Neuraxial

Question 1

What is density?

Answer 1

The ratio of mass to volume

Question 2

What is specific gravity?

Answer 2

The density of a substance relative to another substance (usually the density of something compared to the density of water)

Question 3

What is baricity?

Answer 3

The specific gravity where CSF is the substance being compared to (rather than water)

Question 4

What is added to increase baricity?

Answer 4

Dextrose

Question 5

What is added to decrease baricity?

Answer 5

Water

Question 6

What are the highest points of lordosis in the supine position?

Answer 6

C5 and L3

Question 7

What are the highest points of kyphosis in the supine position?

Answer 7

T6 and S2

Question 8

In the supine position, how will an an intrathecal hypobaric solution spread?

Answer 8

In the lower lumbar region, because in order to reach the cervical region it would have to sink to the thoracic lordosis, which it can’t do

Question 9

What is the primary mechanism of hypotension with neuraxial anesthesia?

Answer 9

Blockade of sympathetic preganglionic B fibers (sympathectomy)

Question 10

The spine of the scapula corresponds with what vertebral level?

Answer 10

T3

Question 11

The tip of the scapula corresponds with what vertebral level?

Answer 11

T7

Question 12

What is the intercristal line?

Answer 12

Tuffier’s Line

Question 13

In infants up to 1 yr, Tuffier’s line corresponds with:

Answer 13

L5-S1

Question 14

Answer 14

Question 15

Answer 15

Question 16

Answer 16

Question 17

The spinal cord ends in a taper called _______ at _________

Answer 17

conus medullaris

L1 (L3 in infants)

Question 18

Where does the dural sac end?

Answer 18

S2 in adults

S3 in infants

Question 19

What is the Filum Terminale?

Answer 19

A continuation of the pia mater below the level of the conus medullaris. It helps anchor the spine to the coccyx

Question 20

Answer 20

Question 21

Answer 21

Question 22

Which veins drain the spinal cord and meninges?

Answer 22

Batson’s Plexus, which passes through the lateral and anterior regions of the epidural space

Question 23

The epidural space contains:

Answer 23

nerves
fat pads
blood vessels

Question 24

Answer 24

Question 25

Name the dermatomes: C6 C7 C8 T4 T6 T10 L4

Answer 25

Question 26

Posterior nerve roots carry:

Answer 26

Sensory information

Question 27

Anterior nerve roots carry:

Answer 27

motor and autonomic information

Question 28

With spinal anesthesia, how much higher is autonomic blockade than sensory blockade?

Answer 28

Autonomic blockade is 2-6 dermatomes higher than sensory blockade

Question 29

With spinal anesthesia, how much higher is sensory blockade than motor blockade?

Answer 29

Sensory blockade is two dermatomes higher than motor blockade

Question 30

In the lumbar region, spread is primarily ________

Answer 30

cephalad

Question 31

LA spread In the midthoracic region is _________

Answer 31

equally cephalad and caudad

Question 32

In the cervical region, spread is mostly ______

Answer 32

caudad

Question 33

With epidural anesthesia, how much higher than sensory blockade is autonomic blockade?

Answer 33

There is no differential autonomic blockade with epidural anesthesia! Only spinal! BUT motor blockade 2-4 dermatomes lower

Question 34

Which sensory modality will fade first?

Answer 34

Temperature Then Sharp Then pressure

Question 35

The primary drug-related determinant of epidural block HEIGHT is:

Answer 35

Volume

Question 36

The primary drug-related determinant of epidural block DENSITY is:

Answer 36

LA concentration

Question 37

How does neuraxial anesthesia impact respiratory mechanics?

Answer 37

It impairs inspiration and expiration because it knocks out accessory muscles

Question 38

Does spinal anesthesia cause drowsiness?

Answer 38

Actually yes. It reduces sensory input to the RAS

Question 39

How does spinal anesthesia impact the gut?

Answer 39

Increases peristalsis and relaxes sphincters

Question 40

What reflex contributes to asystole from spinal anesthesia?

Answer 40

Bezold-Jarisch: the heart slows to allow time to fill

Question 41

What is the most likely cause of apnea with spinal anesthesia?

Answer 41

Brainstem hypoperfusion

Question 42

Neuraxial opioids do NOT impact:

Answer 42

sympathectomy proprioception motor blockade

Question 43

What is the MOST lipophilic opioid?

Answer 43

Sufentanil

Question 44

What is the LEAST lipophilic opioid?

Answer 44

Morphine

Question 45

How will a lipophilic opioid behave in the subarachnoid space?

