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SRNAClinical Practicuum Prep > EPIDURAL ANESTHESIA > Flashcards

EPIDURAL ANESTHESIA Flashcards

1
Q

Risk factor for cauda equina usually with undiagnosed?

A

Undiagnosed spinal stenosis (detected during

evaluation of the new neurologic deficits) was a risk factor for cauda equina syndrome

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2
Q

Cutaneous Landmarks : Fifth finger
Segmental level is ____
significance________

A

Fifth finger
C8
All cardioaccelerator fibers (T1-T4) blocked

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3
Q

Cutaneous Landmarks : Nipple line
Segmental level is ____
Type of operation_______
Significance______

A

T4-T5
Upper abdominal
Possibility of cardio-accelerator blockade

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4
Q

T4-T5 is at the

A

nipple line

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5
Q

Cutaneous Landmarks : Tip of xiphoid
Segmental level is ____
Type of operation_______
Significance_____

A

T6
Lower Abdominal
Splanchnics (T5-L1) blocked

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6
Q

Cutaneous Landmarks : Umbilicus
Segmental level is ________
Type of operation_______
Significance________

A

T10
Hip
Sympathetic blockade to lower extremities

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7
Q

Cutaneous Landmarks : Lateral aspect of foot
Segmental level is ________
Type of operation_______
Significance________

A

S1
Leg and foot
No lumbar sympathectomy

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8
Q

Cutaneous Landmarks : Lateral aspect of foot
Segmental level is ________
Type of operation_______
Significance________

A

Perineum S2-S4 Hemorrhoidectomy

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9
Q

Termination of the spinal cord in adult is

A

L1

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10
Q

The dural sac terminates at

A

S2

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11
Q

When is paramedian approach recommended for Epidural anesthesia?

A

When at the THORACIC level T1 - T7 to bypass ANGLED spinous process

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12
Q

At levels below T7_________

A

Needle insertion becomes similar to L2-L3

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13
Q

Lumbar Spine The epidural space is________

A

widest, i.e., 5-6 mm.

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14
Q

Lumbar Spine Needle insertion below

A

L1 (in adults) avoids the spinal cord.

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15
Q

Lumbar Spine The ligamentum flavum is

A

thickest in the midline in the lumbar area.

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16
Q

Lumbar Spine: The spinous processes

A

have only slight downward angulation.

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17
Q

Lumbar Spine The epidural veins are

A

prominent in the lateral portion of the epidural space.

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18
Q

Thoracic Spine

The epidural space is__________

A

3-5 mm in the midline, narrow laterally.

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19
Q

Thoracic Spine The ligamentum flavum is

A

thick but less so than in the midlumbar region.

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20
Q

Thoracic Spine The spinous processes have

A

extreme downward angulation; the paramedian

approach is recommended.

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21
Q

Cervical Spine
The epidural space is_______
The ligamentum flavum is_____
The spinous process at C7 is

A

narrow, only 2 mm at C3-6
thin.
almost horizontal.

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22
Q

Vertebra prominens level

A

C7

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23
Q

Root of scapular spine level

A

T3

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24
Q

Inferior angle of scapula level

A

T7

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25
Q

Intercristal line level

A

L3, 4

26
Q

Posterior superior iliac spine

A

S2

27
Q

The major sites of action of epidurally injected local anesthetics are

A

The spinal nerve roots, where the dura is relatively thin.

28
Q

How does the addition of vasoconstriction help local anesthetics?

A

The addition of vasoconstricting agents reduces blood flow in the richly vascularized epidural space, reducing systemic absorption; because more of the drug remains in Close to the nerve, the onset of block is quicker and the duration of action is longer.

29
Q

Complications of Epidural

A

Spinal hematomas, Cauda Equina, meningitis, epidural abscess.

30
Q

Local anesthetic dose may be calculated by the following formula:

A

dose equals 1 to 1.5 mL of local anesthetic agent per segment blocked

31
Q

When Epidural start regressing

A

A second dose of approximately 50% of the initial dose will maintain the original level of anesthesia if injected when the blockade has regressed 1 or 2 dermatomes

32
Q

How to give a 2nd dose?

