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Repro and Sexual Health > Anatomy of anaesthesia for labour > Flashcards

Anatomy of anaesthesia for labour Flashcards

1
Q

What is the motor function of the reproductive system in women?

A 
Uterine cramping (menstruation) 
Uterine contraction (labour) 
Pelvic floor muscle contraction (sneezing)
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2
Q

What is the sensory function of the female reproductive system?

A

Pain from adnexae (ovaries and fallopian tubes)
Pain from uterus
Pain from vagina
Pain from perineum

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3
Q

Why is it important to know if the pain is from pelvis or perineum?

A

Fundamental to deciding which nerve fibre types are carrying out which function
Pelvis: body cavity, sympathetic, parasymp or visceral afference
Perineum; body wall, somatic motor and sensory

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4
Q

What separates the pelvis from perineum?

A

Levator ani

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5
Q

Which nerve fibres mediate uterine cramping?

A

Hormonal; sympathetic and parasymp

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6
Q

Which nerve fibres mediate uterine contraction?

A

Hormonal; symp and parasymp

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7
Q

Which nerve fibres mediate pelvic floor muscle contraction?

A

Somatic motor

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8
Q

Which nerve fibres mediate pain from adnexae?

A

Visceral afferents

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9
Q

Which nerve fibres mediate pain from uterus?

A

Visceral afferents

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10
Q

Which nerve fibres mediate pain from vagina?

A 
Visceral afferents (pelvic) 
Somatic sensory (perineum)
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11
Q

Which nerve fibres mediate pain from perineum?

A

Somatic sensory

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12
Q

How is pain sensed from the superior aspect of pelvic organs/ touching peritoneum?

A

Visceral afferents
Run alongside symp fibres
Enter spinal cord between levels T11-L2
Pain is perceived by patient as suprapubic

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13
Q

How is pain sensed from the inferior aspect of pelvic organs/ not touching peritoneum?

A

Visceral afferents
Run alongside parasymp fibres
Enter spinal cord at levels S2,3,4
Pain perceived in S2,3,4 dermatome (perineum)

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14
Q

How is pain sensed from the urethra/ vagina in the pelvis (above levator ani)?

A

Visceral afferents
Parasymp
Spinal cord levels S2,3,4

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15
Q

How is pain sensed from the urethra/ vagina in the perineum below the levator ani?

A

Somatic sensory
Pudendal nerve
Spinal cord levels S2,3,4
Localised pain within perineum

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16
Q

What spinal cord levels will the symps that supply the pelvis arise from?

A

Sacral sympathetic trunks
T11-L2
Superior hypogastric plexus

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17
Q

What spinal cord levels will the parasymps that supply the pelvis arise from?

A

Sacral outflow (S2,3,4)
Pelvic splanchinic nerves
Emerge from spinal roots
Mixes with sympathetic in inferior hypogastric plexus

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18
Q

In the female reproductive system; where will visceral afferents travel to?

A

Back to T11-L2 from pelvic organs which touch the peritoneum (uterine tubes, uterus, ovaries)

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19
Q

In the female reproductive system; where will the pudendal nerve travel to?

A

Back to S2,3,4

Organs within the perineum; inferior vagina, perineal muscles, glands, skin

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20
Q

What are the 2 important spinal cord levels in terms of pain from female repro system?

A

T11-L2

S2-4

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21
Q

Pain sensation from perienum?

A

Body wall
Somatic sensation
Pudendal nerve
S2,3,4

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22
Q

Pain sensation from pelvis

A

Body cavity
Autonomics/ visceral afferents
Then distinguish if touching peritoneum or not

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23
Q

Pain sensation from pelvic structures touching peritoneum

A

Superior
Follows sympathetics
T11-L2

24
Q

Pain sensation from pelvic structures not touching peritoneum?

A

More inferior
Follows parasymps
S2,3,4

25
Q

What are the 3 modes for anaesthesia in labour?

