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Reproduction and Sexual Health > clinical anatomy of anaesthesia for labour > Flashcards

clinical anatomy of anaesthesia for labour Flashcards

1
Q

reproductive system has two types of nerve innervation?

A
  • motor
  • sensory
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2
Q

motor function of repro system

A
  • uterine ‘cramping’ during constriction
  • uterine contraction during labour
  • pelvic floor muscle contraction during sneezing
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3
Q

sensory function of repro system

A
  • pain from adnexae - ovaries and fallopian tubes
  • pain from uterus
  • pain from vagina
  • pain from perineum
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4
Q

if structure is in pelvis i.e. body cavity nerve supply from?

A
  • sympathetic
  • parasympathetic
  • visceral afferent
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5
Q

if structure is in perineum i.e. body wall where is nerve supply from?

A
  • somatic motor and somatic sensory
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6
Q

what is above levator ani muscle

A

pelvis

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7
Q

what is below levator ani muscle

A

perineum

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8
Q

uterine cramping and uterine contraction is controlled by

A
  • sympathetic/parasympathetic driven by hormones
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9
Q

pelvic floor muscle contraction is controlled by?

A
  • somatic motor
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10
Q

pain from adnexae is from?

A
  • visceral afferents
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11
Q

pain from uterus is from?

A
  • visceral afferents
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12
Q

pain from vagina is from?

A
  • visceral afferents (pelvic part)/somatic sensory (perineum)
    > different as vagina is both above and below pelvic floor
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13
Q

pain from perineum?

A
  • somatic sensory
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14
Q

peritoneum drapes over superior pelvic organs, so pain from superior aspect of pelvis travel in visceral afferent fibres that run alongside?

A
  • sympathetic fibres
  • enter spinal cord between T11-L2
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15
Q

pain is perceived from superior aspect of pelvic organs as?

A
  • suprapubic
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16
Q

inferior aspect of pelvic organs/not touching peritoneum how does pain travel?

A
  • travels along visceral afferents running alongside parasympathetic fibres
  • enter spinal cord at levels S2, S3, S4
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17
Q

pain from inferior aspect of pelvic organs is percieved where?

A
  • S2, S3, S4 dermatome (perineum)
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18
Q

pain from structures above levator ani - in the pelvis travel how?

A
  • along visceral afferents
  • run alongside parasympaethic fibes
  • enter spinal cord levels at S2, S3, S4
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19
Q

pain from structures below levator ani - in the perineum (body wall) travel how?

A
  • along somatic sensory fibres
  • as part of pudendal nerve
  • enter spinal cord levels S2, S3 and S4
  • localised pain within perineum
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20
Q

sympathetic nerves travel down what?

A
  • sacral sympaethic trunks
  • T11-L2
  • form superior hypogastric plexus
    • provide visceral motor innervation
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21
Q

parasympathetic nerves originate form where?

A
  • originate from sacral outflow (S2,3,4)
  • emerge from spinal roots
  • mix with sympathetics in inferior hypogastric plexus
22
Q

parasympathetic nerves travel in what?

A
  • pelvic splanchnic nerves
23
Q

pain from female repro system - two important spinal cord levels are:

A
  • T11-L2
  • S2-S4
24
Q

peritoneum touches bottom of uterus/sup aspect of vagina

A
25
Q

levator ani separates divisions of what

A
  • pelvis and perineum
  • everything below = perineum
  • everything above = pelvis
26
Q

which pelvic organs touch peritoneum

A
  • uterine tubes, uterus, ovaries
  • travel via sympathetic fibres
  • T11 - L2
27
Q

which pelvic organs are inferior to peritoneum

A
  • cervix, and superior vagina
  • travel via parasympathetic fibres
  • S2, S3 and S4
28
Q

in perineum - ie below level of levator ani - inferior vagina, perineal muscles, glands and skin what is nerve information travelling by?

