Exam 1 Flashcards
What are the four types of neuroaxial anesthesia?
Spinal, Epidural, CSE, & Caudal
Which type of neuroaxial anesthesia is typically used in pediatric patients?
Caudal
Which surgical procedures are commonly indicated for the use of neuroaxial anesthesia?
Lower abdomen, perineum, & lower extremities
- How is neuroaxial anesthesia used in thoracic surgery?
It is an adjunct to GETA
What mental benefit does central neuroaxial anesthesia provide compared to general anesthesia?
Great mental alertness
When using central neuroaxial anesthesia, how can propofol be utilized if a patient is moving too much?
Can be used to sedate patient. 25-100mcg/kg/min. Dr. Tubog says he always starts at 100mcgs and goes up.
How does neuroaxial anesthesia affect the post-anesthesia care unit (PACU) discharge process?
Quicker PACU discharge
List three post-operative benefits of neuroaxial anesthesia over general anesthesia.
Quicker to eat, void, & ambulate. Also help with post op pain.
What should be considered when performing neuroaxial anesthesia on a patient with spinal column deformities?
Risks vs. Benefits. How you will navigate around/through the deformities to reach the desired area.
Why is it important to evaluate a patient’s normal neuro-function before administering neuroaxial anesthesia in cases of preexisting spinal cord diseases?
So we know what the baseline is and if we caused damage
How should a clinician proceed if a patient has a history of chronic headache or backache and needs neuroaxial anesthesia?
Establish baseline. Ask if they are experiencing a backache, or headache before proceeding. Determine if another form of anesthesia would be more beneficial.
What is the recommended course of action if a spinal or epidural procedure is unsuccessful after three attempts?
Find a friend. Stop attempting.
What are the coagulation-related absolute contraindications for neuroaxial anesthesia?
INR >1.5
Platelets < 100,000 (look at trends)
Nagelhout 2x the normal (PT, aPTT, bleeding time)
Patient Refusal
Explain why evidence of infection at the dermal puncture site is a contraindication for neuroaxial anesthesia.
Could introduce the infection to the CSF, blood stream, body
What criteria must be met to consider severe/critical valvular heart disease as an absolute contraindication for neuroaxial anesthesia?
AS < 1cm2 or MS < 1cm2
Clinical Triad: Angina, Syncope, HF with (EF < 30-40%)
HSS
Operation > Duration of LA
Increased ICP
Death Spiral: Decreased SVR, Hypotension, decreased CO
What are the components of the clinical triad of aortic stenosis? Which one is the worst?
Angina, Syncope, HF
HF is the worst - (New York classification 4)
What are the two main parts into which each vertebra (except CI) is divided?
The anterior segment (the body) and the posterior segment (the vertebral arch).
Which structures connect the anterior and posterior segments of a vertebra?
The lamina and pedicle.
What critical space is formed by these connections and what does it house?
The vertebral foramen, which houses the spinal cord, nerve roots, and the epidural space.
Where do the transverse processes and spinous processes protrude?
The transverse processes protrude laterally, and the spinous processes protrude posteriorly.
What is the functional significance of spinous and transverse processes?
Muscles attach to these areas, stabilizing and supporting the spine. The spinous process also serves as a landmark for the midline of the back.
How do the spinous processes of lumbar vertebrae differ from those of thoracic and cervical vertebrae?
The spinous processes in lumbar vertebrae stick out directly backward (posterior), while those in cervical and thoracic vertebrae tilt downward (caudal).
Why is it easier to reach the epidural and intrathecal spaces in lumbar vertebrae compared to cervical and thoracic vertebrae?
Because lumbar vertebrae’s spinous processes stick out directly backward, making the spaces around the spinal cord more accessible.
What are the primary functions of intervertebral discs and foramina?
Intervertebral discs act as shock absorbers between vertebrae, and intervertebral foramina are openings where spinal nerves exit the spine.
How is the intervertebral foramen formed and what happens when the intervertebral discs degenerate?
The anterior side of the foramen is formed by the vertebral body and intervertebral disc, and the posterior side by the facet joints. Disc degeneration narrows the foramina, which can press on spinal nerves causing pain, numbness, or weakness
Why might the side-lying position be harder to learn or perform?
Due to structural complexity and alignment of spinal segments, it could be more challenging to identify specific anatomical landmarks and positions in a side-lying posture.
What are the subarachnoid and epidural spaces, and how are they positioned relative to the meningeal layers covering the spinal cord?
The subarachnoid space is situated between the arachnoid mater and the pia mater. It is filled with cerebrospinal fluid (CSF) which cushions the spinal cord.
The epidural space lies outside the dura mater and inside the vertebral canal. It contains fat and small blood vessels, providing a cushioning layer for the structures within the spinal canal.
Can you list and order the meningeal layers from outermost to innermost?
The meningeal layers are, from outermost to innermost: dura mater, arachnoid mater, and pia mater.
What is the epidural space, and where is it located relative to the dura mater?
The epidural space is located outside the dura mater within the spinal canal. It lies between the dura mater and the vertebral wall.
What are the distinguishing features of the dura mater?
The dura mater is the tough, outermost membrane of the meninges. It provides a durable protective covering for the spinal cord and brain.
Where is the arachnoid mater situated among the meningeal layers?
The arachnoid mater is the middle layer of the meninges, positioned between the dura mater and the pia mater.
What is contained within the subarachnoid space, and what is its function?
.
The subarachnoid space contains cerebrospinal fluid (CSF) which cushions the spinal cord and brain, providing a protective fluid buffer and helping in the removal of metabolic waste
What is spinal anesthesia, and in which space is it administered?
Spinal anesthesia is a type of regional anesthesia involving the injection of anesthetics into the subarachnoid space, often between the lumbar vertebrae, to provide numbness and pain relief from the waist down.
How does the pia mater relate to the spinal cord?
The pia mater is the innermost meningeal layer, closely adherent to the surface of the spinal cord. It provides structural support and helps in the supply of blood to the spinal cord.