiewicz is known for what?

A

It supplies the ANTERIOR two thirds of the lower spinal cord.

Almost always found on the L side of the aorta.

78
Q

Compromise of the arteria radicularis magna aka the artery of Adamkiewicz will cause what symptoms?

A

Loss of motor function and pinprick below the level of the lesion

79
Q

Clopidogrel, ASA/dipyridamole, prasugrel, and ticagrelor needs to be stopped for how long before neuraxial anesthesia?

80
Q

Popliteal fossa from medial to lateral

A

Popliteal a -> Popliteal v -> Tibial n -> Common peroneal n.

81
Q

The fascia iliaca block covers which nerves?

A

Femoral

Lateral femoral cutaneous

82
Q

What nerve is close to the great saphenous vein, and is a known complication of nerve injury during vein harvest for CPB?

A

Saphenous nerve

- branch of femoral

83
Q

The ______ is a branch of the sciatic n. and divides at lvl of knee

A

common peroneal n.

84
Q

The most common isolated mononeuropathy of the lower extremity

A

Common peroneal n
(branch of sciatic)
- ie: during lithotomy position in stirrups or excessive hip flexion (sciatic n. stretch)

85
Q

_______ n. is responsible for foot dorsiflexion and provides cutaneous sensation to small patch of skin btwn first and second toes

A

Deep peroneal n

- commonly injured by trauma to lateral knee -> foot drop

86
Q

Which n is commonly injured by trauma to lateral knee -> foot drop

A

Deep peroneal n

  • foot dorsiflexion
  • sensation to small patch of skin btwn first and second toes
87
Q

_____ n innervates the peroneus longus and brevis (allows for foot eversion), and provides sensation to lateral lower leg and most of dorsum of foot

A

superficial peroneal n

88
Q

The _____ n. innervates the lower leg posterior compartment m. primarily responsible for foot plantar flexion.
- Also provides cutaneous sensation to posterolateral lower leg and lateral foot. ( heel)

A

Tibial n.

- commonly injured by trauma to lower leg/ankle

89
Q

N/V occurs after spinal ~ __% of the time, d/t _____

A

20%

Unopposed parasympathetic (vagal) activity after sympathetic block –>
inc peristalsis of GI tract
(NOT hypotension, although that can contribute/exacerbate nausea)

90
Q

Useful meds to treat n/v after spinal, especially with a high (T5) spinal

A

Atropine or glycopyrrolate
- anticholinergics (parasympathetic blocking)

*Glyco does NOT cross placenta

91
Q

Which n innervates the cricothyroid muscle?

A

EXTERNAL branch of superior laryngeal n.

92
Q

sensory and motor innervation of larynx and trachea are supplied by ____ n. Which branches into _____ and _____.

A

Vagus n.

  • recurrent laryngeal n.
  • superior laryngeal n.
93
Q

The external branch of superior laryngeal n. provides motor function to the cricothyroid muscle, which acts to ______

A

tense the vocal cords during phonation

*“SIME”
Internal branch: sensory
External branch: motor

94
Q

How do these intrinsic muscles in the larynx affect the vocal cords?

  • posterior cricoarytenoids
  • lateral cricoarytenoids
  • thyroarytenoids
A
  • posterior cricoarytenoids (vocal cord abduction)
  • lateral cricoarytenoids (vocal cord adduction)
  • thyroarytenoids (vocal cord relaxation)
95
Q

How does injury to b/l recurrent laryngeal n present?

A

The vocal cords will assume position midway btwn abduction and adduction
(only having superior laryngeal n.)
- stridor and respiratory distress
- loss of phonation

*will require tracheostomy

96
Q

How does injury to unilateral recurrent laryngeal n present?

