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Principles of Anesthesia 1 (Summer 2023) > Master Deck > Flashcards

Master Deck Flashcards

1
Q

What is the outermost layer surrounding the spinal cord?

A

Dura mater

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2
Q

The dural sac terminates at what level?

A

S2

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3
Q

What are the cardioaccelerator nerve fibers? (Select 4)

A

T1 - T4

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4
Q

What is the absolute contraindication of spinal anesthesia?

A

Patient refusal

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5
Q

Sensory blockade of which level is necessary for upper abdominal surgery?

A

T4

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6
Q

For isobaric solution, what is the most important factor in determining the spread of the local anesthetic in subarachnoid block?
- Dose
- Concentration
- Volume
- Baricity

A

Dose

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7
Q

Chloroprocaine is (Select 2)
- metabolized by the Liver
- (–) enantiomer of racemic procaine
- an ester local anesthetic
- short acting local anesthetic

A
  • an ester local anesthetic
  • short acting local anesthetic
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8
Q

The blood in the venous sytem represents what amount of the total blood volume?

A

75%

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9
Q

The effects of Bezold-Jarisch reflex are manifested as (Select 3)
- bradycardia.
- hypotension.
- coronary dilation.
- tachycardia.
- vasoconstriction.
- hyperventilation.

A

bradycardia.
hypotension.
coronary dilation.

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10
Q

The diaphragm is innervated by?

A

C3 - C5

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11
Q

The incidence of cauda equina syndrome is linked to high dose of which local anesthetic?

A

Lidocaine

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12
Q

The patient allergic to para-aminobenzoic acid will most likely develop hypersensitivity to?
- Tetracaine
- Benzocaine
- Cocaine
- Bupivacaine
- Lidocaine
- Ropivacaine

A

Tetracaine
Benzocaine
Cocaine

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13
Q

Which local anesthetic has high affinity to cardiac toxicity?

A

Bupivacaine

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14
Q

Two mL of hyperbaric bupivacaine 0.75% concentration is equivalent to how many mg?

A

15mg

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15
Q

What is the dermatome level for the umbilical area?

A

T10

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16
Q

What needle offers the better control for an epidural

A

Winged Tuohy

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17
Q

At what interval & how long are VS monitored after a spinal?

A

Q3mins for 15-20mins

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18
Q

At what interval & how long are VS monitored after an epidural?

A

Q5mins for 20-30mins

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19
Q

The spread of a spinal block is?
What about the spread of an epidural?

A
  • Higher than expected
  • As expected & can be controlled with LA volume
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20
Q

The nature of a spinal block is ____ & it is ____ for an epidural?

A
  • Dense
  • Segmental
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21
Q

Which neuraxial block is more likely to cause hypotension?

A

Spinal (SAB)

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22
Q

What are the onset times for a spinal & epidural?

A
  • Spinal= 5mins
  • Epidural= 10-15mins
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23
Q

What is the max dose for a spinal?

A

3cc

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24
Q

What is the max dose for an epidural?

A

~20cc

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25
Q

What is the max dose for an epidural?

A

~20cc

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26
Q

The LA concentration for a spinal is what?

A

Fixed

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27
Q

Which neuraxial is influenced by gravity?

A

Spinal

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28
Q

Which neuraxial is more likely to cause LA toxicity?

A

Epidural d/t more veins

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29
Q

How many mL dose each segment hold in an epidural?

A

1-2mL

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30
Q

Spinal anesthesia is usually performed for procedures involving what?

A
  • Lower abdomen
  • perineum
  • lower extremities
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31
Q

What is the preferred neuraxial for C-sections?

A

Spinal

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32
Q

What are the absolute contraindications for an SAB?

A
  • Coagulopathy
  • Sepsis
  • Pt refusal
  • Dermal site infection
  • Hypovolemia
  • Spinal cord disorders
  • Valvular heart disease
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33
Q

With what aortic stenosis area (cm²) is a spinal contraindicated?
What about MS?

A
  • AS= <1.0 cm²
  • MS= <1.0 cm²
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34
Q

What neuraxial approach should be used with spinal column deformities?

A

Perimedian approach

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35
Q

At what dermatome level should one start for a thoracic epidural?

A

T7 & then can go up

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36
Q

How many spinal nerves are there?

A

31 pairs
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 coccyx

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37
Q

How many cervical spinal nerve pairs are there?

A

8 pairs

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38
Q

What helps locate the sacral hiatus?

