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Basics Principles 1 > Locals/Regional Anesthesia 1 > Flashcards

Locals/Regional Anesthesia 1 Flashcards

central neuraxial blocks, anatomy, physiology, mechanisms, & complications

1
Q

What are the 3 main bony parts of the vertebrae?

A
  • vertebral body
  • spinous process
  • bony arch
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2
Q

What is the spinous process formed by?

A

Formed by the joining of each lamina

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3
Q

The bony arch is made up of what 3 major parts?

A

lamina
processes
pedicles

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4
Q

Which position are the lamina located? How many?

A

2 lamina posterioly

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5
Q

Which position are the processes located? How many?

A

2 transverse processes

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6
Q

Which position are the pedicles located? How many?

A

2 anterior pedicles

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7
Q

The IV foramen contains what?

A

Spinal cord
CSF

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8
Q

How many vertebrae are in the spinal cord?

A

33 vertebrae

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9
Q

How many vertebrae are in the spinal cord if fused vertebrae are counted as 1?

A

26 vertbrae

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10
Q

How many cervical vertebrae?

A

7 vertebrae

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11
Q

What are the smallest vertebrae?

A

cervical

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12
Q

How many thoracic vertebrae?

A

12 vertebrae

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13
Q

How man lumbar vertebrae?

A

5 vertebrae

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14
Q

What are the largest vertebrae?

A

Lumbar

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15
Q

How many sacral vertebrae? Are they fused? Are they considered 1 vertebrae?

A

Yes, 5 fused vertebrae but may be considered 1 vertebrae

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16
Q

How many coccygeal vertebrae? Are they fused? Are they considered 1 vertebrae?

A

Yes, 4 fused vertebrae but may be considered 1 vertebrae

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17
Q

Which spinal processes have a horizontal angle?

A

Cervical
Low thoracic
lumbar

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18
Q

Which spinal processes have a caudad angulation?

A

thoracic

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19
Q

Do ligaments increase stability and elasticity?

A

Yes

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20
Q

What does the supraspinous ligament connect?

A

Connects the tips of the spinous processes from sacrum to T7

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21
Q

What does the interspinous ligament connect?

A

Connects the posterior spinous processes & fills gap

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22
Q

What is considered the thickest ligament?

A

Interspinous

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23
Q

What does the ligamentum flavum connect?

A

Connects the lamina of the adjacent vertebrae

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24
Q

Which ligament is the primary supportive ligament of the vertebral column?

A

Anterior/posterior longitudinal ligament

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25
Q

What does the Anterior/posterior longitudinal ligament bind?

A

Binds vertebral bodies

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26
Q

_____ angles determine needle approach angles

A

VERTEBRAE angles determine needle approach angles

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27
Q

What is the key surface landmark for C7-T1?

A

Vertebral prominens

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28
Q

What is the key surface landmark for T7

A

Inferior scapula

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29
Q

Where does Touffier’s/intercristal line correlate with?

A

Illiac crest

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30
Q

The illiac crest are located at what vertebrae?

A

top of L4

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31
Q

What is the key surface landmark for S2?

A

Posterior/ Suprior illiac spines

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32
Q

Where is the foramen magnum located?

A

L1-L2

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33
Q

Where does the dural sac terminate?

A

S2

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34
Q

Where does the epidural space start and end?

A

Foramen magnum to the sacral hiatus

35
Q

Where does the spinal cord terminate in adults?

36
Q

Where does the spinal cord terminate in children? What implication does this have for completeing blocks?

A

L3, you must start your block lower than that of adults

37
Q

What is the order of spinal covering from inner to outer?

A

pia mater > arachnoid > subarachnoid > dura mater > epidural space

38
Q

Where is the pia mater located?

A

adheres to the SC and nerves

39
Q

Where is the arachnoid located?

A

between the pia mater and dura mater

40
Q

Where is the subarachnoid loacated?

A

between the arachnoid and pia mater

41
Q

What does the arachnoid hold?

42
Q

What is considered the toughest outer membrane

A

dura mater

43
Q

What is the epidural space and where is it located?

A
  • a potential space between dura mater and ligamentum flavum
44
Q

How many nerve root pairs are there?

45
Q

Group these words together: posterior, ventral, anterior, dorsal

A
  • ventral = anterior
  • dorsal = posterior
46
Q

Is dorsal motor or sensory? Ventral?

