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2-General Anesthesia Exam 2 > Neuraxial Anatomy > Flashcards

Neuraxial Anatomy Flashcards

1
Q

What is the total number of cervical vertebrae?

A

7

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2
Q

What is the total number of Thoracic vertebrae?

A

12

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3
Q

What is the total number of Lumbar vertebrae?

A

5

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4
Q

What is the total number of Sacral vertebrae?

A

5

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5
Q

What is the total number of Coccyx vertebrae?

A

4

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6
Q

What is the location of the conus medullaris in an adult?

A

Conus medullaris terminates at L1/L2 in the adult

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7
Q

What is the location of the conus medullaris in an newborn?

A

L3

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8
Q

What is the spinal cord referred to after the conus medullaris?

A

cauda equina (L2 – sacral)

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9
Q

What is a lumbar laminectomy?

A

Surgery that creates space by removing the lamina

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10
Q

What is the goal of lumbar laminectomy?

A

Enlarges your spinal canal to relieve pressure on the spinal cord or nerves

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11
Q

What is important to know about the vertebral column?

A

Size and shape of vertebral lamina and spinous processes differ

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12
Q

What is the characteristics of the cervical and thoracic vertebrae?

A

have more acutely angled spinous processes

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13
Q

What is the characteristics of the lumbar vertebrae?

A

larger and spinous processes are shorter, broader, and have less overlap

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14
Q

Where is it more difficult to access the areas for spinal and epidural placement?

A

Cervical and thoracic

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15
Q

Where is it more easier to access the areas for spinal and epidural placement?

A

Lumbar

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16
Q

There are ______ natural curves in the vertebral column.

A

four

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17
Q

What are the concave anteriorly vertebrae?

A

thoracic and sacral

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18
Q

What are the concave posteriorly vertebrae?

A

cervical and lumbar

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19
Q

Define scoliosis.

A

Lateral curvature, Most common abnormal curvature

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20
Q

Define Kyphosis.

A

Excessive posterior curvature or hump, typically in thoracic region

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21
Q

Define excessive lordosis.

A

Hollowing of the back as body attempts to restore center of gravity

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22
Q

What is the spinothalamic function of the spinal cord?

A

pain, temperature, itch, and general or light touch sensations

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23
Q

What is the corticospinal function of the spinal cord?

A

voluntary motor function

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24
Q

What is the major vessel that supplies blood to the thoracolumbar segment?

A

Artery of Adamkiewicz

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25
Q

What is another name for Artery of Adamkiewicz?

A

Also known as a radicular artery or radiculo-medullary artery

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26
Q

What is important to know about the origination of the artery of Adamkiewicz?

A

Nagelhout T7
Barash T8-T12 in 75% of cases and L1/L2 in an additional 10% of cases

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27
Q

Where does the Artery of Adamkiewicz supply blood?

A

Provides major blood supply to the lumbar and sacral cord.

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28
Q

What can happen if loss of flow occurs with the Artery of Adamkiewicz?

A

Loss of flow can result in anterior spinal artery syndrome (watershed area)

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29
Q

What is decreased in anterior spinal artery syndrome (watershed area)?

A

Dysfunction of the anterior 2/3 of the cord, including the anterior horns, the spinothalamic tracts, and the corticospinal tracts

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30
Q

How do patients present with anterior spinal artery syndrome (watershed area)?

A

acute paraparesis and impaired bowel and bladder function

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31
Q

What are the characteristics of the supraspinous ligaments?

A

Strong and cordlike

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32
Q

What does the supraspinous ligament connect?

A

Connects the apices of the spinous processes

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33
Q

What is the major ligament in the cervical and upper thoracic region?

A

Supraspinous ligaments

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34
Q

What are the three layers of the supraspinous ligaments?

A

Superficial layer, Middle and Inner layer

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35
Q

What is the characteristics of the interspinous ligament?

A
  • Absent or in poor quality in the cervical region
  • Thin in the lumbar region
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36
Q

What are the three posterior spinal ligaments?

A

Interspinous ligament & Supraspinous ligaments, Ligamentum Flavum

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37
Q

What is the characteristics of the ligamentum flavum?

A
  • Strongest posterior ligament
  • Joins the vertebral arches through vertical extensions for the adjacent lamina
38
Q

Where does the ligamentum flavum run?

A

Runs caudad from the inferior border of one lamina to the upper border of the lower lamina on both sides of the midline

39
Q

Where does the ligamentum flavum get thicker?

A

At the L2–L3 interspace, the ligamentum flavum is 3- to 5-mm thick. (NYSORA)

40
Q

Define ligamentum flavum

A

Ligamentum flavum: “yellow ligament” made of elastin that preserves upright posture- the elastin prevents buckling of the ligamentum into the spinal canal during extension

41
Q

What is the entire length of the spinal cord?

A

42-45cm in length

42
Q

Where does the spinal cord terminate in adults?

A

Terminates at L2 in most adults, Approximately a 1% exception to this rule

43
Q

Where does the spinal cord terminate in children?

A

Caused by the vertebral column growing faster than the spinal cord

44
Q

Where does the spinal cord taper?

A

conus medullaris

45
Q

What is the cauda equina?

A

Nerve pathways continue in a collection of rootlets called the cauda equina or horse’s tail

46
Q

What is cauda equine syndrome?

