Exam 1 - Neuraxial Principles (Part 3) Flashcards
What mechanism causes hypothermia/shivering?
The redistribution of blood flow and heat to the periphery due to vasodilation. usually with hyper/hypobaric solutions
What equipment should always be in the operating room (except for pediatric cases)?
Bair hugger
Will a Bair hugger work for neuraxial anesthesia?
Not really
What drug can prevent/treat neuraxial shivering?
Ondansetron (Zofran) 4-8 mg
Which 2 monitoring equipment do you absolutely need during neuraxial anesthesia administration?
BP cuff and pulse ox
If you gave a lot of versed in pre-op, what else might the patient need?
Oxygen
If you need to convert to general anesthesia, what materials do you need to have prepared?
- Favorite blade
- ETT (2 sizes) with stylet and 10cc syringe attached
- Drugs (Fentanyl, Lidocaine, Propofol)
- Optional: tongue depressor, oral airway
What is a failed block?
For some reason, the anesthetic doesn’t set in or is not reaching the desired level of block. Will need to convert to General.
What are other reasons to convert to GA?
- High Spinal
- LAST
- Anaphylaxis
- Severe CV collapse
- Case exceeds duration of local anesthetic
What is the treatment for Local Anesthetic Systematic Toxicity?
Intralipids 20% 1.5 mL/kg Bolus followed by 0.25 mL/kg drip
While waiting for intralipids 20% to arrive from the pharmacy, what drug can you give instead that may buy you some time?
Propofol (1%)
Among anesthesia meds, what type of drug has common allergy-related issues?
Muscle relaxants (Rocuronium)
Allergy to LAs are rare, but if one does occur, the LA was probably an _____.
Ester
What is the ester derivative?
PABA (Para-Aminobenzoic Acid)
How can you tell if the LA is wearing off during the case?
The patient will say it hurts
A patient assessment for neuraxial anesthesia is the same as general, but what is especially important to ask about?
Anticoagulants and Antiplatelets
- What are they taking, when did they stop or are they still taking them, etc?
When obtaining informed consent, what are the risks of spinal anesthesia that the patient needs to be aware of?
- Hypotension
- Headache
- Hematoma
Dermatome level: C-section/upper abdominal surgeries
T4
Dermatome level: urologic/gynecologic/lower abdominal surgeries
T6
Dermatome level: Testicular procedures
T8
Dermatome level: Vaginal delivery/uterine/hip procedure/tourniquet/TURP
T10
Dermatome level: Thigh/lower leg/knee surgery
L1
Dermatome level: Foot/Ankle surgery
L2
Dermatome level: Penis
S2
Dermatome level: Scrotum
S3
Dermatome level: Peri-anal/anal surgery (“saddle block”)
S2-S5
Spinal Block Set-Up Tray
Which type of spinal needle increases the incidence of post-dural puncture headache?
Cutting
Which type of spinal needle will have a more noticeable “pop”?
Non-cutting/Pencil-point
Besides decreased incidence of PDPH and noticeable “pop”, what is another advantage of non-cutting/pencil-point needles?
They “drag” fewer contaminants into subnormal tissue.
What is the risk of PDPH using a non-cutting needle?
< 1%
Know the steps of a Spinal procedure.
When confirming placement during a spinal, how do you differentiate between CSF and the LA used to numb the insertion site?
CSF will be warm
What is one method to improve the flow of CSF after inserting the spinal needle?
Rotate the needle 360 degrees.
If the LA isn’t hyperbaric, how will you know you’re aspirating CSF without the “swirl”
The volume of the syringe will still increase.