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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
What does the Anterior/posterior longitudinal ligament bind?
Binds vertebral bodies
26
_____ angles determine needle approach angles
VERTEBRAE angles determine needle approach angles
27
What is the key surface landmark for C7-T1?
Vertebral prominens
28
What is the key surface landmark for T7
Inferior scapula
29
Where does Touffier's/intercristal line correlate with?
Illiac crest
30
The illiac crest are located at what vertebrae?
top of L4
31
What is the key surface landmark for S2?
Posterior/ Suprior illiac spines
32
Where is the foramen magnum located?
L1-L2
33
Where does the dural sac terminate?
S2
34
Where does the epidural space start and end?
Foramen magnum to the sacral hiatus
35
Where does the spinal cord terminate in adults?
L1-L2
36
Where does the spinal cord terminate in children? What implication does this have for completeing blocks?
L3, you must start your block lower than that of adults
37
What is the order of spinal covering from inner to outer?
pia mater > arachnoid > subarachnoid > dura mater > epidural space
38
Where is the pia mater located?
adheres to the SC and nerves
39
Where is the arachnoid located?
between the pia mater and dura mater
40
Where is the subarachnoid loacated?
between the arachnoid and pia mater
41
What does the arachnoid hold?
CSF
42
What is considered the toughest outer membrane
dura mater
43
What is the epidural space and where is it located?
- a potential space between dura mater and ligamentum flavum
44
How many nerve root pairs are there?
31 pairs
45
Group these words together: posterior, ventral, anterior, dorsal
- ventral = anterior - dorsal = posterior
46
Is dorsal motor or sensory? Ventral?
- dorsal = sensory - ventral = motor
47
Gray matter provides how many cc/100 gm/min of blood to the brain?
80 cc/100 gm/min
48
White matter provides how many cc/100 gm/min of blood to the brain?
20 cc/100 gm/min
49
What is the avg amount of blood supply to the brain from the SC?
50 cc/100 gm/min
50
Are blood flow and auto regulation to the SC similar to the brains?
Yes, slightly less blood flow
51
Where does the blood supply for the SC come from?
1 anterior spinal artery 2 posterior spinal arteries
52
Is CSF an ultra filtrate?
No
53
What lytes are associated with CSF?
High Na Low K, Ca, Bicarb, Glu
54
What is normal appearance of CSF?
clear, colorless, water-like solution
55
Why could CSF be yellow/xanthochromia?
post SAH
56
Why could CSF be hazy or turbid?
leukocytes or protein
57
Is it normal to see some blood in CSF which quickly clears while doing a block?
Yes
58
What does the monroe kelly doctrine say in regards to CSF?
brain tissue, blood and CSF work together to keep normal ICP
59
What is normal ICP?
5-15mmhg
60
Can you do a subarachnoid block if the patient has increased ICP?
NO
61
What is a sensory dermatome?
Specific area of skin innervated by a single spinal nerve
62
What is the sequence of clinical anesthsia blocking?
- 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
What is first to get blocked? What is last?
SNS blocked first Motor blocked last
64
What is first to come back when block wears off? What is last?
Motor back first SNS back last
65
What is the order in which nerve fibers are blocked from 1st to last?
B fibers > C & A delta fibers > A gamma fibers > A beta fibers > A alpha fibers
66
Which fibers are preganglionic? Which are post ganglionic?
- preganglionic B fibers - postganglionic C and A delta fibers
67
What are the zones of differential blockade?
ANS > Sensory > Motor
68
How many dermatomes must be blocked in order to have a sympathetic block?
Approximately 2 dermatomes above the sensory level
69
How to determine a sensory block?
determined by loss of normal sensation (like pinprick or cold) which is 2 levels above motor
70
Which nerve is hardest to block?
Motor
71
What is involved in patient prep & consent?
- explaination risks and agreeement - IV access - Fluids (can co treat) - sedation (sometimes)
72
What is the preferred position for spinals?
sitting because it allows for easier visualization of anatomy
73
What is involved in proper patient sitting positioning for a spinal?
- no torquing (remain straight) - dangle or cross legged - chin to chest - arms resting on knees
74
What are the 2 approaches to inserting a spinal/epidural?
- midline - paramedian
75
Which insertion technique is most common?
midline
76
Why would you use a paramedian insertion approach?
For older individuals with calcified interspinous
77
For what spinal location can you use the paramedian approach?
with lumbosacral spinals
78
How would you do the paramedian approach?
1 cm down, 1 cm lateral
79
What is the order in which the needle punctures the layers during a SPINAL in the medial approach?
Skin Sub Q Supraspinous Interspinous Flavum Epidural space Dura mater Subdural space Arachnoid Subarachnoid
80
Which layer is bypassed in the paramedian insertion approach?
Supraspinous ligament
81
What is the order in which the needle punctures the layers during an EPIDURAL?
Skin Sub-Q Supraspinous ligament Interspinous ligament Ligamentum flavum Epidural space
82
How deep is the epidural space?
4-6 cm depth
83
When is the Taylor's approach used for SAB?
In the event of severe arthritis
84
What approach is used for the Taylor's Approach?
paramedian technique at L5-S1

Basics Principles 1 (6 decks)

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