Exam 1 Spinal & Epidural Neuraxial Anesthesia [5/28/24] Flashcards
What cannot be given through the spinal?
Reglan and Zofran `
3
What are the clinical Indications for neuroaxial anesthesia?
- Surgical procedures involving the lower abdomen, perineum, and lower extremities
- Orthopaedic surgery [alot of spinals]
- Vascular surgery on the legs
- Thoracic surgery (adjunct to GETA) [usually epidurals]
S5
What are the 6 benefits for neuraxial anesthesia?
Reduces the following:
1. Postoperative ileus
2. thromboembolic events
3. PONV
4. Respiratory Complications
5. Bleeding
6. Narcotic Usage
S6
List the other benefits of neuraxial anesthesia.
- Great mental alertness
- Less urinary retention*
- Quicker to eat, void, and ambulate
- Avoid unexpected overnight admission from complications of general anesthesia
- Quicker PACU discharge times*
- Preemptive anesthesia
- Blunts stress response from surgery
S7
If using neuraxial anesthesia, and the pt needs to be put to sleep but needs to maintain respiratory drive what can be administered?
- Propofol
- 100-300 mcg/kg
S7
What are the relative contraindication for neuroaxial anesthesia
- Deformities of spinal column [issues w/positioning]
- Preexisting disease of the spinal cord [residual weakness]
- Multiple Sclerosis, post polio syndrome
- Chronic headache/backache
- Inability to perform SAB/Epidural after 3 attempts
S8
Why are chronic headaches/backaches a relative CI for neuroaxial anesthesia?
- A complication of neuroaxial anesthesia is post-dural puncture heacache.
- if pt has backpain, and we are sticking needes in the back it might worsen the pain
S8
What are the absolute CI for neuroaxial anesthesia?
- Coagulopathy
- Patient refusal
- Evidence of dermal site infection
- known coag disoder or on anticoagulants
- Severe or critical valcular heart disease
- HSS [idiopathic hypertrophic subaortic stenosis]
- Operation >duration of LA
- Increased ICP
- Severe CHF
Contraindicated Patients Don’t Seem Happy Or Invincible Systematically
S9-10
What are the coagulation problems that are absolute contraindications for neuroaxial anesthesia
- INR > 1.5
- PLT < 100,000*
- PT, PTT, BT x 2
List the factors involved in the coagulation cascade
* Intrinsic
* Extrinsic
* Common
- Intrinsic: 12, 11, 9, 8
- Extrinsic: 3, 7
- Common: 10, 5, 1, 2,13
S9
PT/INR measures?
PTT measures?
- PT/INR = extrinsic
- PTT = intrinsic
S9
PT = PLAY TENNIS OUTSIDE = EXTRINSIC
PTT = PLAY TABLE TENNIS INSIDE = INTRINSIC
What does the bleeding time look at?
- Examines PLT activation and adhesion.
- longer BT = problem with PLTs.
S9
What severe valvular heart diseases are absolute CI for neuroaxia anesthesia?
- Aortic stenosis <1cm2
- Mitral stenosis <1cm2
S10
List the valve area for AS for the following:
* Mild
* Moderate
* Severe
* Critical
- Mild: >1.5 [greater than or equal to]
- Moderate: 1.0 - 1.5
- Severe: 0.7 - 1.0
- Critical: < 0.7
cm2
What is the average course of valvular aortic stenosis in adults
- Age 35-40: increasing obstuction, myocardial overload
- Age 60: onset of severe symptoms **
- Age 63: average age of death.
S10
What are the s/sx of severe or critical AS? What are its survival rates?
- Angina - 5yrs
- Syncope - 3yrs
- Heart failure - 2 yrs, the worst [NYHF 3 or 4]
S10
What is the death spiral that occurs due to AS?
- hypotension causes myocardial ischemia
- ischemia contractile dysfunction
- decreases CO
- worsening hypotension
- increased ischemia
S10
Compare & Contrast the following characteristics of spinals and epidural:
* Onset
* Spread
* Nature of block
* Motor block
* Hypotension
S11
Compare & Contrast the following characteristics of spinals and epidural:
* Onset
* Duration
* Placement level
* Difficulty of placement
* Dosing
* Concentration
* LA toxicity
* Gravity influence
* Manipulation of dermatome spread after dosing
S10
What is the placement and needle size for spinals?
- Placement:L4-L5
- Smaller needle: 25-27g
S12
What is the placement and needle size for epidurals?
- Placement: anywhere there is epidural space
- bigger needle: 18-19 g
- can do epidurals by thoracic but draw back is accidentally hitting the spinal cord.
S12
Positioning affects epidurals or spinals?
How would you postion a pt with right hip pain?
- Affects epidurals
- pain in right buttock - turn to right side to have LA stay on that side.
S12
How many total vertebras do we have?
* Total:
* Cervicle:
* Thoracic:
* Lumbar:
* Sacrum:
* Coccyxs:
- Total: 33
- Cervicle: 7
- Thoracic: 12
- Lumbar: 5
- Sacrum: 5
- Coccyx: 4
S14
What are the 4 curvatures of the spine?
- Normal
- Scoliosis
- Kyphosis
- Lordosis
S14
Each vertebra, except for ____, is divided into two main parts:
* The____ segment, known as the body.
* The ____ segment, called the vertebral arch.
- C1
- anterior
- posterior
slide 15
what 2 structures link the anterior and posterior segments?
the lamina and pedicle
slide 15
The vertebral foramen is a crucicial space within the verbra why?
houses the spinal cord, nerve roots, and the epidural space, which is a protective cushioning area around the spinal cord.
slide 15