  • phonation?
  • respiration?
A

Ipsilateral vocal cord adduction (paramedian position)

  • difficulty with phonation
  • no respiratory distress
97
Q

______ innervates the hypopharynx, while the glossopharyngeal n. alone innervates the pharynx

A

Both hypoglossal and glossophayngeal

98
Q

L unilateral vocal cord paralysis may occur after ___ ligation as the L recurrent laryngeal n. loops under the aortic arch in same vicinity

A

Patent ductus arteriosus (PDA)

99
Q

List in order of most vascular to least, which injection sites will the highest blood level of local anesthetic following completion of the block

A

Intravenous > Intercostal bock > caudal > epidural > brachial plexus > axillary > lower limb > subcutaneous

IICEBALLS

100
Q

Most important factors of systemic LA absorption and block duration

A

Use of vasoconstrictors (ie. epi)

location of block

101
Q

Blocking which nerves prevent coughing?

A

Recurrent laryngeal and superior laryngeal

102
Q

Which three nerves provide sensory and motor innervation to the airway?

A
  1. Glossopharyngeal
  2. Recurrent laryngeal
  3. Superior laryngeal
103
Q

The internal br of superior laryngeal n provides sensory innervation to base of tongue, epiglottis, aryepiglottic folds
- what are 2 diff ways you can block it?

A
  1. Cotton soaked in LA placed in piriform sinus w/ R-angled clamp for 5-10 min
  2. Injection of LA at Greater cornu of hyoid bone through thyrohyoid membrane
104
Q

A pt has been receiving LMWH, how long until after last dose can you perform neuraxial procedure?

A

Therapeutic dose: wait 24 hours

Prophylactic dose: wait 12 hours

105
Q

You performed neuraxial procedure and did NOT leave catheter, how soon can you restart LMWH?

A

Therapeutic dose:

  • wait 24 hours after non high bleeding risk surgery
  • wait 48-72 hours after high bleeding risk surgery

Prophylactic dose: wait 12 hours

106
Q

You performed neuraxial procedure and DID leave catheter, how soon can you restart LMWH?

A

Therapeutic dose:
- Do not administer LMWH while neuraxial catheter is in place

Prophylactic dose:

  • Do not administer twice daily dose
  • Can administer once daily prophylactic dose 12 hours after insertion
107
Q

When can you remove neuraxial catheter after once daily prophylactic dose of LMWH?

A

12 hours after last dose

108
Q

You just removed neuraxial catheter, how soon can you restart LMWH?

A

Therapeutic dose:

  • wait 4 hours after removal
  • or 24 hours after needle/catheter placement, whichever is greater

Prophylactic dose:

  • wait 4 hours
  • or 12 hours after needle/catheter placement, whichever is greater
109
Q

What is laryngospasm?

A

involuntary, sudden closure of BOTH true and false vocal cords

110
Q

Disproportionate opening of false vocal cords during expiration describes ____

111
Q

The middle cardiac vein is usually associates with the ____

A

POSTERIOR descending coronary artery (typically from RCA)

112
Q

The anterior cardiac vein is associated w/ the ______

113
Q

The great cardiac vein is associated with the _____

A

L ANTERIOR descending artery

114
Q

Describe the oculocardiac reflex, which is most often encountered in children undergoing strabismus sx

A

Traction on extraocular muscle or pressure on eyeball -> stimulate ciliary ganglion -> ophthalmic division of TRIGEMINAL n -> gasserian ganglion -> trigeminal nucleus -> vagus n -> bradycardia/arrhythmia/cardiac arrest

115
Q

What nerve fiber is responsible for FASTEST transmission of nociception, temp and touch?

A

A-delta fibers

*A fibers are large myelinated nerves w/ high conduction speed

116
Q

What nerve fiber is responsible for conduction of proprioception and motor function?

117
Q

What nerve fiber is responsible for touch, pressure, and transmitting info from Meissner corpuscles and Merkel disks?

118
Q

What nerve fibers are responsible for transmission of nociception?

