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Apex > Neuraxial > Flashcards

Neuraxial Flashcards

1
Q

What is density?

A

The ratio of mass to volume

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2
Q

What is specific gravity?

A

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

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3
Q

What is baricity?

A

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

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4
Q

What is added to increase baricity?

A

Dextrose

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5
Q

What is added to decrease baricity?

A

Water

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6
Q

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

A

C5 and L3

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7
Q

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

A

T6 and S2

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8
Q

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

A

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

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9
Q

What is the primary mechanism of hypotension with neuraxial anesthesia?

A

Blockade of sympathetic preganglionic B fibers (sympathectomy)

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10
Q

The spine of the scapula corresponds with what vertebral level?

A

T3

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11
Q

The tip of the scapula corresponds with what vertebral level?

A

T7

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12
Q

What is the intercristal line?

A

Tuffier’s Line

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13
Q

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

A

L5-S1

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14
Q
A
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15
Q
A
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16
Q
A
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17
Q

The spinal cord ends in a taper called _______ at _________

A

conus medullaris

L1 (L3 in infants)

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18
Q

Where does the dural sac end?

A

S2 in adults

S3 in infants

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19
Q

What is the Filum Terminale?

A

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

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20
Q
A
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21
Q
A
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22
Q

Which veins drain the spinal cord and meninges?

A

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

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23
Q

The epidural space contains:

A

nerves
fat pads
blood vessels

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24
Q
A
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25
Q

Name the dermatomes:

C6
C7
C8
T4
T6
T10
L4

A
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26
Q

Posterior nerve roots carry:

A

Sensory information

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27
Q

Anterior nerve roots carry:

A

motor and autonomic information

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28
Q

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

A

Autonomic blockade is 2-6 dermatomes higher than sensory blockade

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29
Q

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

A

Sensory blockade is two dermatomes higher than motor blockade

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30
Q

In the lumbar region, spread is primarily ________

A

cephalad

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31
Q

LA spread In the midthoracic region is _________

A

equally cephalad and caudad

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32
Q

In the cervical region, spread is mostly ______

A

caudad

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33
Q

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

A

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

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34
Q

Which sensory modality will fade first?

A

Temperature
Then Sharp
Then pressure

35
Q

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

A

Volume

36
Q

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

A

LA concentration

37
Q

How does neuraxial anesthesia impact respiratory mechanics?

A

It impairs inspiration and expiration because it knocks out accessory muscles

38
Q

Does spinal anesthesia cause drowsiness?

A

Actually yes. It reduces sensory input to the RAS

39
Q

How does spinal anesthesia impact the gut?

A

Increases peristalsis and relaxes sphincters

40
Q

What reflex contributes to asystole from spinal anesthesia?

A

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

41
Q

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

A

Brainstem hypoperfusion

42
Q

Neuraxial opioids do NOT impact:

A

sympathectomy
proprioception
motor blockade

43
Q

What is the MOST lipophilic opioid?

A

Sufentanil

44
Q

What is the LEAST lipophilic opioid?

A

Morphine

45
Q

How will a lipophilic opioid behave in the subarachnoid space?

A

Shorter duration
Less spread
Early resp depression

46
Q

How will a hydrophilic opioid behave in the subarachnoid space?

A

Longer duration
Wider Spread
Late resp depression

47
Q

How do neuraxial opioids inhibit pain?

A

They inhibit afferent pain transmission in the substantia gelatinosa

48
Q

How do neuraxial opioids impact block density?

A

They increase density when combined with LAs

49
Q

Which LA decreases the efficacy of neuraxial opioids?

A

2-chloroprocaine

50
Q

Early phase respiratory depression results from:

A

systemic absorption

51
Q

Late phase respiratory depression results from:

A

rostral spread of LAs to the brainstem

52
Q

Late phase respiratory depression is only caused by ______ opioids

A

hydrophilic

53
Q

Urinary retention is most common in which demographic?

A

young men

54
Q

N/V from neuraxial opioids results from stimulation of ________

A

area postrema of the medulla

vestibular apparatus

55
Q

Which opioid may reactivate herpes simplex labialis type 1?

A

Morphine can reactivate oral herpes 2-5 days after administration

56
Q

Sedation from neuraxial opioids is most common with which drug?

A

Sufentanil

57
Q

How do opioids impact diuresis?

A

They have an antidiuretic effect by increasing vasopressin release

58
Q

Describe the degree of transfer between epidural opioids and breast milk

A

Negligible

59
Q

Is increased ICP a contraindication to spinal anesthesia?

A

Yes. Any sudden change in CSF volume can cause herniation

60
Q

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

A

Ao and Mitral stenosis
hypertrophic cardiomyopathy

61
Q

Can MS patient receive spinal anesthesia?

A

Yes. There is a small chance of exacerbation.

You should use a lower dose and concentration of LA because myelination is disturbed

62
Q

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

A

3-5

63
Q

Caudal anesthesia is useful in procedures requiring a ______ level block

A

T10 or lower

64
Q

What are absolute contraindications to caudal anesthesia?

A

Spina Bifida
Meningomyelocele
Meningitis

65
Q

How should LOR be assessed in caudal anesthesia?

A

It should always be with saline, NEVER air

66
Q

How should a patient be positioned for a caudal anesthetic?

A

Either in Simm’s Position OR Prone

67
Q

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

A

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

68
Q

Is aspirin a contraindication for neuraxial anesthesia?

A

No

69
Q

How long should plavix be held before neuraxial?

A

7 days?

70
Q

How long should lovenox be held for neuraxial?

A

12 hrs for prophy
24 hrs for therapeutic

71
Q

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

A

Streptococcus Viridians

72
Q

How is a sphenopalatine block performed?

A
73
Q

What factors increase the risk of transient neurological symptoms?

A

Lidocaine
Lithotomy
Knee Arthroscopy

74
Q

What are the s/s of TNS?

A

Severe back and butt pain that radiates to both legs

75
Q

How long does TNS last?

A

1-7 days

76
Q

What helps with TNS symptoms?

A

NSAIDs
Opioids
Trigger point injections

77
Q

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

A
78
Q

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

A

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

79
Q

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

A

Repeat in 15-20 minutes

80
Q

What should you do in the event of unilateral spinal?

A

Position poorly blocked side down

Give a few mL of local IV

If that doesn’t work. convert

81
Q

What is the most common cause of a unilateral epidural?

A

Catheter in too far

82
Q

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

A

No. You have to remove both simultaneously

83
Q

Which spinal nerves are the most resistant to LAs?

A

L5 and S1

They are the thickest

84
Q
A

Apex (46 decks)

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