Answer 45

Shorter duration Less spread Early resp depression

Question 46

How will a hydrophilic opioid behave in the subarachnoid space?

Answer 46

Longer duration Wider Spread Late resp depression

Question 47

How do neuraxial opioids inhibit pain?

Answer 47

They inhibit afferent pain transmission in the substantia gelatinosa

Question 48

How do neuraxial opioids impact block density?

Answer 48

They increase density when combined with LAs

Question 49

Which LA decreases the efficacy of neuraxial opioids?

Answer 49

2-chloroprocaine

Question 50

Early phase respiratory depression results from:

Answer 50

systemic absorption

Question 51

Late phase respiratory depression results from:

Answer 51

rostral spread of LAs to the brainstem

Question 52

Late phase respiratory depression is only caused by ______ opioids

Answer 52

hydrophilic

Question 53

Urinary retention is most common in which demographic?

Answer 53

young men

Question 54

N/V from neuraxial opioids results from stimulation of ________

Answer 54

area postrema of the medulla vestibular apparatus

Question 55

Which opioid may reactivate herpes simplex labialis type 1?

Answer 55

Morphine can reactivate oral herpes 2-5 days after administration

Question 56

Sedation from neuraxial opioids is most common with which drug?

Answer 56

Sufentanil

Question 57

How do opioids impact diuresis?

Answer 57

They have an antidiuretic effect by increasing vasopressin release

Question 58

Describe the degree of transfer between epidural opioids and breast milk

Answer 58

Negligible

Question 59

Is increased ICP a contraindication to spinal anesthesia?

Answer 59

Yes. Any sudden change in CSF volume can cause herniation

Question 60

What three cardiac abnormalities should not be candidates for spinal anesthesia?

Answer 60

Ao and Mitral stenosis hypertrophic cardiomyopathy

Question 61

Can MS patient receive spinal anesthesia?

Answer 61

Yes. There is a small chance of exacerbation. You should use a lower dose and concentration of LA because myelination is disturbed

Question 62

In the lumbar region, the epidural space is _______ cm from the skin

Answer 62

3-5

Question 63

Caudal anesthesia is useful in procedures requiring a ______ level block

Answer 63

T10 or lower

Question 64

What are absolute contraindications to caudal anesthesia?

Answer 64

Spina Bifida Meningomyelocele Meningitis

Question 65

How should LOR be assessed in caudal anesthesia?

Answer 65

It should always be with saline, NEVER air

Question 66

How should a patient be positioned for a caudal anesthetic?

Answer 66

Either in Simm's Position OR Prone

Question 67

In a patient receiving lovenox, how should the medication be timed to remove the epidural?

Answer 67

Hold lovenox for 12 hours, pull the epidural, then restart four hours later

Question 68

Is aspirin a contraindication for neuraxial anesthesia?

Answer 68

No

Question 69

How long should plavix be held before neuraxial?

Answer 69

7 days?

Question 70

How long should lovenox be held for neuraxial?

Answer 70

12 hrs for prophy 24 hrs for therapeutic

Question 71

Which organism is usually responsible for post-spinal bacterial meningitis?

Answer 71

Streptococcus Viridians

Question 72

How is a sphenopalatine block performed?

Answer 72

Question 73

What factors increase the risk of transient neurological symptoms?

Answer 73

Lidocaine Lithotomy Knee Arthroscopy

Question 74

What are the s/s of TNS?

Answer 74

Severe back and butt pain that radiates to both legs

Question 75

How long does TNS last?

Answer 75

1-7 days

Question 76

What helps with TNS symptoms?

Answer 76

NSAIDs Opioids Trigger point injections

Question 77

What should you do if an epidural catheter segment breaks off during removal?

Answer 77

Question 78

What should you do in the event of a patchy spinal?

Answer 78

Don't repeat the spinal, since the risk of neurotoxicity is high. Transition to another technique.

Question 79

What should you do in the event of a completely failed spinal?

Answer 79

Repeat in 15-20 minutes

Question 80

What should you do in the event of unilateral spinal?

Answer 80

Position poorly blocked side down Give a few mL of local IV If that doesn't work. convert

Question 81

What is the most common cause of a unilateral epidural?

Answer 81

Catheter in too far

Question 82

Should you pull back on an epidural catheter with the needle in face?

Answer 82

No. You have to remove both simultaneously

Question 83

Which spinal nerves are the most resistant to LAs?

Answer 83

L5 and S1 They are the thickest