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AAN2 > Class 9 Spinals and Epidurals > Flashcards

Class 9 Spinals and Epidurals Flashcards

1
Q

What is the benefit of using a stylet when placing a spinal?

A

-Prevents introduction of dermal cells, which can lead to dermoid spinal tumor

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2
Q

Name the 4 types of spinal needles?

A
  • Quinke
  • Sprotte
  • Whitacre
  • Greene
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3
Q

Name the 3 types of epidural needles.

A
  • Hustead
  • Touhy
  • Crawford
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4
Q

What are the absolute contraindications to spinal anesthesia?

A
  • Patient refusal
  • Lack of cooperation
  • Uncorrected coags
  • Infection at block site
  • Increased ICP
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5
Q

How should a cutting needle be introduced?

A

-Longitudinal to avoid cutting nerves

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6
Q

What are the relative contraindications for spinal anesthesia?

A
  • Distal infection
  • Unknown surgery duration
  • Hypovolemia
  • Indeterminate neurologic disease (must chart thoroughly)
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7
Q

What 4 things affect uptake and spread of spinals?

A
  • Concentration of LA in CSF
  • Surface area of exposed nerve
  • Lipid content of nerve
  • Blood flow to nerve
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8
Q

What affects the distribution of spinals?

A
  • Baricity
  • Position
  • Dose
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9
Q

What are the 3 baricities and what do they do?

A
  • Isobaric = Stays
  • Hypobaric = Moves up
  • Hyperbaric = Moves Down
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10
Q

What 8 things will affect the level of your spinal?

A
  • Baricity
  • Position
  • Dose
  • Site of injection
  • Speed of injection
  • Age
  • Volume
  • Concentration
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11
Q

What does adding dextrose do to a spinal?

A

-Hyperbaric

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12
Q

What addition will help make your spinal hypobaric?

A

Sterile water

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13
Q

How does spinal anesthesia affect the liver?

A

-As long as MAP is unchanged the liver will not be affected.

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14
Q

How does spinal anesthesia affect the CV system?

A

-Sympathectomy causing hypotension and bradycardia

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15
Q

How does the spinal cause hypotension?

A

Venodilation and arterial dilation

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16
Q

With normal lungs, at what block height will a patient experience respiratory problems?

A

-C3,4,5 (high spinal)

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17
Q

At what block height does bradycardia become a problem?

A

T1-T4

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18
Q

GI sympathetic innervation comes from what level?

A

-T6-L2

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19
Q

With a normal spinal, what GI problems can occur?

A
  • Increased secretions
  • Sphincters relax
  • Bowel constricts
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20
Q

What drug can be used to treat spinal associated nausea and vomiting?

A

Atropine

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21
Q

All spinal medications must be free of what?

A

-Preservatives

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22
Q

What can be a complication associated with lidocaine spinals?

A

-TNS (transient neurologic symptoms)

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23
Q

What is the onset, duration and dose of lidocaine spinal?

A
  • Onset = 3-5 minutes
  • Duration = 60-90 minutes
  • Dose = 25-50mg
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24
Q

What is the onset, duration and dose of Tetracaine spinal?

A
  • Onset = 3-6 minutes
  • Duration = 70-180 minutes
  • Dose = 5-20mg
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25
Q

What is the onset, duration and dose of bupivicaine spinal?

A
  • Onset = 5-8 minutes
  • Duration = 90-150 minutes
  • Dose = 5-20mg
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26
Q

If placing a spinal in prone position, what type of solution should be used?

A

-Iso or hypo baric

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27
Q

Where are the iliac crests located?

A

L4/5

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28
Q

What should you do if the patient has parasthesia during spinal placement?

A

-Stop advancing and check for CSF

29
Q

When is a paramedian approach used?

A

-calcified intraspinous ligament or difficult positioning

30
Q

What is the first resistance faced when using a paramedian approach?

A

-ligamentum flavum

31
Q

After a spinal what must a patient do prior to discharge?

A

-Void

32
Q

What are the 4 things that can cause a neurologic injury?

A
  • Needle introduce to nerve or cord
  • Spinal cord ischemia
  • Bacterial contamination
  • Hematoma
33
Q

What 2 things can cause cauda equina syndrome?

A

Microcatheters and repeated Lido dosing

34
Q

What causes arachnoiditis?

