Exam 1 Part 5 Flashcards
MAC according to the ASA responsibilities include:
- same as general standards
- offer psychological support and comfort
MAC technique requires the use of oxygen. True or false.
False
Monitoring MAC
Same as general
- oxygenation
- circulation
- ventilation
- temperature
Capnography necessary for only ventilated patient. True or false.
True
Neuraxial anesthesia, like spinal and epidural anesthesia is most commonly performed under MAC or awake?
awake
Neuraxial preparation
DAMOS
- sedation
- oxygen
- monitors
- drugs
- airway
ABSOLUTE neuraxial contraindications
- infection at the site of infection
- patient refusal
- coagulopathy
- hypovolemia
- increased ICP
- severe aortic or mitral stenosis
Relative neuraxial contraindications
- sepsis
- uncooperative patient
- neurologic deficit
- severe spinal deformity
Controversial neuraxial contraindications
Prior back surgery
Inability to communicate
Complicated surgery
Surgeon preference
Iliac crest crosses body of ___
L4
T7 - T8 interspace at ____ of ______.
base
scapula
Coumadin
Need PT/INR
Plavix
Need 7 days
spinal ligaments (3)
- ligamentum flavum
- supraspinous ligament
- interspinous ligament
T6 dermatome
xiphoid process
Block of posterior nerve roots interrupts ______ and _____ sensation.
somatic
visceral
Blockade of anterior nerve roots prevent ____ and ____ outflow.
Motor
autonomic
Somatic blockade interrupts painful stimuli and abolishes skeletal muscle tone.
Results in _____ blockade.
differential blockade
Differential blockade: mainly _____ at site of injection.
2 dermatomes away ____ blockade
2 dermatomes away from that, _____ blockade
- motor
- sensory
- sympathetic (test with ice)
Autonomic blockade:
Sympathetic response originating from ____ region.
Spans T __ to ___
thoracolumbar
T1 - L2
Parasympathetic is from _____ region.
Will NOT block vagus since vagus from brainstem
craniosacral
Cardiovascular blockade results in
decrease BP, HR, contractility, vasomotor tone
inhibit cardiac accelerators at T1-T4
Epidural results in urinary retention. True or false?
True
Advantages of epidurals:
- Decreased risk of post dural puncture headache (later)
- Decreased risk of hypotension because of slower onset
- greater control over intensity of sensory block
- greater control over motor block
Disadvantages of epidural
- slower onset time
- block is less dense
Epidural test dose:
- Volume:
- Concentration:
Why test dose?
- 3 ml of 1.5% lidocaine with 1:200,000 epi (5mcg/ml)
To ensure we are in the right space
Epidural increase in HR indicates what during a test dose?
The epidural is in the vein/artery.
If the patient complains cannot feel legs right after giving test dose, indicates what?
the epidural is in the spinal region
Local agent used in epidural has to be ______ ______.
PRESERVATIVE FREE
Spinal anesthesia pharmacology
- preservative free
- add vasoconstrictors and/or opioids
- baricity
CSF specific gravity is _____ to _____.
1.003-1.008
To make hypobaric solution add ____ which is ____ than CSF.
To make hyperbaric solution add _____ which is ____ than CSF.
sterile water, lighter
glucose, heavier
Complications of neuraxial anesthesia:
- High neural block
- CARDIAC ARREST
- Urinary retention
- Inadvertent total spinal anesthesia
- POSTDURAL PUNCTURE HEADACHE when dura is breached due to decrease pressure of CSF.
- neuro injury
Postdural puncture headache
Treatment?
- onset 12 hours to several days after
- lie down, in the dark
- drink lots of Mt. Dew (caffeine stimulates CSF production)
- Conservative–NSAIDS, Tylenol, fluid, caffeine
- EPIDURAL BLOOD PATCH
Caudal anesthesia
Sacral hiatus creased by unfused s4-5
common in kids for procedures below diaphragm
Place epidural at ___-____.
L3 - L4