A

The sacral cornu to either side

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39
Q

What is the needle approach with thoracic neuraxial?

A

Cephalad

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40
Q

Where are adipose tissue & blood vessels located in the epidural space?

A

Laterally

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41
Q

What is the average lumbar distance from skin to ligamentum Flavum?

A

4-6cm

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42
Q

In most adults the spinal cord ends at ____ & at ____ for children?

A
  • L1
  • L3
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43
Q

The dural sac terminates at what location?

A

S2

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44
Q

What conditions cause low CSF?

A
  • Obesity
  • Pregnancy
  • ascites
  • increased abdominal pressure
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45
Q

LA anesthetic selection depends on?

A
  • Type of surgery
  • Length of surgery
  • Surgeon
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46
Q

Which LA is not mixed with Epinephrine?

A

Ropivicaine

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47
Q

What class of medications are used as neuraxial adjuncts?

A
  • Opioids
  • Alpha-2 agonists
  • Vasopressors
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48
Q

How do vasopressors affect neuraxial anesthesia?

A

The extend the duration only

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49
Q

How do alpha-2 agonists affect neuraxial anesthesia?

A

Improve density, duration & analgesia

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50
Q

How do opioid adjuncts affect neuraxial anesthesia?

A

Intensify the block/density
- Do not extend the duration

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51
Q

What are the spinal doses for
- Morphine
- Fentanyl
- Sufentanil

A
  • Morphine: 100 - 400 mcg
  • Fentanyl: 10 - 25 mcg
  • Sufentanil: 2.5 - 10 mcg
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52
Q

What are the epidural doses for
- Morphine
- Fentanyl
- Sufentanil

A
  • Morphine: 3 - 5 mg
  • Fentanyl: 50 - 100 mcg
  • Sufentanil: 10 - 25 mcg
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53
Q

Fentanyl & Sufentanil cause early respiratory depression due to being?

A

Lipophilic

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54
Q

What is a very common side effect of neuraxial anesthesia?

A

Pruritis

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55
Q

Neuraxial pruritis can be?
- Treated with:
- Prophylaxis:

A
  • Treat: benadryl 25-50 mg IV, Naloxone 0.1 mg IV, Buprenex
  • Prophylaxis: Minimize morphine dose <300mcg, Zofran 4 - 8 mg, Nubain 2.5 - 5 mg
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56
Q

What med can help prevent neuraxial hypotension?

A

Zofran 4 - 8 mg

57
Q

What happenz to a SAB when Tetrcaine is mixed with a vasoconstrictor?

A

Profound increase in length of block

58
Q

What med is given to prevent the 5 & Dime reflex?

A

Robenol (Glycopyrrolate)

59
Q

What is the neuraxial adjunct dose for precedex?

A

3 mcg

60
Q

What is the neuraxial adjunct dose for Clonidine?

A

15 - 45 mcg

61
Q

What is the neuraxial adjunct dose for epinephrine?

A

0.2 - 0.3 mg

62
Q

What is the neuraxial adjunct dose for phenylephrine?

A

2 - 5 mg

63
Q

What factors affect LA uptake into neural space?

A
  • LA concentration in CSF
  • Surface area of neural tissue
  • Lipid content of the nerve
  • Blood flow to the nerve
64
Q

List the affected nerves for a SAB in order first to last?

A

1) B-fibers
2) C-fibers
3) A-delta fibers
4) A-alpha, A-beta & A-gamma

65
Q

C-fibers transmit ____ information & B-fibers transmit ____information?

A
  • Sensory
  • Sympathetic
66
Q

Blocking C & A-delta fibers will result in the loss of?

A

Pain & temperature senses

67
Q

What fibers are used for motor tone?

A

A-gamma

68
Q

Proprioception & motor function is controlled by what fibers?

A

A-alpha

69
Q

The sympathetic level is ____ levels higher/lower than the sensory?

A
  • 2 - 6 levels
  • higher
70
Q

The sensory level is ___ levels higher/lower than the motor level?

A
  • 2 levels
  • higher
71
Q

How are LA’s eliminated from the SAB?

A

Via vascular reabsorption

72
Q

What drug factors are the most important affecting LA distribution & block height?

A

Dose & Baracity

73
Q

What patient factors are the most important affecting LA distribution & block height?

A
  • CSF Volume
  • Advanced age
  • Pregnancy
74
Q

What procedure factors are the most important affecting LA distribution & block height?