A
  • dorsal = sensory
  • ventral = motor
47
Q

Gray matter provides how many cc/100 gm/min of blood to the brain?

A

80 cc/100 gm/min

48
Q

White matter provides how many cc/100 gm/min of blood to the brain?

A

20 cc/100 gm/min

49
Q

What is the avg amount of blood supply to the brain from the SC?

A

50 cc/100 gm/min

50
Q

Are blood flow and auto regulation to the SC similar to the brains?

A

Yes, slightly less blood flow

51
Q

Where does the blood supply for the SC come from?

A

1 anterior spinal artery
2 posterior spinal arteries

52
Q

Is CSF an ultra filtrate?

53
Q

What lytes are associated with CSF?

A

High Na
Low K, Ca, Bicarb, Glu

54
Q

What is normal appearance of CSF?

A

clear, colorless, water-like solution

55
Q

Why could CSF be yellow/xanthochromia?

56
Q

Why could CSF be hazy or turbid?

A

leukocytes or protein

57
Q

Is it normal to see some blood in CSF which quickly clears while doing a block?

58
Q

What does the monroe kelly doctrine say in regards to CSF?

A

brain tissue, blood and CSF work together to keep normal ICP

59
Q

What is normal ICP?

60
Q

Can you do a subarachnoid block if the patient has increased ICP?

61
Q

What is a sensory dermatome?

A

Specific area of skin innervated by a single spinal nerve

62
Q

What is the sequence of clinical anesthsia blocking?

A
  • symp blocking w/peripheral vasodilation & skin temp elevation
  • loss of pain & temp sensation
  • loss of proprioception
  • loss of touch and pressure sensation
  • motor block
63
Q

What is first to get blocked? What is last?

A

SNS blocked first
Motor blocked last

64
Q

What is first to come back when block wears off? What is last?

A

Motor back first
SNS back last

65
Q

What is the order in which nerve fibers are blocked from 1st to last?

A

B fibers > C & A delta fibers > A gamma fibers > A beta fibers > A alpha fibers

66
Q

Which fibers are preganglionic? Which are post ganglionic?

A
  • preganglionic B fibers
  • postganglionic C and A delta fibers
67
Q

What are the zones of differential blockade?

A

ANS > Sensory > Motor

68
Q

How many dermatomes must be blocked in order to have a sympathetic block?

A

Approximately 2 dermatomes above the sensory level

69
Q

How to determine a sensory block?

A

determined by loss of normal sensation (like pinprick or cold) which is 2 levels above motor

70
Q

Which nerve is hardest to block?

71
Q

What is involved in patient prep & consent?

A
  • explaination risks and agreeement
  • IV access
  • Fluids (can co treat)
  • sedation (sometimes)
72
Q

What is the preferred position for spinals?

A

sitting because it allows for easier visualization of anatomy

73
Q

What is involved in proper patient sitting positioning for a spinal?

A
  • no torquing (remain straight)
  • dangle or cross legged
  • chin to chest
  • arms resting on knees
74
Q

What are the 2 approaches to inserting a spinal/epidural?

A
  • midline
  • paramedian
75
Q

Which insertion technique is most common?

76
Q

Why would you use a paramedian insertion approach?

A

For older individuals with calcified interspinous

77
Q

For what spinal location can you use the paramedian approach?

A

with lumbosacral spinals

78
Q

How would you do the paramedian approach?

A

1 cm down, 1 cm lateral

79
Q

What is the order in which the needle punctures the layers during a SPINAL in the medial approach?

A

Skin
Sub Q
Supraspinous
Interspinous
Flavum
Epidural space
Dura mater
Subdural space
Arachnoid
Subarachnoid

80
Q

Which layer is bypassed in the paramedian insertion approach?

A

Supraspinous ligament

81
Q

What is the order in which the needle punctures the layers during an EPIDURAL?

A

Skin
Sub-Q
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space

82
Q

How deep is the epidural space?

A

4-6 cm depth

83
Q

When is the Taylor’s approach used for SAB?

A

In the event of severe arthritis

84
Q

What approach is used for the Taylor’s Approach?

A

paramedian technique at L5-S1

Basics Principles 1 (6 decks)

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