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APEX > NEURAXIAL > Flashcards

NEURAXIAL Flashcards

1
Q

What are the 5 divisions of the spinal column and how many vertebrae are present in each?

A

33 vertebrae
C5 - T12 - L5 - S5 - C4

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2
Q

What are the anatomic borders of the facet joint?

A

Formed by the superior articular process of one vertebra and the inferior articular process of the vertebrae directly above.

Injury to the facet joint can compress the spinal nerve that exits the respective intervertebral foramina causing pain and muscle spasm along the associated dermatome

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3
Q

Order the 5 ligaments of the spinal column from posterior to anterior

A

Supraspinous - interspinous - ligamentum flavum - PLL - ALL

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4
Q

List all of the structures and spaces between the skin and spinal cord as they would be encountered during a subarachnoid block

A

skin - SQ - supraspinous - interspinous - ligamentum flavum - epidural - dura - subdural - arachnoid - subarachnoid - pia mater - spinal cord

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5
Q

What are the boundaries of the epidural space?

A

Cranial border = foramen magnum
Caudal border = Sacrococcygeal ligament
Anterior = PLL
Lateral = vertebral pedicles
Posterior = ligamentum flavum, vertebral lamina

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6
Q

What happens when you inject LA into subdural space during SAB? vs epidural

A

Epidural = high spinal w/delayed onset (15 - 20m)

Spinal = failed spinal

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7
Q

What is the plica mediana dorsalis, and what is its significance?

A

Controversial existence
Band of CT that courses between the ligamentum flavum and the dura mater. Conceivably creates a barrier that impacts the spread of meds in epidural space. Possible etiology for difficult epidural placement as well as unilateral epidural block

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8
Q

Important dermatome levels

A

C6 = thumb
C7 = pointer, middle
C8 = ring, pinky
T4 = nipple
T6 = xiphoid process
T10 = umbilicus
T12 = pubic symphysis
L4 = anterior knee

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9
Q

Site of action for spinal vs. epidural

A

Spinal = myelinated preganglionic fibers of the spinal nerve roots

Epidural = infuse thru the dural cuff before they can block the nerve roots. They also leak through the intervertebral foramen to enter the paravertebral area.

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10
Q

What contributes to the spread of LA in subarachnoid space?

A

Patient position
Baricity
Dosing
Site of Injection

Volume of CSF
Density of CSF

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11
Q

What is the primary determinant for spread of epidural anesthesia

A

Volume

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12
Q

Differential blockade for spinal anesthesia

A

1st = autonomic (+2 - 6 levels above motor)
2nd = sensory (+ 2 levels above motor)
3rd = motor

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13
Q

Differential blockade for epidural anesthesia

A

Only sensory & motor differential
Sensory is 2 - 4 dermatomes higher than motor block

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14
Q

A-Alpha

A

Skeletal muscle motor & proprioception
Blocked last
Heavily myelinated
12 - 20 um

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15
Q

B-Beta Fibers

A

Touch, Pressure
Blocked last
Heavy myelination
5 - 12 um

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16
Q

Gamma Fibers

A

Skeletal muscle tone
Blocked third
Medium myelination
3 - 6 um

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17
Q

Delta

A

Fast pain, temperature, touch
Blocked third
medium myelination
2-5 um

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18
Q

B Fibers

A

Preganglionic Fibers
Blocked 1st
Light myelination
3

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19
Q

C Fiber Sympathetic

A

Sympathetic = postganglionic ANS
Blocked 2nd
No myelination
0.3 - 1.3

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20
Q

C Fiber

A

Slow pain, temperature, touch
Blocked 2nd
No myelinaiton
0.4 - 1.2

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21
Q

Respiratory effects of neuraxial

A

Impaired intercostal muscles (inspiration and expiration)
Abdominal muscle (ability to cough and clear secretions)

If there is apnea, it’s d/t hypoperfusion

22
Q

GI function & neuraxial

A

The gut receives PSNS from CN10 and SNS from sympathetic chain T5 - L2. Neuraxial increases PSNS = sphincters relaxed, peristalsis increased

23
Q

What is the risk of neuraxial anesthesia with the patient with a coagulopathy? What labs?

A

Plt < 100
PT, aPTT, bleeding time 2x normal

24
Q

Cardiac pathologies that are a c/i

A

AS
MS
HCM

25
Q

CSF s/g

A

1.002 - 1.009

26
Q

Lordosis

A

T7

27
Q

Kyphosis

A

L3, C5

28
Q

Cutting point spinal needles

A

Quinke, Pitkin

29
Q

Pencil point needles

A

Sprotte, whitacre ( has a whiittle hole)

30
Q

Rounded bevel spinal needle

A

Green

31
Q

Name the three epidural needles

A

Tuohy 30 degrees
Hustead 15 degrees
Crawford 0 degrees

32
Q

Caudal dosing in children

A

Sacral = 0.5 mL/kg
T10 = 1 mL/kg
Mid Thoracic = 1.25 mL/kg

33
Q

Caudal dosing in adults

A

Sacral = 12 - 15 mL
Low Thoracic (T10) = 20 - 30

34
Q

Absolute c/i to caudal

A

spina bifida, meningitis, meningomyelocele of sacrum

35
Q

MOA of neuraxial opioids

A

-afferent pain tx inhibition in rexed lamina 2
-decreased camp
-decreased ca
-increased k

36
Q

sufentanil intrathecal & epidural dose

A

5 - 10 mcg
25 - 50 mcg

37
Q

fentanyl dosing

A

10 - 20 mcg
50 - 100 mcg

38
Q

hydromorphone

A

0.5 - 1 mg (e only)

39
Q

meperidine

A

10 mg
25 - 50 mg

40
Q

morphine

A

0.25 - 0.3 mg
2 - 5 mg

41
Q

lipophilicity

A

sufent > fent > meperidine > dilaudid > morphine

42
Q

Glycoprotein IIb/IIIa Antagonists - How long do you wait before neuraxial

A

Ex = tirofiban, eptifibatide, abciximab (TEA)

Tirofiban & Eptifabatide = 4 - 8 horus
Abciximab = 24 - 48 hours

43
Q

Thienopyridine - how long do you wait

A

Clopidogrel - 5- 7 days
Prasurgrel - 7- 10 days
Ticlopidine - 10 days
restart in 24 hours

44
Q

Unfractionated heparin

A

Low dosing (< 5k) = 4 - 6hours
High dosing < 20,000 = 12 hours
> 20, 000 = 24 hours

restart in 1 hour
hold 4 - 6 hours before removal

45
Q

Warfaarin

A

5 days and verify INR

46
Q

10a anti-factor (oral)

A

apixaban
betrixabaan
edoxaban
rivoraxaban

WAIT 72 hours prior to placing

removing = 6 hours before 1st dose

47
Q

Thrombolytic agents

A

i.e., tpa, streptokinase, alteplase, urokinase

ABSOLUTE C/I

48
Q

Conus medullaris in adult

A

L1 L2 vs L3 in kids
Subarachnoid space ends @ S2, vs S3 (kids)

49
Q

Cauda equina cause

A

Neurotoxicity
5% lido & microcatheters = RF

50
Q

TNS

A

Cause = positioning, muscle spasm
RF = lido, lithotomy, ASC, knee arthro
s/s = back/butt pain that radiates to both legs

develops in 6 - 36 hours, persists for 7 days

51
Q

Most common organism for post-spinal meningitis

A

STREPTOCOCCUS VIRIDANS FROM THE MOUTH

APEX (18 decks)

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