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Reproduction and Sexual Health > Anatomy 3 - Anaesthesia for Labour > Flashcards

Anatomy 3 - Anaesthesia for Labour Flashcards

1
Q

What nerve fibre types cause uterine cramping e.g. in menstruation?

A

Autonomic control - parasympathetic/ sympathetic causing hormone release

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2
Q

What nerve fibre types cause uterine contraction?

A

Autonomic control - parasympathetic/ sympathetic causing hormone release (oxytocin)

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3
Q

What nerve fibre types cause pelvic floor contraction e.g. which sneezing?

A

Somatic motor

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4
Q

What nerve fibre types sense pain from adnexae?

A

Visceral afferents (i.e. organ to spinal cord)

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5
Q

What nerve fibre types sense pain from uterus?

A

Visceral afferents

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6
Q

What nerve fibre types sense pain from vagina?

A

Pelvic part - visceral afferents

Perineum - somatic sensory

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7
Q

What nerve fibre types sense pain from perineum?

A

Somatic sensory

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8
Q

What nerve fibres are associated with structures in the pelvis (body cavity)?

A

Sympathetic
Parasympathetic
Visceral afferent

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9
Q

What nerve fibres are associated with structures in the perineum (body wall)?

A

Somatic motor

Somatic sensory

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10
Q

How does pain sensation travel from the superior aspect of pelvic organs/ touching the peritoneum to CNS?

A

Visceral afferents

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11
Q

What do the visceral afferent nerve fibres from from the superior aspect of pelvic organs/ touching the peritoneum run alongside?

A

Sympathetic fibres

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12
Q

Where do the visceral afferents from the superior aspect of pelvic organs/ touching the peritoneum enter the spinal cord?

A

Between T11 and L2

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13
Q

How is pain from between T11 and L2 perceived by patient?

A

Suprapubic pain

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14
Q

How does pain sensation travel from the inferior aspect of pelvic organs/ NOT touching the peritoneum to CNS?

A

Visceral afferents

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15
Q

What do the visceral afferent nerve fibres from the inferior aspect of pelvic organs/ NOT touching the peritoneum run alongside?

A

Parasympathetic fibres

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16
Q

Where do the visceral afferents from the inferior aspect of pelvic organs/NOT touching the peritoneum enter the spinal cord?

A

S2, S3, S4

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17
Q

Where is the S2, S3, S4 dermatome?

A

Perineum

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18
Q

How does pain sensation travel from the structures crossing pelvis to perineum below levator ani (i.e. in the perineum) to CNS?

A

Somatic sensory - pudendal nerve S2, S3, S4

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19
Q

Where do the somatic sensory nerve fibres from structures in the perineum enter the spinal cord?

A

S2, S3, S4

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20
Q

How does pain sensation travel from the structures crossing pelvis to perineum above levator ani (i.e. in the pelvis - urethra, vagina) to CNS?

A

Visceral afferents

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21
Q

What are the 2 important spinal cord levels with regards to pain from the female reproductive system?

A

T11 - L2

S2 - S4

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22
Q

Where is the ‘pelvic pain line’?

A

Peritoneum

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23
Q

Where does sympathetic outflow go from?

A

T1 - L2/L3

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24
Q

What are splanchnic nerves?

A

Paired visceral nerves

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25
Q

What do splanchnic nerves carry?

A

Fibres of the autonomic nervous system (visceral efferents) - all sympathetic except pelvic splanchinc which carry parasympathetic fibres
Sensory fibres from the organs (visceral afferents)

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26
Q

What are pelvic splanchnic nerves?

A

Splanchnic nerves that arise from sacral spinal nerves S2, S3, S4 to provide parasympathetic innervation to the hindgut

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27
Q

Where do the sympathetic nerves synapse?

A

Anterior to aorta - prevertebral ganglia

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28
Q

What do sympathetic nerves form at prevertebral ganglia?

A

Superior and inferior mesenteric ganglia

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29
Q

How do the sympathetic nerves reach the distal aspect of the fallopian tube?

A

‘Hitch a ride’ on periarticular plexis

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30
Q

What is the hypogastric nerve?

A

Transition between superior and inferior hypogastric plexuses

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31
Q

Where does the hypogastric nerve enter sympathetic chain?

A

T10 - L2

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32
Q

Where is the superior hypogastric plexus situated?

A

On vertebral bodies anterior to bifurcation of abdominal aorta

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33
Q

What does the superior hypogastric plexus contain?

A

Parasympathetic fibres which arise form pelvic splanchnic nerves S2 - S4

p - parasympathetic
p - pelvis

34
Q

What does the inferior hypogastric plexus supply?

A

Viscera of pelvic cavity (visceral afferents)

35
Q

What is the ilioinguinal nerve a branch of?

A

Lumbar plexus

36
Q

What nerve root is ilioinguinal nerve?

A

L1

37
Q

What modality is ilioinguinal nerve?

A

Motor

Sensory

38
Q

What is the motor function of ilioinguinal nerve?