A

Type A-delta

  • large, myelinated
  • sharp, immediate, well localized

C fibers

  • small, unmyelinated
  • dull, achy, not well localized
119
Q

Sensitivities of different nerve fibers to local anesthetics from most to least sensitive

A

Sympathetics > pain/sensory > Motor

aka

Small myelinated (A-delta, A-gamma) > Large myelinated (A-alpha, A-beta) > C (unmyelinated)

“sympathetic people matter”

120
Q

Which pts are most at risk for permanent new/worsening neurologic injury from neuraxial anesthesia?

A
  • Pts w/ space-occupying extradural lesions (ie. tumors, epidural lipoma)
  • reduced cross-sectional area (ie: spinal stenosis, ligamentum flavum hypertrophy)
121
Q

(True/false) pts with CNS diseases (MS), trauma to spinal cord, and post-polio syndrome RARELY have exacerbation of diseases following neuraxial anesthesia

122
Q

the _____ n provides innervation to the biceps muscle (elbow flexion) and is often missed during an axillary nerve block

A

musculocutaneous nerve

123
Q

the _____ n provides sensory innervation to the medial brachium and is not covered by an axillary nerve block (and others)
(needs to be blocked if upper arm tourniquet is used)

A

intercostobrachial

124
Q

The _____ n. should be blocked during spinal anesthesia for a lateral wall bladder surgery

A

obturator n.

  • innervates adductor muscles of thigh
  • can be stimulated and “jerk” reflex can result in surgeon being kicked, ureter injury, or bladder perforation
125
Q

What lung function is most affected with thoracic and lumbar epidurals?

A

Peak expiratory pressure (PEP)
- reduced 40% bc it is largely dependent on abdominal musculature (relative to thoracic muscle)

Cough
- by 50%

126
Q

The external jugular vein receives blood from posterior and deep structures of the head and empties into the _____

A

subclavian vein

127
Q

Subcutaneous infiltration of the entire width of the medial axillary fossa will block _____ n.

A

intercostobrachial

128
Q

Supraclavicular block covers which nerves?

A
  1. Musculocutaneous
  2. Radial
  3. Ulnar
  4. Median

*NOT intercostobrachial as it is not a branch of the brachial plexus

129
Q

In the elderly, what does it mean that the compliance of the epidural space is decreased? How does that affect neuraxial anesthesia?

A

The space will expand less when LA is injected

- cranial and caudal spread will be increased

130
Q

In the elderly, what does it mean that the dura mater is more permeable? How does that affect neuraxial anesthesia?

A

There is an increased number of arachnoid villi

- the LA can now more easily reach the spinal nerve roots

131
Q

A high grade stenotic lesion along the ____ may result in AV node block

A

posterior descending artery

branch of the RCA

132
Q

Structures encountered from lumbar paramedian approach to spinal anesthesia?

A

Ligamentum flavum -> epidural space -> dura mater -> arachnoid mater

*supraspinous and interspinous ligaments are not encountered

133
Q

The anterior spinal artery supplies blood to _____, which contains the corticospinal and spinothalamic tracts, which provides sensation of _____

A

anterior two thirds of spinal cord

pain and temp
- can be loss below the lvl of a lesion

134
Q

(anterior/posterior) spinal cord syndrome is more common

A

anterior
- only supplied by 1 anterior spinal artery (artery of ademkiewicz)

*posterior is supplied by 2 posterior spinal arteries

135
Q

anterior spinal cord syndrome will have which sensation INTACT below the level of the lesion? which is LOST?

A

intact: proprioception and vibration
loss: motor, temp, pain

136
Q

diagnostic test of choice for retained epidural catheter fragment. When

A

CT scan

  • leave if asymptomatic
  • neurosurgery consult if
137
Q

Most important factor affecting spread of local anesthetic in:
Epidurals:
Spinals:

A

Epidurals:
- volume

Spinals:

  • dosage
  • baricity
  • pt positioning
138
Q

Acute hemodynamic changes during carotid endarterectomy can occur secondary to compression of ____, with increased baroreceptor output leading to decreased sympathetic discharge and increased parasympathetic discharge

