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AS - N931 Advanced Principles of Anesthesia > Neuraxial Anesthesia > Flashcards

Neuraxial Anesthesia Flashcards

1
Q

Neuraxial Anesthesia

A 
Local anesthetic placed around CNS
Includes the following:
- Spinal
- Epidural 
- Caudal
- Regional
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2
Q

Vertebral Column:
___ Bones
___ Spinal Nerves

A

33 bones sequentially interconnected
Separated by fibrocartilaginous disks

31 spinal nerves

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3
Q 
Vertebral Bones:
\_\_\_ Cervical
\_\_\_ Thoracic
\_\_\_ Lumbar
\_\_\_ Sacrum
\_\_\_ Coccyx
A 
7 cervical 
12 thoracic
5 lumbar
5 sacrum (fused)
4 coccyx
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4
Q 
Spinal Nerves:
\_\_\_ Cervical
\_\_\_ Thoracic
\_\_\_ Lumbar
\_\_\_ Sacrum
\_\_\_ Coccyx
A 
8 cervical nerve pairs
Only 7 cervical bones
12 thoracic
5 lumbar
5 sacrum
0 coccyx
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5
Q

Anterior Curvature

A

Cervical & lumbar

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6
Q

Posterior Curvature

A

Thoracic & sacral

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7
Q

Anatomic Landmarks

A

Vertebra prominens C7
Inferior scapula angle T7
Tuffier’s line L4-L5 disc

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8
Q

Lumbarization

A

L5 & S1 fused

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9
Q

Sacralization

A

S1 & S2 fused

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10
Q

Spinal Structure Order

needle path when placing epidural or spinal

A
  1. Skin
  2. Subcutaneous tissue & fat
  3. Supraspinous ligament
  4. Interspinous ligament
  5. Ligamentum flavum
  6. Epidural space
  7. Dura
  8. Subarachnoid space
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11
Q

Supraspinous Ligament

A

Strong fibrous cord that connects spinous processes at the apex

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12
Q

Interspinous Ligament

A

3 layers
Thin & membranous ligament that connects adjoining spinous processes
Limits spinal flexion

Thinner in the lumbar region

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13
Q

Ligamentum Flavum

A

Yellow, elastic tissue
Strongest & most posterior
“crunchy”

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14
Q

Spinal Cord Length

A

Average 40cm
Men 45cm

Diameter 1cm
Wider in cervical/lumbar regions d/t extremities

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15
Q

Spinal Cord Layers

A

DAP →

Dura mater - tough mother, outermost thick
Arachnoid mater - spider web
Pia mater - loving, tender mother

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16
Q

Dura Mater

A

Outermost
Tough fibrous layer
Extends from foramen magnum to S2-S3

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17
Q

Arachnoid Mater

A

Delicate middle layer
Spider web
Non-vascular
Ends at S2

18
Q

Subarachnoid Space

A

B/w pia & arachnoid mater
CSF found here
Spinal anesthesia site - subarachnoid & intrathecal
Local anesthetic spinal target direct proximity to spinal nerves ↓amount/dose

19
Q

Pia Mater

A

Tightly bound
Highly vascular
Covers the spinal cord

20
Q

Spinal Cord Level

A

Extends to L1-L2 in adults
Place spinal anesthesia BELOW spinal cord level
Less likely to cause damage in cauda equina (only axons no cell bodies)

Longer in children L3
Caudal anesthesia ideal d/t anatomy

21
Q

Conus Medullaris

A

Cone shaped spinal cord end

22
Q

Filum Terminae

A

1st sacral vertebral soma

23
Q

Cauda Equina

A

Horse’s tail
Only nerve axons
Hang freely w/in thecal or dural sac
Less likely to puncture nerve root

24
Q

Epidural Space

A

Potential space
Continuous w/in vertebral canal

Contains fat, arteries, veins, lymphatics, & nerve roots

25
Q

Average distance from skin to lumbar epidural space = ___ cm

A

5cm
2.5-8cm
Dependent on intervertebral space & body habitus
Varies based on location w/in vertebral column
Lumbar vs. sacral

26
Q

CSF

A

Cerebral spinal fluid located b/w pia & arachnoid mater w/in the subarachnoid space
Clear, colorless fluid (straw, pale yellow)
Selective blood filtrate
1.003-1.009 specific gravity

27
Q

CSF Function

A

Mechanical buffer to protect the brain & spinal cord

28
Q

Total CSF Volume

A

Adult 150mL
Produce 21mL/hr
Spinal subarachnoid space holds 20-35mL

29
Q

Spinal Cord Blood Supply

A

Arterial distribution:
- Segmental arteries
- Longitudinal arteries (2/3 anterior x1 & 1/3 posterior x2)
Artery of Adamkiewicz (anterior artery supplies distal 2/3 spinal cord) T9-12
- Radicular

Venous:
- Epidural veins
- Valveless plexus
- Most prominent lateral 
Engorged in pregnant & obese patients
Venous congestion ↑puncture risk
30
Q

Dermatomes

A

Cutaneous sensation map
Method to determine block functional level
Based on embryonic development

31
Q

T4

A

Nipple line

32
Q

T10

A

Umbilicus

33
Q

Spinal Anesthesia

A

One shot
Trendelenburg to help LA move upward
↓dosage direct contact w/ spinal nerves

34
Q

Epidural Anesthesia

A

Able to titrate medication and potential convert labor pain epidural to C/S epidural
↑LA amount/dose d/t no direct contact w/ spinal nerves

35
Q

Caudal Anesthesia

A

Epidural type

Ideal w/ children

36
Q

Regional Anesthesia

A

Related to specific region

Shoulder or ankle block

37
Q

Scoliosis

A

Lateral spine curvature

Potential to restrict lung expansion

38
Q

Kyphosis

A

Excessive posterior curvature or hunchback

Elderly patients

39
Q

Lordosis

A

Excessive anterior curvature
Obese or pregnant patients
Attempt to compensate & maintain gravitational center

40
Q

Identify & Label Vertebrae

A 
Body
Pedicle
Lamina
Transverse process
Spinous process
Vertebral foramen
Intervertebral foramen
Superior articulating process
Inferior articulating process

AS - N931 Advanced Principles of Anesthesia (17 decks)

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