A

Occurs when the nerve roots of the cauda equina are compressed and disrupt motor and sensory function to the lower extremities and bladder

47
Q

Where is the cervical enlargement of the spinal cord located?

A

C4-T1
Brachial plexus

48
Q

Where is the Lumbosacral enlargement of the spinal cord located?

A

L2-S3
Lumbar and Sacral Plexuses

49
Q

What are the two spinal enlargements of the spinal cord?

A

Cervical Enlargement & Lumbosacral Enlargement

50
Q

What are the three layers of the spinal cord?

A

Dura mater, arachnoid and pia mater

51
Q

What are the meninges?

A

Provide a protective covering for the cord and nerve roots

52
Q

Where do the meninges extend?

A

Extend from the foramen magnum to the base of the cauda equine

53
Q

What is the location and function of the dura mater?

A
  • Outermost layer
  • Covers the nerve roots while they are inside the spinal canal
54
Q

What is the most protective layer of the spinal cord?

A

Dura mater

55
Q

What is considered the subarachnoid space?

A

The space under this meninge is considered the subarachnoid space and is filled with CSF

56
Q

What is the characteristics of the pia mater?

A
  • Thin
  • In direct contact with the spinal cord
57
Q

What is the characteristics of the arachnoid mater?

A
  • Very thin
  • Consistency of a spiders web
58
Q

What is the epidural space?

A

A potential space outside the dural sac but inside the vertebral canal

59
Q

Where does the epidural space occur?

A

Continuous from the base of the cranium to the base of the sacrum at the sacrococcygeal membrane

60
Q

What is contained in the epidural space?

A

Contains epidural veins, fat, lymphatics, segmental arteries and nerve roots

61
Q

What is fat in terms of the epidural space?

A

Fat is physiologically fluid acting as padding and lubrication for the movement of neural structures within the canal

62
Q

What is important to know about the distance to the epidural space in individuals?

A

Distance to epidural space varies with vertebral level and is loosely correlated with patient weight

63
Q

What offers greatest epidural space?

A

Midline approach (versus paramedian) offers greatest epidural space

64
Q

What is the distance from the skin to the lumbar epidural space?

A

2.5-8cm, mean 5cm

65
Q

What is the distance from the midline thoracic epidural space?

A

3-5 cm

66
Q

What is the distance from the midline lower cervical region of epidural space?

A

1.5-2cm

67
Q

What is a dermatome?

A

The area of cutaneous sensation supplied by a spinal nerve that is anatomically identified as it passes through an intervertebral foramen

68
Q

What can be useful to help identify dermatomes?

A

Anatomic map

69
Q

Dermatomes are based on what?

A

cutaneous sensation

70
Q

What is the function of dermatomes in anesthesia?

A

Used to document the functional level of blockade in regional anesthetics

71
Q

What is the primary site of MOA of local anesthetics?

A

on the nerve roots within the spinal cord

72
Q

What is affected with drug concentrations at a minimal effective concentration?

A

When drug concentrations reach a minimum effective concentration neuronal transmission is altered by affecting sodium ion channels

73
Q

Neurons differ in _______ to local anesthetics

A

Susceptibility

74
Q

What is a differential block?

A

finds lack of transmission of autonomic nerves, but retains sensory and motor nerve function

75
Q

When can differential blocks be used?

A

Differential blocks an opportunity/risk in cases where sensory anesthesia is the goal without sympathetic blockade in patients with coexisting disease

76
Q

Label the dermatome man.

A

Slide 27

77
Q

What are the components of differential blockade?

A

Sensory, motor, sympathetic nerve functions obtunded at different rates and degree

78
Q

What gives a differential block its main characteristics?

A

size, myelination, ion channel composition, LA type and concentration

79
Q

What is the onset sequence of neuraxial blockade?

A

Autonomic→ superficial pain→ touch→ temperature→ motor function→ proprioception (Nagelhout & Elisha)

80
Q

What is the reverse sequence of neuraxial blockade?

A

proprioception→function→ motor →temperature → touch→pain→ superficial →Autonomic

81
Q

What is true about sympathetic blockade and differential?

A

Differential blockade of the local anesthetics (sympathetic blockade may be a high as 2-6 dermatomes higher than the sensory); which is higher than the motor block

82
Q

What is true about analegisa differential blockade?

A

(loss to sharp pain) 2+ segments cephalad than touch- sometimes patient still feel “touch” or pulling sensations on less dense blocks- shouldn’t be painful

83
Q

What is the sensation block order?

A

cold temp; sharp pain; touch

84
Q

What is true about the MOA of an epidural injection?

A

must spread and diffuse through meninges and dural cuffs to reach nerve roots or spinal cord

85
Q

Neuraxial: Injectate travels by ________ flow rather than diffusion and in a non-circumferential manner

A

bulk

86
Q

What is true about the MOA of spinal injections?

A

denser unless modifications are made to the epidural, such as increasing concentration, volume, or time

87
Q

What are the abolute and relative contraindications to neuraxial?

A

Review slide 34

88
Q

What is the contraindicated platelet count for a neuraxial?

A

Platelets less than 100,000 and/or PT/PTT/Bleeding time greater than 2x normal

89
Q

Can you do a neuraxial on a tattoo?

A

Depends on when and where it was done

90
Q

What is occuring in this picture? What is the intervention?

A

Epidural hemotoma, immediately going to the OR

2-General Anesthesia Exam 2 (11 decks)

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