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.
2
Q
The musculocutaneous n. is most commonly visualized between which two muscles?
A
Biceps
Coracobrachialis
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
4
Q
How to perform intercostobrachial n block
A
subQ injection of local anesthetic just distal to axilla.
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.
6
Q
With the interscalene brachial plexus block, the ____ n is frequently spared.
A
Ulnar n.
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.
8
Q
Sciatic n. is responsible for innervation of which muscles?
A
Gastrocnemius
Soleus
Plantaris
Digital flexors
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)
10
Q
Femoral n innervates which muscles? What are their actions?
A
Iliopsoas
- Hip flexion
Quadriceps femoris
- Extension of lower leg at knee
11
Q
In adults, the conus medullaris ends at ____ and the dural sac terminates at _____
A
L1-L2
S1-S2
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
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
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)
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)
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
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)
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
19
Q
a ______ is where the meninges alone protrude through the defect in the vertebral column
A
meningocele
20
Q
a ______ is where the meninges, nerve roots, and CSF, protrude through the defect in the vertebral column
A
myelomeningocele
21
Q
Medial to lateral, what are the neurovascular structures in the antecubital fossa?
A
Median n, brachial a, radial n.
22
Q
Subclavian vein central line
- approach and landmarks?
A
Insert needle 1 cm below mid-clavicle angled towards sternal notch
23
Q
L IJ central line has higher risk of what?
A
- Pneumothorax (high-riding cupola of L lung)
2. Thoracic duct cannulation
24
Q
Femoral vein central line
- approach and landmarks?
A
palpate femoral artery,
insert needle medial to artery and 1-2cm below inguinal ligament
25
Supraclavicular approach to central line placement
| - approach and landmarks?
Lateral border of Sternocleidomastoid at its insertion point on clavicle
26
The MEDIAL lower leg is innervated by the _____ n., which is a branch of the femoral n.
saphenous
| medial crural
27
The sciatic n innervates the LATERAL lower leg and the skin of the foot through its 2 branches: ____ and ____
common peroneal
and
tibial n.
28
The ______ n. provides sensory innervation to the lateral posterior portion of the leg.
Sural n (S1-2)
29
The tibial n. is a branch of the ______ n. and provides sensory innervation to the _____
sciatic n.
heel and plantar regions of the foot
30
How long do you have to wait to perform neuraxial anesthesia if the pt is on:
- Therapeutic LMWH
- Prophylactic LMWH
- Therapeutic LMWH: 24h after last dose
| - Prophylactic LMWH: 12h after last dose
31
When performing caudal epidural, ______ is the structure that is transversed just prior to the epidural space.
Sacrococcygeal ligament
32
3 landmarks for caudal block
```
2 PSIS and
sacral hiatus (directly superior to coccyx)
```
33
Sciatic n. block is performed between which 2 bony landmarks?
Greater trochanter and ischial tuberosity
| gluteal approach
34
The LATERAL lower leg is innervated by the _____ n. and the MEDIAL lower leg is ______,
sciatic.
saphenous
35
The sciatic n. block provides anesthesia to which n?
sciatic n and its two components
- Tibial .
- Common peroneal
36
The common peroneal n. is a branch of the ______ n. and provides sensory innervation to the _____
sciatic
lateral lower leg
37
Infraclavicular n. block traverses the pec major and minor (NOT serratus anterior bc the lung is immediately deep to it) and targets _____
the brachial plexus at the level of the cords
38
Advantage of infraclavicular block over axillary block?
Disadvantage?
Includes the musculocutaneous and axillary n.
Higher risk of pneumothorax
39
Pts with (low/high) baseline vagal tone at increased risk of bradycardia and cardiac arrest.
high
- they would have lower resting baseline HR
- baseline ANS favors parasympathetics
- benefit from pretreatment with antimuscarinic (glycopyrolate or atropine)
40
Motor stimulation with ____mA is associated with intraneural injection
< 0.2
41
Benefits to retrobulbar blocks as opposed to peribulbar block?
Cons?
1. Requires less LA
2. Denser block
_____
1. Higher risk of:
- intravascular and intradural injection
- retrobulbar hematoma
- penetration of globe
42
Femoral n. block: contraction of the _____ m. indicates correct placement of the needle
quadriceps (posterior division - main trunk of leg)
43
The lumbar plexus block aka the psoas compartment block is primarily used for femoral shaft and neck fractures, as it covers which key nerves?
femoral n.
obturator n.
