Anatomy & Regional Flashcards
Vasopressin and ACTH, TrH secreted from … nucleus
Paraventricular
Thermoregulation, Thirst, GnRH, and non REM regulated/secreted through … nucleus
Preoptic area
SA node and bronchial tree have predominantly PSNS or SNS tone?
PSNS
Innervation of sweat gland (short preganglionic neuron releases … and postganglionic sympathetic neuron release … and act on … receptors
Both ACh and act on muscurinic
All other postganglionic sympathetic releases NE with exception of adrenal medulla releases Epi and NE
Autonomic neurotransmitters
ACh
all preganglionic PSNS and SNS
all postganglionic PSNS
Postganglionic SYMPATHETIC sweat glands
Postganglionic sympathetic on skeletal blood vessels
Autonomic neurotransmitters
NE and Epi
Only Epi
NE and Epi -> Postganglionic adrenal medulla
All other POSTganglionic not to adrenal and not PSNS pulse the 2 postganglionic SNS to sweat glands and skeletal blood vessels (which both stimulated by ACh)
SNS nerve supply to the UE originated from … and synapses into … ganglion. Postganglionic fibers supply …. and their function …
T1 to T4/5 (sympathetic in general originates T1 - L2/3)
Synapses into sup, middle, and inf cervical ganglion
Postganglionic supply H&N, UE, heart and lung
Function; vasmotor, pilmotor, secretory, and pupillary dilatation.
PSNS originated from
Craniosacral
Cranial 3,7,9,10
S2-4
Causes of Atlanta-axial instability
RA
Achondroplasia
Down syndrome
Anesthetic consideration in ankylosing spondylitis
Airway( cervical immobility and instability, TMJ stiffness)
Systemic; restrictive lung, aortic insufficiency, uveitis, vasculitis
Neuroaxial; osseous ligments, reduces intervertebral space
Nerve supply to tongue
Ant 2/3 Trigeminal (sensory) Facial (Taste)
Post 1/3 sensory and taste by IX
Nerve supply to epiglottis
IX -> sup surface
Sup laryngeal N -> inf surface
Sensory innervation of larynx
Above vocal -> sup laryngeal N
Below vocals -> recurrent laryngeal
Motor innervation of larynx
Recurrent laryngeal supplies all except cricothyroid which supplied by sup laryngeal N (function is tensor of vocal cord)
To block sup laryngeal N, inject into
Post Cornu of hyoid bone
To block Recurrent laryngeal N, inject into
Transtracheal
To block IX N, inject into
Tonillar fossa
Recurrent laryngeal N injury causes
Hoarseness if unilateral
Airway obstruction if b/l
Sup laryngeal N injury causes
Change in voice (cricothyroid which is a tensor of vocal cord loses its function)
To prevent gag reflex, block … N and for cough, block …. N
IX for gag
Sup and recurrent laryngeal N for cough
Location of recurrent laryngeal N in neck
Btw trachea and esophagus, medial to carotid sheath
Location of vagus nerve in neck
Within crayons sheath, btw internal jugular and carotid A
Relation of sympathetic chain to carotid sheath
Posterior to the sheath
Relation of phrenic to carotid sheath
Lateral to the sheath
PXT higher risk with left or right internal jugular venous cannulation ?
Left
Because the diaphragm higher on left side and also the thoracic duct more likely to be injured with the left
The most complication with interscalene block …
Ipsilateral diaphragmatic paralysis
When trapezius twitch elicited during interscalene block, direct the needle to
Anteriorly
With axillary block, least likely brachial nerve to be blocked ?
C5 Musculocutaneous (which supplies lateral forearm) to supplement with this Nerve block, inject within the body of coracobrachialis
It will block for sure the C8-T1 (ulnar and medial)
With interscalene block, least likely to block nerve?
C8-T1
It will for sure block C5-C6 (all radial, medial, axillary and musculocutaneous except Ulnar)
During brachial blockade is it motor or sensory that is blocked first?
Motor
Interscalene block will be more successful when … twitch is elicited
Biceps (musocutaneous N)
Intercostobrachial N supplies the … and it is or not part of brachial pluxes
Medial aspect of the arm
It is not (it is form from T2 which is not in brachial pluxes)
The onset of brachial plexus block is fastest with … approach
Supraclavicular
Axillary block will miss … nerve, which supplies the …
Musculocutaneous
sensory of Lateral forearm
To supplement axillary block with Musculocutaneous nerve block, inject the local at …
The body of coracobrachialis muscle
The base of middle finger supplied by …
Median N
Sciatic nerve block landmark
Greater trochanter and posterior superior iliac spine
Landmark for meralgia parasthetica …
Anterior superior iliac spine
Landmark of stellate ganglion block
Tubercle of chassaiganc (tubercle of transverse process of C6)
Landmark of superficial cervical plexus block
Posterior border of SCM
Landmark of Deep cervical plexus block
Mastoid process and tubercle of chassaiganc
Landmark of deep cervical plexus block
At the transverse process of C2-C4
The correct position for CVP tip catheter
At 2nd costochondral junction on right side
At level of 4th vertebra
RA/SVC junction
Celiac plexus is formed by … and …
Greater splanchnic nerve and lesser splanchnic nerve (T5-L1)
Where is the celiac pluxes located in relation to spine
L1
Celiac plexus has preganglionic… and celiac ganglion is a …. the postganglionic provides …
Preganglionic has sympathetic and parasympathetic
The ganglion is symptomatic and postganglionic provides sympathetic and sensory
Distribution of celiac plexus
Mid stomach to mid transverse colon (visceral pain only)
The 2 most common SE of celiac plexus block
Orthostatic hypotension due to splanchnic vasodilation
And diarrhea
The 3rd MCC is paraplegic due to injury to the artery of adamkewicz
Neuroaxial blockade time interval and anticoagulant
Tidopidine
Therapeutic LMWH
Ppx LMWH
14 days
24 hours
12 hours
Potential Advers effect of spinal microcatheters ?
Increases incidence of transient neurological sx and cauda equina syndrome (LBP, sensory abnormality in saddle area, bowel and bladder dysfunction and weakness of LL)
Midline spinal needle passes through…
Paramedian approach passes 2 ligaments …. and encounter …. muscle instated.
Skin -> SC tissue -> supraspinous ligament -> interspinous -> ligmantum flavum -> dura -> arachnoid
(Dose not encounter anterior spinous ligament).
Paramedian approach passes supraspinous and interspinous; instead encounters paraspinous muscle).
The bony landmark of the end of dura sac is ….
Posterior superior iliac spine
Level where spinal cord ends in adults … and neonates ….
L1
L3
The level where dura ends in adults at … and neonates …
S2
S3
Factors affecting the spread after subarachnoid blockade are
Total dose
Baricity
Position during and immediately following injection of hyperbaric solution
(Height has minimal effect).
Subdural block can be differentiated from subarachnoid blockade by …
Slower onset
Extensive sensory block with minimal motor block
Hypotension less than spinal, but more than epidural
What’s the indicator of complete resolution of spinal blockade
Ability to urinate
Ilioinginal vs iliohypogastric
Origin
Supplies
Site of block
Both originates from L1
Peins, sctoutm/labia, upper medial thigh (where iliohypogastric just inguinal region)
Both at 2 cm above medial to the anterior superior iliac spine
What’s the sole block option for femoral muscle biopsy?
Femoral block
Femoral triangle bouderies, content and floor?
Sup: inguinal ligament
Medial: adductor longus
Lateral: sartorius
Contain LN -> V -> A -> N (medial to lateral) vein closer to peins
The floor made of adductor longus, pectinius -> iliospoas (medial to lateral)
