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Principles of Anesthesia I > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the four types of neuroaxial anesthesia?

A

Spinal, Epidural, CSE, & Caudal

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2
Q

Which type of neuroaxial anesthesia is typically used in pediatric patients?

A

Caudal

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3
Q

Which surgical procedures are commonly indicated for the use of neuroaxial anesthesia?

A

Lower abdomen, perineum, & lower extremities

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4
Q
  1. How is neuroaxial anesthesia used in thoracic surgery?
A

It is an adjunct to GETA

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5
Q

What mental benefit does central neuroaxial anesthesia provide compared to general anesthesia?

A

Great mental alertness

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6
Q

When using central neuroaxial anesthesia, how can propofol be utilized if a patient is moving too much?

A

Can be used to sedate patient. 25-100mcg/kg/min. Dr. Tubog says he always starts at 100mcgs and goes up.

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7
Q

How does neuroaxial anesthesia affect the post-anesthesia care unit (PACU) discharge process?

A

Quicker PACU discharge

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8
Q

List three post-operative benefits of neuroaxial anesthesia over general anesthesia.

A

Quicker to eat, void, & ambulate. Also help with post op pain.

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9
Q

What should be considered when performing neuroaxial anesthesia on a patient with spinal column deformities?

A

Risks vs. Benefits. How you will navigate around/through the deformities to reach the desired area.

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10
Q

Why is it important to evaluate a patient’s normal neuro-function before administering neuroaxial anesthesia in cases of preexisting spinal cord diseases?

A

So we know what the baseline is and if we caused damage

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11
Q

How should a clinician proceed if a patient has a history of chronic headache or backache and needs neuroaxial anesthesia?

A

Establish baseline. Ask if they are experiencing a backache, or headache before proceeding. Determine if another form of anesthesia would be more beneficial.

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12
Q

What is the recommended course of action if a spinal or epidural procedure is unsuccessful after three attempts?

A

Find a friend. Stop attempting.

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13
Q

What are the coagulation-related absolute contraindications for neuroaxial anesthesia?

A

INR >1.5
Platelets < 100,000 (look at trends)
Nagelhout 2x the normal (PT, aPTT, bleeding time)
Patient Refusal

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14
Q

Explain why evidence of infection at the dermal puncture site is a contraindication for neuroaxial anesthesia.

A

Could introduce the infection to the CSF, blood stream, body

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15
Q

What criteria must be met to consider severe/critical valvular heart disease as an absolute contraindication for neuroaxial anesthesia?

A

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

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16
Q

What are the components of the clinical triad of aortic stenosis? Which one is the worst?

A

Angina, Syncope, HF
HF is the worst - (New York classification 4)

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17
Q

What are the two main parts into which each vertebra (except CI) is divided?

A

The anterior segment (the body) and the posterior segment (the vertebral arch).

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18
Q

Which structures connect the anterior and posterior segments of a vertebra?

A

The lamina and pedicle.

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19
Q

What critical space is formed by these connections and what does it house?

A

The vertebral foramen, which houses the spinal cord, nerve roots, and the epidural space.

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20
Q

Where do the transverse processes and spinous processes protrude?

A

The transverse processes protrude laterally, and the spinous processes protrude posteriorly.

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21
Q

What is the functional significance of spinous and transverse processes?

A

Muscles attach to these areas, stabilizing and supporting the spine. The spinous process also serves as a landmark for the midline of the back.

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22
Q

How do the spinous processes of lumbar vertebrae differ from those of thoracic and cervical vertebrae?

A

The spinous processes in lumbar vertebrae stick out directly backward (posterior), while those in cervical and thoracic vertebrae tilt downward (caudal).

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23
Q

Why is it easier to reach the epidural and intrathecal spaces in lumbar vertebrae compared to cervical and thoracic vertebrae?

A

Because lumbar vertebrae’s spinous processes stick out directly backward, making the spaces around the spinal cord more accessible.

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24
Q

What are the primary functions of intervertebral discs and foramina?

A

Intervertebral discs act as shock absorbers between vertebrae, and intervertebral foramina are openings where spinal nerves exit the spine.