LFCN
genitofemoral n.
*spares the sciatic n.
44
Which lung lobe is most prone to collecting secretions in the supine pt?
R lower lobe - posterior segment
| most inferoposterior
45
The R coronary artery supplies which walls of the heart?
Inferior and inferoseptal walls of the LV
46
When is coronary circulation described as R or L dominant?
Right:
- If Posterior descending a. arises from RCA
Left:
- If Posterior descending a. arises from LCx
47
The lateral femoral cutaneous n contains fibers from the _____ n roots, and provides sensory innervation to the anterolateral thigh down to the knee
L2-L4
48
Femoral triangle to the adductor canal
Anteromedial wall: sartorius, posterior wall
Posterior wall: adductor longus and adductor magnus
Lateral wall: vastus medialis
(counterintuitive)
49
2/3 of the blood from the bronchial circulation drains into the ______, and 1/3 drains into the _____
Pulmonary vein
RV through pleurohilar veins or Pulmonary arteries
50
The R bronchial tree gets its circulation from _______, and the L bronchial tree gets it from ______
R: intercostal arteries
L: Bronchial circ arising Directly from aorta
51
Superficial cervical plexus block procedure are often used for carotid endarterectomy. How is it performed?
insert needle over posterior border of SCM and injecting LA along C2-C4 nerve roots.
52
The ______ is the fusion of the C7-T1 cervical sympathetic ganglia and lies on the anterior surface of the C7 vertebral body.
Stellate ganglion
53
What level is the stellate ganglion block performed?
C6 at Chassaignac tubercle
| close proximity to the ganglion, which lies anterior to C7
54
How do you perform stellate ganglion block?
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
55
Benefits of TAP blocks
Limited side effects
56
Goal of TAP blocks
Block anterior rami of T7-L1
| - Analgesia to skin, m, and parietal peritoneum of abd wall
57
(Cardiac MRI / 2-D ECHO) is best at determining ventricular EF.
Cardiac MRI
- std error 5%
- No radiation or contrast
- Habitus is not an issue
(Echo std error 10%)
58
Femoral n. contains divisions of L ____. It courses through the _____ m. and then between the psoas and ilacus m., covered by the _______
L2, L3, L4
Psoas major m.
Fascia iliaca
59
The historical "three-in-one" block provides blockade of which n?
femoral n.
lateral femoral cutaneous n.
obturator n.
60
Femoral n, a, v, which is more lateral?
Lateral to medial:
| Nerve -> arterty -> vein
61
Injecting LA at the greater cornu of the hyoid bone blocks which nerve?
- What sensory innerv. does it block?
Internal branch of the superior laryngeal n.
- sensory innervation to the base of the tongue, epiglottis, aryepiglottic folds and arytenoids
*can prevent laryngospasm
62
Transtracheal LA injection at the cricothyroid membrane blocks which n?
Recurrent laryngeal n.
| - vocal cords ABduction and trachea
63
(Short axis / long axis) and towards the direction of flow is the best way to obtain red signal on color doppler US
Short axis
64
Mechanism of Intravenous regional anesthesia (ie: bier block)
Vascular supply of LA to the distal peripheral nerves contribute to anesthesia
65
Which nerves are responsible for vocal cord adduction and abduction?
Vocal cord relaxation (LOWERS voice pitch)?
ADDuction:
- Lateral cricoarytenoids
ABduction:
- Posterior cricoarytenoids
Relaxation:
- Thyroarytenoid ms.
*All of these intrinsic muscles are supplied by the recurrent laryngeal nerves.
66
Which n is responsible for elongating the vocal cords (tensor), and RAISING the pitch of the sound produced?
What is it innervated by?
cricothyroid m.
- innervated by the superior laryngeal n.
*Say "cricothyroid" in a high pitch every time to help remember
67
How do you identify the vertebra prominens (C7) during placement of paravertebral catheters?
The most cephalad vertebra that remains IMMOBILE during neck flexion and extension
68
The _____ provides sensation to the entire larynx above the glottis.
Internal branch of the superior laryngeal n
69
Laryngospasm is mediated by the ______ n.
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
Superior laryngeal n.
| - Which branch provides sensory and motor innervation?
Internal branch: sensory
External branch: motor
"SIME"
71
What happens when the aCH receptor opens (aCH binds to both a-subunits)?