A
  • somatic sensory information carried back in pudendal nerve
  • to S2, S3 and S4
29
Q

study flow diagram

A
30
Q

spinal cord becomes cauda equina at what level?

A
  • L2 vertebra
31
Q

subarachnoid space ends at level of ?

A
  • S2
32
Q

anaesthetic is injected into which level?

A
  • L3-L4 (L5) region
  • intercristal plane determines levels of L4 spinous process (most superior point on iliac crests) however variety in intercritsal planes and should be careful when doing this
33
Q

epidural needs to pass through which structures?

A
  • interspinous ligament (runs between spinous processes)
  • supraspinous ligament (run sup aspect of spinous processes)
  • ligamentum flavum (makes popping sound)
    -> loss of resistance and has entered epidural space (fat and veins) - bathes spinal roots in anaesthetic
34
Q

spinal anaesthetic: needle passes through?

A
  • supraspinous lig
  • interspinous
  • lig flavum
  • epidural space
  • dura mater
  • arachnoid mater
  • finally reaches SAS (between arachnoid and pia) contains CSF
  • spinal anaesthetic is delivered here into CSF
35
Q

all spinal nerves and their named nerves contain what?

A
  • sympathetic fibres
36
Q

sympathetic fibres supply?

A
  • all arterioles
    > thus blockade to sympathetic fibres blocks sympathetic tone to all arterioles in lower limb causing = vasodilation
37
Q

what is risk of spinal anaesthetic to lower limb?

A
  • vasodilation
  • flushed, reduced sweating, warm lower limb
  • hypotension can be caused - patient should be closely observed during this procedure
38
Q

sympathetic fibres originate from where?

A
  • arise form autonomic control centres of brain
  • exit spinal cord with T1-L2 spinal nerves
  • travel to sympathetic chains/trunks which make up whole vertebral column
  • pass into all spinal nerves and ant and post rami or named nerves
39
Q

below L2 level sympathetic ganglia receive fibres from what level?

A
  • from L2 level via sympathetic chain
  • distribute them via connections w lumbar, sacral and coccygeal spinal nerves
40
Q

the pudendal nerve has what functions

A
  • somatic nerve carrying somatic motor and sensory fibres and is known as nerve of perineum
  • role in motor control of external anal and external urethral sphincters
41
Q

where is pudendal nerve dervied from?

A
  • branch of sacral plexus - S2, S3, S4
42
Q

where is pudendal nerve derived from?

A
  • branch of sacral plexus - S2, S3, S4
43
Q

pudendal nerve exists pelvis via what?

A
  • greater sciatic foramen
  • and passes posterior to sacrospinous ligament (near ischial spine - its attachment site)
  • re-enters pelvis/perineum via lesser sciatic foramen
  • travels in pudenal canal
  • branches to supply structures of perineum
44
Q

the pudendal nerve crosses posteiror to lateral aspect of what?

A
  • sacrospinous ligament
45
Q

what part of pelvis can be used as a landmark for pudendal nerve block?

A
  • ischial spine
46
Q

when is pudendal nerve block administered?

A
  • forceps delivery
  • painful vaginal delivery
  • episiotomy incision
    -> also post delivery for perineal suturing
47
Q

during labour branches of what nerve can be stretched?

A
  • pudendal nerve
48
Q

what fibres and muscle can be torn also during lavour?

A
  • fibres within levator ani (puborectalis)
  • external anal sphincter muscle could be torn
49
Q

1st degree tear during labour

A
  • skin

2nd degree - perineal muscles
3rd degree - partial anal sphincter involvement
4th degree - complete anal sphincter tear and bowel lining and weakened pelvic floor and fecal incontinence

50
Q

what is an episiotomy?

A
  • an incision into skin and perineal muscles
  • incision is posterolateral incision into fat filled ischioanal fossa
  • aim of this incision is to avoid any tearing or incision going towards anal sphincter

Reproduction and Sexual Health (29 decks)

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