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Y3 Obs and Gynae Anatomy > Anatomy of Anaesthesia for Labour > Flashcards

Anatomy of Anaesthesia for Labour Flashcards

1
Q

List nerves associated with the perineum

A

BODY WALL
Somatic motor
Somatic sensory

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2
Q

List nerves associated with the pelvis

A

BODY CAVITY
Sympathetic
Parasympathetic
Visceral afferent

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3
Q

Which nerve structures transmit pain from the pelvis?

A

Visceral afferents - sympathetic or parasympathetic

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4
Q

Which nerve structures transmit pain from the perineum?

A

Pudenal nerve - somatic sensory

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5
Q

Where do visceral afferents enter the spinal cord for pelvic organs that TOUCH THE PERITONEUM? Where is pain perceived? List these organs

A

T11-L2 via sympathetic fibres
Suprapubic region
Uterine tubes, uterus, ovaries

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6
Q

Where do visceral afferents enter the spinal cord for pelvic organs that are not touching the peritoneum (ABOVE LEVATOR ANI)? Where is pain perceived? List these organs

A

S2-S4 via parasympathetic fibres
S2,3,4 dermatome
Cervix and superior vagina

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7
Q

Where does the pudenal nerve enter the spinal cord for structures in the perineum (BELOW LEVATOR ANI)? Where is pain perceived? List these organs

A

S2-S4 via somatic sensory fibres
Localised pain in perineum
Inferior vagina, perineal muscles, glands, skin

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8
Q

Structures above levator ani are supplied by which nerve fibres?

A

IN PELVIS

Visceral afferents

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9
Q

Structures below levator ani are supplied by which nerve fibres?

A

IN PERINEUM

Pudenal nerve

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10
Q

What type of anaesthesia targets intraperitoneal, subperitoneal and somatic structures?

A

Spinal anaesthetic

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11
Q

What type of anaesthesia targets subperitoneal and somatic structures?

A

Epidural anaesthetic

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12
Q

What type of anaesthesia targets somatic structures only?

A

Pudenal nerve block

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13
Q

Spinal cord becomes cauda equina at what vertebral level?

A

L2 vertebra

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14
Q

SAS ends at which vertebral level?

A

S2

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15
Q

Anaesthesia is injected into which vertebral region?

A

L3-L4 to anaesthetise cauda equina

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16
Q

What is the surface landmark for injecting anaesthesia?

A

L4 spinous process

Superior point on iliac crests

17
Q

Describe the layers a needle passes through for spinal anaesthetic

A 
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
Dura matter
Arachnoid matter
SAS with CSF
18
Q

Describe the layers a needle passes through for epidural anaesthetic

A

Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space

19
Q

What is the distinguishing feature of ligamentum flavum?

A

Yellow as it is elastic

20
Q

Describe sympathetic outflow below L2 vertebra

A

Sympathetic ganglia receive fibres from L2 via sympathetic chain
Distribute to lumbar, sacral, coccygeal spinal nerves

21
Q

All spinal nerves and named nerves contain sympathetic fibres. True/ False?

A

True

22
Q

What do sympathetic fibres supply, creating sympathetic tone? Blockage of sympathetic tone causes…

A

All arterioles

Vasodilatation

23
Q

List signs that spinal anaesthetic is working

A

Flushed lower limbs
Warm lower limbs
Reduced sweating

24
Q

The pudenal nerve supplies all of the perineum. True/False?

A

False

Supplies most of it - also supplied by ilioinguinal nerve

25
Q

Outline the route taken by the pudenal nerve to structures of the perineum

A

Exits pelvis via greater sciatic foramen –>
Passes posterior to sacrospinous ligament –>
Reenters pelvis/ perineum via lesser sciatic foramen –>
Travels in pudenal canal –>
Branches supply perineum

26
Q

What is the pudenal canal?

A

Passage in obturator fascia containing internal pudenal artery and vein, pudenal nerve and nerve to obturator internus

27
Q

Which bony landmark is used in the administration of pudenal nerve block?

A

Ischial spine

28
Q

List instances in which a pudenal nerve block can be applied

A

Labour
Forceps delivery
Vaginal delivery
Epiostomy

29
Q

During labour, branches of which nerve can be torn?

A

Pudenal nerve (supplying levator ani and external anal sphincter)

30
Q

Which component of the levator ani is typically torn fist during labour?

A

Puborectalis

31
Q

How is tearing in the perineum during childbirth described?

A

First degree
Second degree
Third degree

32
Q

What is the clinical significance of damage to dtructures due to perineal tearing?

A

Weakened pelvic floor

Faecal incontinence

33
Q

What is an ‘epiostomy’

A

A surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues

34
Q

List types of epiostomy incision

A

Posterolateral

Median

35
Q

A posterolateral epiostomy incision is made into which anatomical structure?

A

Ischioanal fossae

36
Q

A median incision is not used as often as it can damage which structure?

A

External anal sphincter if further tearing occurs posteriorly

37
Q

The pudenal canal passes on the surface of which muscle?

A

Obturator internus

Y3 Obs and Gynae Anatomy (7 decks)

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