*The receptor opens when the ligand binds, not when depolarization happens!
Conformational change of ion channel ->
- Influx of Calcium and Sodium.
- Efflux of Potassium
=
Sodium current exceeds potassium current
72
The _____ n. roots exit above the numbered pedicle.
The _____ n. roots exit below the same numbered pedicle.
cervical
(ie: C3 exits above C3 pedicle)
Lumbar
(ie: L4 exits below L4 pedicle)
73
Where best to hear these murmurs?
- AR:
- AS:
- MR:
- MS:
- MVP:
- PDA:
- VSD:
- 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
Name that murmur:
- Blowing, holosystolic murmur
- Mid-diastolic murmur w/ opening snap
- Late systolic click
- Blowing, holosystolic murmur: MR
- Mid-diastolic murmur w/ opening snap: MS
- Late systolic click: MVP
75
I regional or local anesthesia w/ no supplemental sedation, what is the required monitoring needed?
ventilation w/ only qualitative observation (ie. chest rise)
76
Qualifying circumstances for billing unique clinical situations
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
The arteria radicularis magna aka the artery of Adamkiewicz is known for what?
It supplies the ANTERIOR two thirds of the lower spinal cord.
Almost always found on the L side of the aorta.
78
Compromise of the arteria radicularis magna aka the artery of Adamkiewicz will cause what symptoms?
Loss of motor function and pinprick below the level of the lesion
79
Clopidogrel, ASA/dipyridamole, prasugrel, and ticagrelor needs to be stopped for how long before neuraxial anesthesia?
5-7 days
80
Popliteal fossa from medial to lateral
Popliteal a -> Popliteal v -> Tibial n -> Common peroneal n.
81
The fascia iliaca block covers which nerves?
Femoral
| Lateral femoral cutaneous
82
What nerve is close to the great saphenous vein, and is a known complication of nerve injury during vein harvest for CPB?
Saphenous nerve
| - branch of femoral
83
The ______ is a branch of the sciatic n. and divides at lvl of knee
common peroneal n.
84
The most common isolated mononeuropathy of the lower extremity
Common peroneal n
(branch of sciatic)
- ie: during lithotomy position in stirrups or excessive hip flexion (sciatic n. stretch)
85
_______ n. is responsible for foot dorsiflexion and provides cutaneous sensation to small patch of skin btwn first and second toes
Deep peroneal n
| - commonly injured by trauma to lateral knee -> foot drop
86
Which n is commonly injured by trauma to lateral knee -> foot drop
Deep peroneal n
- foot dorsiflexion
- sensation to small patch of skin btwn first and second toes
87
_____ n innervates the peroneus longus and brevis (allows for foot eversion), and provides sensation to lateral lower leg and most of dorsum of foot
superficial peroneal n
88
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)
Tibial n.
| - commonly injured by trauma to lower leg/ankle
89
N/V occurs after spinal ~ __% of the time, d/t _____
20%
Unopposed parasympathetic (vagal) activity after sympathetic block -->
inc peristalsis of GI tract
(NOT hypotension, although that can contribute/exacerbate nausea)
90
Useful meds to treat n/v after spinal, especially with a high (T5) spinal
Atropine or glycopyrrolate
- anticholinergics (parasympathetic blocking)
*Glyco does NOT cross placenta
91
Which n innervates the cricothyroid muscle?
EXTERNAL branch of superior laryngeal n.
92
sensory and motor innervation of larynx and trachea are supplied by ____ n. Which branches into _____ and _____.
Vagus n.
- recurrent laryngeal n.
- superior laryngeal n.
93
The external branch of superior laryngeal n. provides motor function to the cricothyroid muscle, which acts to ______
tense the vocal cords during phonation
*"SIME"
Internal branch: sensory
External branch: motor
94
How do these intrinsic muscles in the larynx affect the vocal cords?
- posterior cricoarytenoids
- lateral cricoarytenoids
- thyroarytenoids
- posterior cricoarytenoids (vocal cord abduction)
- lateral cricoarytenoids (vocal cord adduction)
- thyroarytenoids (vocal cord relaxation)
95
How does injury to b/l recurrent laryngeal n present?
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
How does injury to unilateral recurrent laryngeal n present?
- phonation?
- respiration?