A

A second dose of approximately 50% of the initial dose will maintain the original level of anesthesia if injected when the blockade has regressed 1 or 2 dermatomes

33
Q

The addition of epinephrine can prolong the duration of lidocaine nerve block by

A

up to 50%.

34
Q

Epidural Space

The epidural space may be approached using a_____or _______insertion.

A

midline or a paramedian needle

35
Q

How do you identify the EPIDURAL SPACE?

A

The epidural space is identified by the passage of the

needle from an area of high resistance (ligamentum flavum) to an area of low resistance (epidural space).

36
Q

After the needle is positioned in the ligamentum flavum,

A

a syringe with a freely movable plunger is attached, and continuous pressure is applied to the plunger.

37
Q

If the needle is positioned correctly in the ligament,

the syringe

A

should not inject when pressure is applied to the plunger.

38
Q

As the needle passes into the epidural space,

A

a sudden loss of resistance in the plunger will be felt, and the air or fluid will easily inject. At this point, a flexible
nylon catheter may be advanced 3 to 4 cm through the needle into the epidural space to allow repeated and incremental injections.

39
Q

Accurately identify the level of the vertebrae as well as to estimate the depth of the epidural space

A

Pre-insertion ultrasound imaging has been demonstrated

40
Q

A test dose of is then injected, An

A

3 mL of local anesthetic solution (typically lidocaine,
1.5%) containing 1:200,000 epinephrine and the patient is
observed for signs of intravascular, subdural, or subarachnoid injection.

41
Q

After the test dose inserted How do you assess intravascular, subdural or subarachnoid?

A

increase in systolic blood pressure of at least 15 mm Hg or an increase in heart rate of at least 10 beats/min represents intravascular injection, whereas a change in lower extremity sensation (with or without a decrease
in blood pressure) denotes subdural or subarachnoid injection.

42
Q

Extreme upward angulation required for

A

Midthoracic region

43
Q

What is the widest part of the epidural space?

A

L2 is thought to be the widest part of the epidural space, measuring 5 to 6 mm at this level.

44
Q

The spinal cord begins at the level of the foramen

A

magnum and ends below as the conus medullaris.

45
Q

At birth, the cord extends to

A

L3, but it moves to its adult position at the lower border of L1 by age 1 year.

46
Q

The spinal meninges are three individual membranes that surround the spinal cord

A

Dura, Arachnoid, Pia

47
Q

The dura is a ______layer

A

Tough

48
Q

THin and AVASCULAR

A

ARACHNOID

49
Q

MIddle membrane closely attached to the dura

A

Arachnoid

50
Q

Thin Layer and HIGHLY VASCULAR

A

PIA

51
Q

The space between the arachnoid and pia is the

A

subarachnoid space.

52
Q

Meninges layer from outer to inner

A

Dura, Arachnoid, Pia

53
Q

From closer to spinal cord to out

A

Pia - Arachnoid - Dura

54
Q

SIFED-ASP order of ligaments

A

Supraspinal -> Interspinal –> Flavum , ligamentum –> Epidural -> Dura –> Arachnoid –> Subarachnoid –> Pia

55
Q

The strongest of the ligaments

A

The ligamentum flavum,

56
Q

Blood Supply

The spinal cord is supplied by Throughout their length,

A

one anterior spinal artery and two posterior

spinal arteries.

57
Q

Blood Supply

The three spinal arteries receive contributions from

A

radicular branches of intercostal arteries.

58
Q

The most caudal medullary artery is usually ______

A

the largest, the arteria medullaris magna anterior (artery of Adamkiewicz).

59
Q

The MEDULLARY MAGNA ANTERIOR (artery of Adamkiewicz) artery has a variable origin along the spinal cord, arising
in__________15% of patients,
in _________60%, and
in _________ 25%.

A

between T5 and T8
between T9 and T12
between L1 and L5

60
Q

Primary ligaments that provide vertebral column stability by binding the vertebral bodies.

A

The anterior and posterior longitudinal ligaments

SRNAClinical Practicuum Prep (21 decks)

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