A

Spinal
Epidural
Pudendal nerve block

26
Q

Describe a spinal block

A

Anaesthetizes from waist down; intra and sub peritoneal plus somatic area

27
Q

Describe an epidural block

A

Anesthetizes subperitoneal plus somatic innervated by pudendal

28
Q

Describe a pudendal nerve block

A

Anaesthetizes areas innervated by pudendal nerve

29
Q

When does the spinal cord become cauda equina?

A

L2

30
Q

Where does the SA space end?

A

S2

31
Q

Where is anaesthetic injected in a spinal and epidural?

A

L3-4 (L5) region

32
Q

With which pelvic bony landmark is L4 in line with?

A

Superior point on iliac crests

33
Q

Through which structures will the needle for an epidural pass through?

A

Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space (fat and veins)

34
Q

Through which structures will the needle for a spinal pass through?

A 
Supraspinous
Interspinous 
Ligamentum flavum 
Epidural space
Dura  mater
Arachnoid mater
Subarachnoid space
35
Q

Where do symp nerves exit the spinal cord?

A

T1-L2

36
Q

What occurs with sympathetic outflow below L2?

A

Sympathetic ganglia recieve fibers from L2 via symp chain and then distrubute them via connections with lumbar, sacral and occygeal spinal nerves

37
Q

Do spinal nerves contain symp?

A

Yes; with their named nerve (femoral, sciatic, obturator, pudendal)

38
Q

Which part of the circulation is supplied by sympathetics?

A

Arterioles

39
Q

What will blockade of symp tone in arterioles in lower limb result in?

A

Vasodilation;
skin of lower limbs looks flushed
Warm lower limbs
Reduced sweating

40
Q

What is a sign that spinal anaesthetic is working?

A

Vasodilation in lower limbs

Hypotension

41
Q

What is the nerve of the perineum?

A

Pudendal nerve; somatic motor and somatic sensory, parasymp (S2,3,4)

42
Q

Through which structure will the pudendal nerve exit the pelvis and then re-enter the pelvis?

A

Exit; greater sciatic foramen
Posterior to sacrospinous ligament
Re-enters via lesser sicatic foramen

43
Q

Through which canal does the pudendal nerve travel in?

A

Pudendal canal
Passageway within the obturator fascia
With internal pudendal artery and vein (and nerve to obturator internus)

44
Q

Which aspect of the sacrospinous ligament does the pudendal nerve cross?

A

Lateral

45
Q

What can be used as a landmark to administer pudendal nerve block?

A

Ischial spine (can be felt on internal examination at the 4 and 8 o’clock position)

46
Q

When is a pudendal nerve block utilised?

A

Forceps delivery
Painful vaginal delivery
Episiotomy incision

47
Q

What mechanism for nerve block is utilised for perineal suturing post delivery?

A

LA is injected along site of tear/ episiotomy to anaesthetise branches of pudendal

48
Q

How is the pudendal nerve damaged in labour?

A

Branches can be stretched with resultant stretch of nerve fibres
Fibres within levator ani (puborectalis) or external anal sphincter muscle could be torn and as a result weakened

49
Q

What are the different types of perineal tears?

A

1st
2nd
3rd degree

50
Q

Where is a posterolateral episiotomy incision made?

A

“Safe” fat filled ischioanal fossa to avoid the incision extending into the rectum

51
Q

Where is a medial episiotomy incision made?

A

Not used as much as if further tearing occurs, it will involve the anal sphincter

52
Q

What is a 1st degree tear?

A

Fourchette and vaginal mucosa are damaged and underlying muscles are exposed but not torn

53
Q

What is a 2nd degree tear?

A

Posterior vaginal walls and perennial muscles but anal sphincter is intact

54
Q

What is a 3rd degree tear?

A

Extends to anal sphincter that is torn, but rectal mucosa is intact

55
Q

What is a 4th degree tear?

A

Anal canal is opened, and tear may spread to rectum

Repro and Sexual Health (77 decks)

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