Ipsilateral vocal cord adduction (paramedian position)
- difficulty with phonation
- no respiratory distress
97
______ innervates the hypopharynx, while the glossopharyngeal n. alone innervates the pharynx
Both hypoglossal and glossophayngeal
98
L unilateral vocal cord paralysis may occur after ___ ligation as the L recurrent laryngeal n. loops under the aortic arch in same vicinity
Patent ductus arteriosus (PDA)
99
List in order of most vascular to least, which injection sites will the highest blood level of local anesthetic following completion of the block
Intravenous > Intercostal bock > caudal > epidural > brachial plexus > axillary > lower limb > subcutaneous
IICEBALLS
100
Most important factors of systemic LA absorption and block duration
Use of vasoconstrictors (ie. epi)
location of block
101
Blocking which nerves prevent coughing?
Recurrent laryngeal and superior laryngeal
102
Which three nerves provide sensory and motor innervation to the airway?
1. Glossopharyngeal
2. Recurrent laryngeal
3. Superior laryngeal
103
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?
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
A pt has been receiving LMWH, how long until after last dose can you perform neuraxial procedure?
Therapeutic dose: wait 24 hours
Prophylactic dose: wait 12 hours
105
You performed neuraxial procedure and did NOT leave catheter, how soon can you restart LMWH?
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
You performed neuraxial procedure and DID leave catheter, how soon can you restart LMWH?
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
When can you remove neuraxial catheter after once daily prophylactic dose of LMWH?
12 hours after last dose
108
You just removed neuraxial catheter, how soon can you restart LMWH?
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
What is laryngospasm?
involuntary, sudden closure of BOTH true and false vocal cords
110
Disproportionate opening of false vocal cords during expiration describes ____
coughing
111
The middle cardiac vein is usually associates with the ____
POSTERIOR descending coronary artery (typically from RCA)
112
The anterior cardiac vein is associated w/ the ______
RCA
113
The great cardiac vein is associated with the _____
L ANTERIOR descending artery
114
Describe the oculocardiac reflex, which is most often encountered in children undergoing strabismus sx
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
What nerve fiber is responsible for FASTEST transmission of nociception, temp and touch?
A-delta fibers
*A fibers are large myelinated nerves w/ high conduction speed
116
What nerve fiber is responsible for conduction of proprioception and motor function?
A-alpha
117
What nerve fiber is responsible for touch, pressure, and transmitting info from Meissner corpuscles and Merkel disks?
A-beta
118
What nerve fibers are responsible for transmission of nociception?
Type A-delta
- large, myelinated
- sharp, immediate, well localized
C fibers
- small, unmyelinated
- dull, achy, not well localized
119
Sensitivities of different nerve fibers to local anesthetics from most to least sensitive
Sympathetics > pain/sensory > Motor
aka
Small myelinated (A-delta, A-gamma) > Large myelinated (A-alpha, A-beta) > C (unmyelinated)
"sympathetic people matter"
120
Which pts are most at risk for permanent new/worsening neurologic injury from neuraxial anesthesia?
- Pts w/ space-occupying extradural lesions (ie. tumors, epidural lipoma)
- reduced cross-sectional area (ie: spinal stenosis, ligamentum flavum hypertrophy)
121
(True/false) pts with CNS diseases (MS), trauma to spinal cord, and post-polio syndrome RARELY have exacerbation of diseases following neuraxial anesthesia
True
122
the _____ n provides innervation to the biceps muscle (elbow flexion) and is often missed during an axillary nerve block
musculocutaneous nerve
123
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)
intercostobrachial
124
The _____ n. should be blocked during spinal anesthesia for a lateral wall bladder surgery
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
What lung function is most affected with thoracic and lumbar epidurals?
Peak expiratory pressure (PEP)
- reduced 40% bc it is largely dependent on abdominal musculature (relative to thoracic muscle)
Cough
- by 50%
126
The external jugular vein receives blood from posterior and deep structures of the head and empties into the _____
subclavian vein
127
Subcutaneous infiltration of the entire width of the medial axillary fossa will block _____ n.
intercostobrachial
128
Supraclavicular block covers which nerves?
1. Musculocutaneous
2. Radial
3. Ulnar
4. Median
*NOT intercostobrachial as it is not a branch of the brachial plexus
129
In the elderly, what does it mean that the compliance of the epidural space is decreased? How does that affect neuraxial anesthesia?