A
  • Betadine
  • Infection
  • Myelograms from oil based dye
  • Blood
  • Neuro irritant
  • Surgical intervention
  • Intrathecal steroids
  • Trauma
35
Q

What are the treatments for PDPH?

A
  • Fluids
  • Caffeine
  • Bed rest
  • Analgesia
  • Sumatriptan
  • Blood patch (invasive)
36
Q

What increases the risk for spinal hematoma?

A
  • Anticoags
  • ↑ age
  • Female
  • HX of GI bleeds
  • Length of therapy
37
Q

What is the first indication of CV collapse r/t spinal anesthesia?

A

Bradycardia treat agressive

38
Q

What are the absolute contraindications to epidurals?

A
  • Patient refusal
  • Hypovolemia
  • ↑ ICP
  • Infection at site
39
Q

What are the controversial contraindications with epidurals?

A
  • Inability to communicate
  • Tattoos
  • Complicated surgery w/ heavy blood loss
40
Q

Where is an epidural place and at what age can that level be used?

A
  • L2-4

- Adult levels after age 8

41
Q

Where does spinal cord end in a child? Adult

A
  • L2/L3

- L1

42
Q

An epidural block below T4 can affect what?

A
  • Vasomotor tone (T5-L1)

- Decreased venous return = decreased CO

43
Q

An epidural block above T4 will affect what?

A
  • Sympathetic fibers (T1-T4)

- Hypotension and bradycardia

44
Q

Respiratory arrest with an epidural is likely caused by what?

A

-sympathectomy and brain ischemia

45
Q

What is segmental block epidural?

A

-Only blocking specific levels

46
Q

How does LA concentration effect an epidural?

A
  • Low concentration will block only sensory

- High concentration will block motor

47
Q

What is the key factor in epidural spread?

A
  • Volume

- 1-2 ml for each level to be blocked.

48
Q

A lumbar epidural will spread more ______ than caudal. While thoracic gets an _______ spread.

A
  • Cephalad

- Even

49
Q

How does position effect epidurals?

A

-It doesn’t

50
Q

How does age effect epidural dosing?

A

Increased age = decreased dose

51
Q

How does height effect epidurals?

A

< 5’2” = 1ml per level

> 5’2” = increase by .1ml for every 2 inches

52
Q

How does pregnancy and obesity effect epidural dosing?

A

Decreased dose needed

53
Q

What will identify the epidural space? what are the 2 ways to find it?

A
  • Loss of resisance

- Advance and tap or continous pressure

54
Q

How is the sacral hiatus identified?

A

-Sacral cornu

55
Q

When placing a caudal block you will feel a pop after going through what?

A

-sacrococcygeal membrane

56
Q

How far do you advance a caudal block in adults? children?

A
  • Adults no more than 1.5 cm

- Kids no more than .5 cm

57
Q

What is the appropriate test dose for epidural?

A

-3ml of 1.5%lido w/ 15mcg ept

58
Q

What should you never do with and epidural?

A

withdraw catheter through needle, may sheer off piece of catheter that can remain in the back

59
Q

What must always be done prior to epidural injection?

A

-Aspiration

60
Q

How are epidurals dosed in the lumbar?

A
  • Lumbar = 1-2ml per segment
  • Thoracic = 0.7 ml per segment
  • Caudal = 3 ml per segment
61
Q

What is the dose for continuous epidural infusions?

A

4-15 ml/hr

62
Q

How would you treat a unilateral epidural block?

A
  • Pull catheter back slightly
  • Unaffected side down
  • redose
  • replace
63
Q

How do you treat an inadequate epidural?

A
  • raise head and redose w/ higher concentration

- Add fentanyl

64
Q

When are PDPH most common?

A
  • With younger females

- After wet tap

65
Q

A subdural injection with result in what?

A
  • Delayed response

- High spinal

66
Q

A subarachnoid injection will result in what?

A

-Fast high spinal

67
Q

What are the symptoms of meningitis?

A
  • Non positional headache
  • fever
  • Lethargy
  • confusion
  • Nuchal rigidity
68
Q

How to treat meningitis?

A
  • Emergent antibiotics

- Head CT, lumbar puncture, neuro consult

69
Q

Review Antigoag reccomendations

A

ok

AAN2 (11 decks)

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