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25
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
26
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.
27
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.
28
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.
28
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.
29
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.
30
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.
31
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
32
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.
33
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.
34
Where exactly is the epidural space located within the spinal canal, and what does it contain?
The epidural space is located between the outermost dura mater and the inner walls of the vertebral canal. It contains fat, small blood vessels, and lymphatics.
35
What is the subdural space, and why is it considered a potential space?
The subdural space is a potential space located between the dura and arachnoid mater. It's termed "potential" because it only becomes a space when pathological processes, such as bleeding or fluid collection, force separation of the dura and arachnoid mater.
36
What fills the subarachnoid space, and what are its primary functions
The subarachnoid space is filled with cerebrospinal fluid (CSF). It cushions the spinal cord, serves as a shock absorber, and helps in metabolite exchange between the blood and central nervous system.
37
What are the anatomical boundaries of the epidural space, and how are they defined?
The epidural space is bordered: - Anteriorly by the posterior longitudinal ligament and intervertebral discs. - Laterally by the pedicles and intervertebral foramina. - Posteriorly by the ligamentum flavum and the vertebral laminae.
38
From which anatomical landmark (cranially) to which (caudally) does the epidural space extend?
The epidural space extends from the foramen magnum (where the spinal cord begins at the base of the skull) to the sacral hiatus (near the end of the vertebral column).
39
What clinical relevance does the location of the epidural space have concerning the administration of epidurals?
Knowledge of the exact boundaries of the epidural space is critical for the safe and effective administration of epidural anesthesia, which involves the injection of anesthetics into the epidural space for pain relief during surgeries or childbirth.
40
What forms the anterior boundary of the epidural space, and why should it be avoided during epidural procedures?
The anterior boundary is formed by the posterior longitudinal ligament covering the vertebral bodies and intervertebral discs. Avoiding this boundary is critical because penetration may lead to severe complications like bleeding or damage to the vertebral structures.
41
What defines the lateral boundaries of the epidural space?
The lateral boundaries are defined by the pedicles of the vertebrae and intervertebral foramina through which spinal nerves exit.
42
Describe the structures forming the posterior boundary of the epidural space.
The posterior boundary is formed by the ligamentum flavum, which connects the laminae of adjacent vertebrae, and the vertebral arches.
43
Why might the ligamentum flavum be significant when performing an epidural procedure?
The ligamentum flavum is a critical landmark during epidural procedures. When the needle penetrates this ligament, a change in resistance is felt, indicating proximity to the epidural space.
44
What are the contents of the epidural space?
The epidural space contains fat, venous plexuses, lymphatics, segmental arteries, and spinal nerve roots.
45
How does neuraxial anesthesia effect the parasympathetic and sympathetic system?
Parasympathetic: Increased activity, d/t sympathetic being blocked. Becomes more dominant. Sympathetic: Decreased activity of sympathetic nerves.
46
What are the resulting changes of an unopposed vagal tone?
Relaxes Sphincters Increases Peristalsis Small, contracted gut with active peristalsis (20% incidence of N/V) Increased GI blood flow Reduces postoperative incidence of ileus in abdominal surgery
47
At what level of block is the Urinary sphincter tone relaxed?
At a sympathetic blockade above T10
48
Name the Meningeal layers from outermost to innermost
Epidural, Dura Mater, Arachnoid layer, Subarachnoid space, & Pia Mater
49
What key space is considered a potential space and where is its location?
The subdural space Located between the dura mater & arachnoid mater
50
What is Plica Mediana Dorsalis?
Band of connective tissue located between the ligamentum flavum & dura mater. Its existence is controversial & not confirmed
51
How many pairs of spine nerves are there? How many does each section have?
31 pairs total. Cervical - 8 Thoracic - 12 Lumbar - 5 Sacral - 5 Coccyx - 1
52
What factors effect the block height of a spinal