A
  • Pt position
  • Epidural injection post spinal (EVE)
75
Q

What type of LA is best suited for C-sections or hysterectomy?

A

Hyperbaric LA

76
Q

What is the best LA type for prone cases?

A

Hypobaric

77
Q

What are the doses of Hyperbaric SAB in Non-Obstetric patients?
- @ T4
- @ T10
- @ sacral

A
  • T4= 2 mL
  • T10= 1.5 mL
  • Sacral= 1 mL
78
Q

What is barbotage?

A

Aspirating CSF & seeing the “swirl” mixing into the LA

79
Q

What is the Bezoid-Jarisch reflex?

A

The body tries to normalize cardiac function –> bradycardia

80
Q

What can be given to inhibit the Bezoid-Jarisch reflex?

A

Zofran 4 - 8 mg IV

81
Q

What fibers maintain arterial & venous tone?

A

Preganglionic B-fibers

82
Q

What fluids are the best option for preloading?

A

Warmed Isotonic solutions

83
Q

Why are glucose containing solutions avoided in neuraxial anesthesia?

A

Glucose leads to increased u/o, which can lead to more hypotension

84
Q

What is the best option for normovolemic hypotension?

A

Ephedrine

85
Q

GI sympathetic outflow originates at what dermatomes?

A

T6 - L1

86
Q

A Pt complains of nausea after neuraxial anesthesia, what is most likely going to happen & how can it be averted?

A
  • Hypotension
  • Treat with ~ 1cc Neo
87
Q

What VS monitoring is definitely needed for a spinal?

A

BP & SpO2

88
Q

What is the dose for intralipid rescue?

A

1.5 mL/kg bolus –> 0.25 mL/kg drip

89
Q

What dermatome correlates with the testicles?

A

S2

90
Q

Vaginal delivery or a TURP require a block up to which dermatomes?

A

T10

91
Q

What two needles increase the chances of a spinal headache?

A

Quincke & Pitkin (they are cutting needles)

92
Q

What is the quickest way to determine if the fluid coming out of the spinal needle is CSF?

A

The fluid will be warm

93
Q

How is a Pt positioned while performing a lateral spinal?

A
  • Legs flexed up to abdomen
  • Forehead flexed down towards knees
94
Q

What solution will result in a swirl?

A

Hyperbaric solutions

95
Q

When is a paramedian approach needed?

A

For a Pt with scoliosis or someone with rods.

96
Q

What will be bypassed in a spinal with a paramedian approach?

A
  • The supraspinous ligament &
  • The interspinous ligament
97
Q

The spinal needle is in the right place but you get no CSF, what do you do?

A
  • rotate needle 90° & wait 10-15 sec
  • insert stylet & remove it
  • try aspirating
  • withdraw needle & try again
98
Q

There is blood in your spinal needle, what do you do?

A
  • check if it clears up after a few drops of CSF
  • reposition the needle if blood continues to drip
99
Q

During a spinal the Pt complains of pain in the leg, what do you do?

A
  • Ask the Pt where the pain is
  • Do not inject anything
  • Withdraw the needle and direct more medially
100
Q

During a spinal you continue to hit bone, what do you do?

A
  • Reposition Pt
  • Change needle if damaged
  • Try a different interspace or paramedian approach
  • Stop after 3 attempts
101
Q

You hit a bony prominence early during a spinal, how do you direct your needle?

A

Direct it caudal

102
Q

You hit a bony prominence late during a spinal, how do you direct your needle?

A

Direct it cephalad

103
Q

What is an early symptom of a high spinal?

A

Inability to phonate

104
Q

What are the causes of a high spinal?

A
  • Excessive dose
  • Failure to reduce dose in elderly, obese, & short ppl)
  • Rapid injection
  • Improper position after SAB
  • unrecognized intrathecal placement of epidural catheter
105
Q

Where would a PDPH headache located & what exacerbates it?

A
  • Located in frontal & occipital lobes
  • Upright position makes it worse
106
Q

What possible S/S are associated with PDPH?

A
  • Photophobia
  • Diplopia (CN 5v1)
  • Tinnitus (CN 8)
  • seizures
107
Q

What are the treatments for PDPH?

A
  • Supine position
  • NSAIDs, narcotics (fentanyl)
  • Methylxanthine (caffeine) (caution in elderly sensitive to caffeine)
  • Blood patch
108
Q

What is the dose for caffeine PO or IV?