A

carotid SINUS baroreceptors
- a mechanoreceptor

  • think “sinus pressure”
  • pressure on the sinus

*the carotid body is a chemoreceptor

139
Q

The carotid body is a (chemoreceptor/mechanoreceptor)

A

chemoreceptor

140
Q

(true/false) hearing loss is associated with spinal anesthesia

A

true

  • unknown why
  • transient (1-3d)
141
Q

(true/false) there is a decrease in ventilatory response to hypercapnea under spinal/epidural anesthesia

A

false

- INCREASED ventilatory response to hypercapnea

142
Q

Structures such as blood, which has high water content, which reflects the (most / least) amount of beam rays on ultrasound

A

LEAST
- hypoechoic

*air reflects a good amt back too, need gel

143
Q

Structures such as bone/tendon, which has low water content, which reflects the (most / least) amount of beam rays on ultrasound

A

MOST

- hyperechoic

144
Q

An elevated cardiac fractional area change correlates with _____. This is (increased/decreased) with spinal anesthesia

A

above normal EF and increased Cardiac output

decreased

145
Q

Spinal anesthesia results in hypotension from what 3 mechanisms?

A

Sympathectomy
_____________
1. Arterial dilation
2. Venous dilation

Parasympathetic dominance +
Bezold-Jarisch reflex
_____________
3. Bradycardia

146
Q

What is the Bezold-Jarisch reflex?

A

Parasympathetic-mediated reflex
- acute decrease in LV preload -> stretch receptors in LV sense and slow heart in order to allow LV additional time to fill and increase preload

147
Q

The right coronary artery (RCA) supplies which walls of the heart?

A
  1. RA
  2. Anterior and posterior RV
  3. Upper atrial septum
  4. Posterior third of interventricular septum
  5. Inferior and inferoseptal walls of LV
148
Q

The _______ n supplies cutaneous innervation via its branches to the anteromedial thigh (anterior cutaneous branches), and medial side of lower leg and foot (saphenous n)

A

femoral nerve

149
Q

Pts with ankylosing spondylitis airway related complications

A
  1. Decreased ROM of cervical spine
    - intervertebral disc ossification
  2. Atlantoaxial instability
  3. TMJ hypomobility (ill sealing facemasks)
  4. Constrictive lung disease from pulmonary fibrosis
150
Q

Why are pts with ankylosing spondylitis at increased risk of epidural hematoma?

A
  1. Freq on NSAIDs
    - plt dysfunction and bleeding risk
  2. Lumbar spine fusion from ossification
    - diff placement/repeated attempts
151
Q

What is the Bainbridge reflex?

A

Preload in the heart causes stretch of the myocardium –>

increases intrinsic activity of the hart

152
Q

The great radicular artery (aka largest thoracic radicular artery aka arteria radicularis magna aka artery of Adamkiewicz) originates from ____

A

the aorta btwn T9-T12

153
Q

Posterior spinal cord syndrome will have which sensation INTACT below the level of the lesion? which is LOST?

A

intact: motor, temp, pain

loss: proprioception and vibration
- posterior spinal cord is responsible for these sensations

154
Q

What n. supplies the AFFERENT limb of the laryngospasm reflex?

A

Internal branch of the superior laryngeal n.

- sensory

155
Q

Areas of regional anesthesia from highest to lowest vascularity

A

Intravenous > Tracheal > Intercostal > caudal/paracervical > epidural > brachial plexus > sciatic/femoral > spinal > subcutaneous

156
Q

What n. supplies the EFFERENT limb of the laryngospasm reflex?

A

recurrent laryngeal n.

- motor

157
Q

The ___ rib is associated with the first thoracic vertebra on Xray

158
Q

Which nerve blocks are associated with phrenic n blockage?

A

Supraclavicular (50% of the time)
Interscalene brachial plexus (100% of time)
Stellate ganglion block

Anesthesia based on Nebuchanedzzer II (38 decks)

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