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Regional > APEX - Neuraxial > Flashcards

APEX - Neuraxial Flashcards

1
Q

Each vertebra can be divided into what two segments?

A

Anterior and Posterior segment

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2
Q

What two structures join the anterior and posterior segments of the vertebra and form the vertebral foramen?

A

The laminae and pedicles

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3
Q

What part of the vertebra contains the spinal cord, nerve roots, and epidural space?

A

The vertebral foramen

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4
Q

How do the spinal nerves exit the vertebral column?

A

The spinal nerves exit the vertebral column by way of the intervertebral foramina

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5
Q

The transverse processes project (in what direction), while the spinous process projects (in what direction)

A

The transverse processes projects LATERALLY, while the spinous process projects POSTERIORLY.

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6
Q

The cervical and thoracic spinous processes angle is in what direction?

A

The cervical and thoracic spinous processes angle is a CAUDAL direction. This requires a more cephalad approach with the needle.

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7
Q

Lumbar spinous processes projects in what direction?

A

Lumbar spinous processes projects in a POSTERIOR direction. This makes access to the epidural and intrathecal spaces easier.

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8
Q

The supraspinous ligament joins what part of the vertebra

A

The tips of the spinous processes

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9
Q

How does the Interspinous Ligament connect the vertrebras?

A

The Interspinous Ligament travels adjacent to and joins the spinous processes

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10
Q

What is the significance of the Ligamentum Flavum?

A

Piercing the ligamentum flavum contributes to the loss of resistance when the needle enters the epidural space.

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11
Q

What ligaments will you pierce using a Midline approach?

A

Supraspinous ligament
Interspinous ligament
Ligamentum flavum

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12
Q

What ligament will you pierce using a paramedian approach?

A

Ligamentum flavum

The paramedian approach bypasses the suprasponous and interspinous ligaments.

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13
Q

What space is between the Ligamentum flavum and dura mater?

A

Epidural space

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14
Q

What space is between the dura mater and the arachnoid mater?

A

Subdural space

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15
Q

What space is between the Arachnoid mater and Pia Mater?

A

Subarachnoid space

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16
Q

What are the layers of the meninges? (In order from outside in)

A

Dura
Arachboid
Pia

DAP

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17
Q

What is the subdural space?

A

The potential space between the dura matter and the arachnoid mater

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18
Q

What is the subarachnoid space?

A

This space is just past the arachnoid mater. It contains CSF, nerve roots, rootlets, and the spinal cord. This is the target when performing a spinal anesthetic.

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19
Q

What is the Dura mater?

A
  • It is the first meningeal layer.
  • After the needle advances through the epidural space, it comes into contact with the dura matter.
  • The Dura matter is a rough fibrous protective shield that protects the spinal cord.
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20
Q

What is the arachnoid mater?

A
  • A think layer of connective tissue that neighbors the dura mater.
  • The second meningeal layer
21
Q

What is the Pia Mater?

A
  • This is the external covering of the spinal cord.

- This is the meningeal layer.

22
Q

How many vertebrae does the sacrum consist of?

A

5 Vertebrae

23
Q

At what level of the spinal column does the superior iliac spines coincide with?

A

S2

24
Q

The sacral hiatus is cover by what ligament?

A

It is covered by the sacrococcygeal liagment

25
Q

How many paired spinal nerves does the spinal cord have?

A

31 paired spinal nerves

26
Q

What is a dermatome?

A

A dermatome is an area of skin that is innervated by a dorsal nerve root from the spinal cord.

27
Q

What is the site of action for spinal anesthesia?

A

In the subarachnoid space, the primary site of local anesthetic action is on the myelinated preganglionic fibers of the spinal nerve roots.

28
Q

What is the site of action for an epidural anesthesia?

A

LA in the epidural space must first diffuse through the dural cuff before they can block the nerve roots.

29
Q

With spinal anesthesia, which fibers are blocked first, second, and last?

A

Autonomic fibers are blocked first (B fibers)
Sensory fibers are blocked second (C and Adelta)
Motor neurons are blocked last (A g, A b, Aa)

30
Q

With neuraxial anesthesia, how is bradycardia caused?

A

Bradycardia is caused by the blockage of the preganglionic cardioaccelerator fibers at T1-T4, this is causes a relative increase of parasympathetic tone.

31
Q

With neuraxial anesthesia, what causes apnea?

A

Apnea is usually the result of cerebral hypoperfusion, it is NOT the result of the phrenic nerve paralysis or high concentrations of local anesthetics in the CSF

32
Q

For neuraxial anesthesia, if a patient is on aspirin, what do you do?

A

Proceed with neuraxial anesthesia if:
patient has normal clotting mechanism and
patient is not on any other blood thinning agents

33
Q

For neuraxial anesthesia, if a patient is on Eptifibatide (Integrilin), what do you do?

A

Hold the medication 8 hours before the block placement

34
Q

For neuraxial anesthesia, if a patient is on abciximab (Rheopro), what do you do?

A

Hold the medication 1-2 days before the block placement

35
Q

For neuraxial anesthesia, if a patient is on Clopidogrel (Plavix), what do you do?

A

Hold the medication for 7 days before the block placement

36
Q

For neuraxial anesthesia, if a patient is on Ticlopidine (Ticlid), what do you do?

A

Hold the medication for 14 days before the block placement

37
Q

For neuraxial anesthesia, if a patient is on SQ heparin for DVT prophylaxis, what do you do?

A

Proceed with neuraxial anesthesia if:
Patient has normal clotting mechanism and
Patient is not on other blood thinning drugs

38
Q

For neuraxial anesthesia, if a patient is on IV heparin, what do you do?

A

Hold for 2-4 hours before the block placement.

Hold for 1 hour after the block placement.

Hold for 2-4 hours after the indwelling catheter has been removed.

39
Q

For neuraxial anesthesia, if a patient is on Enoxaparin, what do you do?

A

Hold 12 hours for the prophylactic dose (1x daily)
Hold for 24 hours for the therapeutic dose (2x daily)

Hold 12 hours before removing indwelling catheter
Hold 2 hours after the indwelling catheter has been removed.

40
Q

For neuraxial anesthesia, if patient is on Warfarin, what do you do?

A

Hold for 5 days before the block placement.

Can remove catheter if INR less than 1.5

41
Q

For neuraxial anesthesia, if patient is on Garlic, Ginko, Ginseng, Glucosamine, or Chondroitin, What do you do?

A

Proceed with neuraxial anesthesia if patient is not on other blood thinning drugs

42
Q

Where is the conus medullaris in adults and children?

A

Adults L1-L2

Infant L3

43
Q

What is the Cauda Equina?

A

A bundle of spinal nerves extending from the conus medullaris to the dural sac

44
Q

Where is the Dural sac?

A

Adults S2
Infant S3

The subarachnoid space terminates at the dural sac

45
Q

What is the Filum Terminale?

A

This extends from the conus medullaris to the coccyx

46
Q

What are the S/S of Cauda Equina Syndrome?

A

Bowel and bladder dysfunction, sensory deficits, weakness, and/or prarlysis

47
Q

What causes Cauda Equina Syndrome?

A

Neurotoxicity is the result of exposure to high concentrations of local anesthetics

48
Q

What causes transient neurologic symptoms?

A

patient positioning, stretching of the sciatic nerve, myofascial strain, and muscle spasms. It is highly unlikely that neurotoxicity causes TNS

49
Q

What are the S/S of transient neurologic symptoms?

A

severe back and butt pain that radiates to both legs.

In general it develops within 6-36 hours and persist for 1-7 days.

Regional (12 decks)

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