A

300 - 500 mg daily or BID

109
Q

Describe a blood patch?

A
  • The patch will be 1 level lower than the tap
  • Need a fresh IV
  • Pre-medicate Pt as injection of blood can be painful
  • Place Pt in lateral position (for comfort)
  • Once in epidural space get 20cc of blood from new IV
  • Inject 20cc into epidural space
110
Q

When do transient neurologic symptoms start after a spinal?
What are the S/S?
When does it resolve?
What med has a higher incidence?

A
  • Develops after block resolves
  • Severe radicular back pain
  • 90% resolve within a week
  • Higher incidence with 5% lidocaine
111
Q

What are the S/S of cauda equina syndrome?

A
  • Bowel/bladder dysfunction
  • paraplegia (late sign)
  • back pain
  • saddle anesthesia
  • sexual dysfunction
112
Q

What are the S/S of Honer’s syndrome?

A

Ptosis, anhydrosis & Miosis

113
Q

What 3 nerves are blocked during an awake intubation?

A
  • Trigeminal (5₂)
  • Glossopharyngeal (IX)
  • Vagus (X)
114
Q

How is CN 5₂ blocked?

A

With cocaine on a Q-tip into the nostrils for 5mins

115
Q

How is CN 9 blocked

A

With a tongue depressor wrapped in 4x4 coated with lidocaine & have Pt suck on it for 5mins

116
Q

How is the vagus nerve blocked for an awake intubation?

A

Inject lidocaine anteriorly and have Pt cough to spread the lidocaine.

117
Q

What 3 things can cause arachnoiditis?

A
  • nonapproved drugs into the intrathecal or epidural space
  • using non-preservative free solutions
  • betadine contamination
118
Q

What are the S/S of spinal/epidural hematomas?

A
  • Pain is a major sign
  • Numbness/weakness
119
Q

Which procedure has a higher incidence of systematic toxicity, spinal or epidural?

A

Epidural, hence the test dose

120
Q

What’s the antibiotic of choice for prophylaxis?

A
  • Cephalosporins
121
Q

What would one change to decrease to the chances of a spinal/epidural abscess occuring?

A

Use CHG + alcohol instead of povidine-iodine

122
Q

To maintain the ability to walk, where does an epidural have to be?

A

Has to be above T10

123
Q

What are the disadvantage of epidurals?

A
  • slower onset
  • longer time to perform
  • less dense block
124
Q

For thoracic epidurals, one should adjust their needle approximately how many degrees cephalad?

A

35° - 55°

125
Q

How does an increased pH affect epidurals?

A

The diffusion is increased

126
Q

What are the 2 determinants of epidural block spread?

A
  • Site of injection
  • volume & dose of LA
127
Q

What is the segmental dose for epidurals?

A

1-2 mL per segment

128
Q

What can one ask the Pt during an epidural test dose to ensure placement?

A
  • Do you have any ringing sensation?
  • Do you have a metallic taste?
  • Any oral numbness
129
Q

What does adding Epi to an epidural result in?

A

Increased duration of the block

130
Q

What is the phenylephrine dose for epidurals?

A

2 - 5 mg

131
Q

Adding bicarb to an epidural will help with?

A
  • Increases the rate of diffusion of the drug
  • increases the speed of onset of the block
132
Q

What is the downside of 2-chloroprocaine in epidurals?
What about the benefit?

A
  • Downside is decreased efficacy of subsequent epidural opioids
  • Must be re-dosed every 45mins
  • Benefit of rapid onset
133
Q

Which LA has the greatest motor function depression in epidurals?
What about the least?

A
  • greatest: Lidocaine
  • least: Ropivacaine
134
Q

When is the Crawford needle preferred?

A
  • In thoracic epidurals.
  • Or difficult or steep angle placements
135
Q

What is the downside to single opening epidural catheters?

A

Can cause spotty blocks

136
Q

What is the test dose for epidurals?

A

3cc of 1.5% Lidocaine with Epi 1:200,000

137
Q

What indicates a positive epidural test dose?

A
  • 20% increase in HR
  • Tinnitus, metallic taste, circumoral numbness
138
Q

An epidural Pt complains of severe depressed motor function 5mins after the epidural, what is the cause?

A

The procedure resulted in a spinal block rather than an epidural

139
Q

How much Bicarb is added to the LA for an epidural?

A

1 meq per 10 mL of LA

Principles of Anesthesia 1 (Summer 2023) (14 decks)

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