The space will expand less when LA is injected
| - cranial and caudal spread will be increased
130
In the elderly, what does it mean that the dura mater is more permeable? How does that affect neuraxial anesthesia?
There is an increased number of arachnoid villi
| - the LA can now more easily reach the spinal nerve roots
131
A high grade stenotic lesion along the ____ may result in AV node block
posterior descending artery
| branch of the RCA
132
Structures encountered from lumbar paramedian approach to spinal anesthesia?
Ligamentum flavum -> epidural space -> dura mater -> arachnoid mater
*supraspinous and interspinous ligaments are not encountered
133
The anterior spinal artery supplies blood to _____, which contains the corticospinal and spinothalamic tracts, which provides sensation of _____
anterior two thirds of spinal cord
pain and temp
- can be loss below the lvl of a lesion
134
(anterior/posterior) spinal cord syndrome is more common
anterior
- only supplied by 1 anterior spinal artery (artery of ademkiewicz)
*posterior is supplied by 2 posterior spinal arteries
135
anterior spinal cord syndrome will have which sensation INTACT below the level of the lesion? which is LOST?
intact: proprioception and vibration
loss: motor, temp, pain
136
diagnostic test of choice for retained epidural catheter fragment. When
CT scan
- leave if asymptomatic
- neurosurgery consult if
137
Most important factor affecting spread of local anesthetic in:
Epidurals:
Spinals:
Epidurals:
- volume
Spinals:
- dosage
- baricity
- pt positioning
138
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
carotid SINUS baroreceptors
- a mechanoreceptor
* think "sinus pressure"
- pressure on the sinus
*the carotid body is a chemoreceptor
139
The carotid body is a (chemoreceptor/mechanoreceptor)
chemoreceptor
140
(true/false) hearing loss is associated with spinal anesthesia
true
- unknown why
- transient (1-3d)
141
(true/false) there is a decrease in ventilatory response to hypercapnea under spinal/epidural anesthesia
false
| - INCREASED ventilatory response to hypercapnea
142
Structures such as blood, which has high water content, which reflects the (most / least) amount of beam rays on ultrasound
LEAST
- hypoechoic
*air reflects a good amt back too, need gel
143
Structures such as bone/tendon, which has low water content, which reflects the (most / least) amount of beam rays on ultrasound
MOST
| - hyperechoic
144
An elevated cardiac fractional area change correlates with _____. This is (increased/decreased) with spinal anesthesia
above normal EF and increased Cardiac output
decreased
145
Spinal anesthesia results in hypotension from what 3 mechanisms?
Sympathectomy
_____________
1. Arterial dilation
2. Venous dilation
Parasympathetic dominance +
Bezold-Jarisch reflex
_____________
3. Bradycardia
146
What is the Bezold-Jarisch reflex?
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
The right coronary artery (RCA) supplies which walls of the heart?
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
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)
femoral nerve
149
Pts with ankylosing spondylitis airway related complications
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
Why are pts with ankylosing spondylitis at increased risk of epidural hematoma?
1. Freq on NSAIDs
- plt dysfunction and bleeding risk
2. Lumbar spine fusion from ossification
- diff placement/repeated attempts
151
What is the Bainbridge reflex?
Preload in the heart causes stretch of the myocardium -->
| increases intrinsic activity of the hart
152
The great radicular artery (aka largest thoracic radicular artery aka arteria radicularis magna aka artery of Adamkiewicz) originates from ____
the aorta btwn T9-T12
153
Posterior spinal cord syndrome will have which sensation INTACT below the level of the lesion? which is LOST?
intact: motor, temp, pain
loss: proprioception and vibration
- posterior spinal cord is responsible for these sensations
154
What n. supplies the AFFERENT limb of the laryngospasm reflex?
Internal branch of the superior laryngeal n.
| - sensory
155
Areas of regional anesthesia from highest to lowest vascularity
Intravenous > Tracheal > Intercostal > caudal/paracervical > epidural > brachial plexus > sciatic/femoral > spinal > subcutaneous
156
What n. supplies the EFFERENT limb of the laryngospasm reflex?
recurrent laryngeal n.
| - motor
157
The ___ rib is associated with the first thoracic vertebra on Xray
first
158
Which nerve blocks are associated with phrenic n blockage?
Supraclavicular (50% of the time)
Interscalene brachial plexus (100% of time)
Stellate ganglion block