A

Internal oblique

Transverse abdominis

39
Q

What is the sensory function of ilioinguinal nerve?

A

Skin on upper medial thigh
Skin over root of penis and anterior scrotum
Skin over mons pubis and labia majora

40
Q

What nerve root is iliohypogastric nerve?

A

First major root of lumbar plexus - L1

Also T12

41
Q

What modality is iliohypogastric nerve?

A

Motor

Sensory

42
Q

What is the motor function of iliohypogastric nerve?

A

Internal oblique

Transverse abdominis

43
Q

What is the sensory function of iliohypogastric nerve?

A

Posterolateral gluteal skin in pubic region

44
Q

What sacral nerves is pudendal from?

A

S2, S3, S4

45
Q

What modality is pudendal nerve?

A

Motor

Sensory

46
Q

Does the pudendal nerve carry sympathetic and parasympathetic nerve fibres?

A

Sympathetic yes

Parasympathetic no

47
Q

Name all the layers a needle passes through for a spinal anaesthetic (7)

A 
Supraspinous ligament
Interspinous space
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
Subarachnoid space (CSF)
48
Q

At what vertebral level does the spinal cord become the cauda equina?

A

L2

49
Q

At what vertebral level does the subarachnoid space end?

A

S2

50
Q

At what vertebral level should spinal anaesthesia be injected?

A

L3 - L4 (L5)

51
Q

What does a spinal anaesthetic anaesthetise?

A

Cauda equina (waist to toes)

52
Q

What surgeries is spinal anaesthetic used for?

A

Prolapse repairs
Some hysterectomies
C-sections

53
Q

What levels does the needle pass through in an epidural anaesthetic?

A

Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space

54
Q

At what vertebral level should epidural anaesthesia be injected?

A

L3 - L4

55
Q

What is the aim of epidural?

A

Analgesia rather than complete lack of feeling

56
Q

How can an epidural stop a patient feeling contractions?

A

Target specific nerves

57
Q

Where does sympathetic outflow originate in the brain?

A

Autonomic centres

58
Q

At what spinal nerve level does the sympathetic outflow exit?

A

T1 - L2

59
Q

Once the sympathetic outflow exits the T1 - L2 spinal nerves, where does it travel?

A

To the sympathetic chains

That run the length of the vertebral column

60
Q

Once the sympathetic outflow reaches the sympathetic chains, where does it pass into?

A

All spinal nerves - anterior and posterior rami and named nerves

61
Q

How do sympathetic ganglia receive fibres below the L2 level?

A

From L2 level via sympathetic chain

Distributed via connections with lumbar, sacral and coccygeal spinal nerves

62
Q

What is sympathetic tone?

A

Sympathetic fibres supply all arterioles

63
Q

What effects does spinal anaesthetic have on sympathetic tone?

A

Blocks all sympathetic tone to all arterioles in lower limb

64
Q

What vaso- effect does spinal anaesthetic have on sympathetic tone of aterioles?

A

Vasodilation

65
Q

What are 3 signs that spinal anaesthetic is working? (i.e. signs of vasodilation)

A

Skin of lower limbs looks flushed
Warm lower limbs
Reduced sweating

66
Q

Why does spinal anaesthetic cause reduced sweating?

A

No sympathetic input to glands

67
Q

What is a risk/ complication of spinal anaesthesia?

A

Hypotension

68
Q

What is the aim of a pudendal nerve block?

A

Anaesthetise majority of perineum

69
Q

What surgeries/ procedures is a pudendal nerve block used for?

A

Episiotomy incision
Forceps use
Perineal stitching post-delivery
Painful delivery

70
Q

What route is taken by pudendal nerve?

A

Exit pelvis via greater sciatic foramen
Passes posterior to sacrospinous ligament
Re-enters pelvis/ perineum via lesser sciatic foramen
Travels within Alcock’s canal

71
Q

What is Alcock’s canal?

A

Passageway within obturator fascia

Pudendal nerve, internal pudendal artery and vein and nerve to obturator internus

72
Q

What do branches of the pudendal nerve supply?

A

Perineum

73
Q

What can be used as a landmark in a pudenal nerve block?

A

Ischial spine

74
Q

What 2 incisions can be used for an episiotomy?

A

Medial

Mediolateral

75
Q

Why is a medial incision episiotomy not used often?

A

Further tearing can occur that involves the anal sphinchter

76
Q

Why is a mediolateral incision episiotomy used?

A

Incises into safe fat filled fossa

Avoids extension into rectum

77
Q

What is a 1st degree perineal tear?

A

Through skin

78
Q

What is a 2nd degree perineal tear?

A

Skin and mucosa

79
Q

What is a 3rd degree perineal tear?

A

Severely through muscle

80
Q

What is a 4th degree perineal tear?

A

Involves anal sphincter and rectal mucosa

Rare in UK

81
Q

What can be the result of a perineal tear?

A

Weakened pelvic floor

Faecal incontinence

Reproduction and Sexual Health (18 decks)

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