Controllable: Baricity, Patient Position, Dose, Site of Injection Non-controllable: Volume of CSF (lower the CSF the higher the height of the block) DO NOT EFFECT: Barbotage, Speed of Injection, Orientation of Bevel, Addition of Vasoconstrictor, Gender
53
What are the factor that effect height of an epidural
Significantly Controllable: LA Volume, Level of Injection, Dose Significantly Non-controllable: Pregnancy & Old Age Small Effect Controllable: LA concentration, Patient Position Small Effect Non-controllable: Height of patient No Affect on Spread Controllable: Additives, Direction of the Bevel, Speed of Injection
54
T5-L2 provide what areas with innervation?
GI
55
Diaphragm is mainly innervated by what nerve?
C4
56
T3 & T4 are associated with what organ?
The heart
57
T8 is associated with what organ 
The stomach
58
T4 & T5 are associated with what?
Esphogus
59
T8 through T 11 is associated with what?
Gallbladder & Liver
60
T 11 is associated with? T11-L1 is associated with?
Colon Bladder
61
T10 is associated with? T10-L1
T10: Small intestine L1: Kidney & Testes
62
In what order does LA inhibition of peripheral nerves occurs?
1. B fibers 2. C fibers 3. Small diameter A fibers (delta & gamma) 4. Large diameter A fibers (alpha & beta)
63
List in order of highest blood concentration to lowest for uptake of LA
Intravenous Tracheal Intercostal Caudal Epidural Brachial Sciatic SQ
64
Dose for bupivacaine 0.5-0.75% at T10, T4; Onset, Duration (Plain) & w/ Epi
T10: 10-15mg T4: 12-20mg Onset: 4-8 mins Duration: Plain - 130-220 mins/ +Epi +20-50%
65
Dose of levobupivacaine 0.5%, dose for T10 & T4, onset, duration (plain)
T10: 10-15mg T4: 12-20mg Onset: 4-8 mins Duration: 140-230 mins
66
Dose for ropivacaine 0.5-1% pain at T4 and T10, onset, duration (plain)
T4: 18-25mg T10: 12-18mg Onset: 3-8 mins Duration (plain): 80-210min
67
Dose for 2-chloroprocaine 3% at T10 & T4, onset, duration (plain)
T10: 30-40mg T4: 40-60mg Onset: 2-4 mins Duration: 40-90 mins
68
Dse for tetracaine .5-1% at T10 and T4, onset, duration(plain), duration w/ Epi
T10: 6-10mg T4 : 12-16mg Onset: 3-5 mins Duration (plain): 90-120 mins Duration w/ Epi: +20-50%
69
What is the 1st DOC for hypotension? What is the 2nd? (Epidural)
2-Chloroprocaine is the 1st choice & Lidocaine is the 2nd Choice
70
What is the dose for sufentanil for intrathecal, epidural, an epidural infusion?
Intrathecal: 5-10mcg Epidural: 25-50mcg Epidural Infusion: 10-20mcg/hr
71
dose for fentanyl for intrathecal, epidural, epidural infusion?
Intrathecal: 10-20mcg Epidural: 50 -100mcg Epidural infusion: 25 -100mcg/hr
72
Dose for hydromorphone for epidural and epidural infusion?
Epidural:0.5-1mg Epidural infusion: 0.1-0.2mg/hr
73
Dose for meperidine for intrathecal, epidural, & epidural infusion?
Intrathecal: 10mg Epidural: 25-50mg Epidural infusion: 10-60mg/hr
74
Dose for Morphine intrathecal, epidural, and epidural infusion?
Intrathecal: 0.25-30mg Epidural: 2-5mg Epidural infusion: 0.1-1mg/hr
75
what are the signs and symptoms of an epidural hematoma?
Lower extremity weakness, numbness. Lower back pain. Bowel and bladder dysfunction.
76
What is the treatment for an epidural hematoma?
Surgical decompression with in eight hours to optimize recovery chances.
77
What is the treatment for postural puncture headache?
Treatment includes bedrest, NSAIDS, caffeine, epidural blood patch, or sphenopalatine ganglion block
78
What is a spenopalatine ganglion block (SPG block)?
soak a cotton swab with LA 1-2% lidocaine or use 0.5% bupivacaine. with the patient’s head tilted back, insert the swab into the nose towards the back of the throat wall. Leave it there for about 5 to 10 minutes. This can quickly reduce headache symptoms caused by post procedure puncture.
79
what is Beer-Lambert law?
it is the laws of absorption. Relates the transmission of light through a solution to the concentration of the solute in a solution. light absorption must be measured at wavelength that are proportional to the number of solutes. Light is lost as it goes through a solution. High absorption equals high saturation. Low absorption equals low saturation. Solution: blood. Solute: hgb aka concentration. Low solution has low absorption of light. High concentration (more solutes) wavelength going through are reduced/light is blocked/high absorption.
80
what is the wavelength of red light?
660nm
81
what is the wavelength of infrared light?
940nm
82
Deoxyhemoglobin absorbs more what kind of light than oxyhemoglobin?
Red light
83
Oxy hemoglobin absorbs more what type of light then Doxy hemoglobin?
Infrared
84
What are Korotkoff Sounds & phases?
hey series of audible frequencies used to measure BP. Phase 1: the most turbulent/audible (SBP) Phase 2: softer and longer sounds Phase 3: crisper and louder sounds Phase 4 softer and muffled sounds Phase 5: sounds disappear (DBP)
85
What is the equation to find Mean BP
DP + 1/3 (SP-DP)

Principles of Anesthesia I (3 decks)

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