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Regional 540 - PM > epidural, combined spinal/epidural > Flashcards

epidural, combined spinal/epidural Flashcards

0
Q

what determines the level of anesthesia with an epidural?

A

VOLUME, no such thing as overdosing an epidural

diffusion dependent

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1
Q

LA spreads __ for epidural

A

cephalad

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2
Q

T/F - any procedure that can be done with a spinal can also be done with epidural

A

true

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3
Q

What’s special about a Touhy?

A

has the most curvature 30*, therefore less likely to pierce arachnoid and enter subarachnoid

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4
Q

What size catheter should you use in the epidural?

A

2 sizes SMALLER than the needle

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5
Q

the majority of the population have loss of resistance between __ - __ cm

A

4-6 cm

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6
Q

the paramedian/lateral approach does not have to pass through what two layers?

A

supraspinous ligament

intraspinous ligament

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7
Q

epidural insertion site for TAH and low abdominal surg

A

L2-L3

2-3 kids is just about right

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8
Q

epidural insertion site for upper abdominal surg

A

T8-T10

ribs 8-10 are the “false” ribs in humans

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9
Q

epidural insertion site for thoracic surg

A

T4-T5

“Thora” has five letters

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10
Q

epidural insertion site for chronic pain therapy or surgery of the arms, shoulders, or upper chest

A

C7-T1

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11
Q

__ affects the density of the block

A

concentration

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12
Q

__ affects the spread of LA throughout the epidural space

A

volume

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13
Q

do blocks occur faster in cephalad or caudad direction?

A

cephalad

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14
Q

what is the “take home” volume per dermatomal segment?

A

1-2 ml per dermatome

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15
Q

where are the opioid receptors in the spinal cord?

A

substantia gelatinosa

16
Q

how much more opioid must you give epidural vs. IV?

spinal vs. Epidural

A

Epidural = IV dose

10x epidural compared to intrathecal

morphine 200 mcg spinal, but 2000 mcg epidural or IV

17
Q

the time of maximum spread of LA for epidural?

A

10-25 minutes

18
Q

when sensory regression of 1-2 dermatomes occurs, give a dose of __ - __ the initial dose

A

30-50%

19
Q

number one complication of epidural

A

backache

20
Q

when should you give epidural morphine?

A

AFTER BABY DELIVERED AND CORD CLAMPED due to resp depression

21
Q

after age __, anatomy changes make caudal site identification difficult and spread of LA less reliable

A

12

slide 30

22
Q

how much volume for caudal anesthesia for sacrum?

how much volume for caudal for T10?

A

10-15 ml

20-30 ml

23
Q

what is in your test dose for an epidural?

A

3 ml’s of 1.5% lido and 1:200,000 epi

equals 45 mg lido and 15 mcg epi total

24
Q

Epidural final site of action

A

Ventral and dorsal rootlets, cord

25
Q

Protein binding gives you

A

Longer duration

26
Q

In adults the dura ends around

In peds the dura ends around

A

L2 aduLts

S4 pedS

27
Q

Why does the caudal approach have such a high failure rate?

A

False passages

Regional 540 - PM (8 decks)

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