Neuraxial Anesthesia

Question 1

Define neuraxial anesthesia

Answer 1

A local anesthetic placed anywhere in the spinal column

Question 2

What is intrathecal

Answer 2

The fluid filled space immediately surrounding the spinal column

Question 3

When was cerebral spinal fluid first identified?

Answer 3

1764 by Cotugno

Question 4

A fluid filled pocket inside the spinal cord is also known as what?

Answer 4

Syrinx

Question 5

What provides stability to the spine when bending over?

Answer 5

Ligamentum flavum

Question 6

What is the dermatome at the level of the nipple?

Answer 6

T4

Question 7

What is the dermatome at the level of the kidneys and uterus?

Answer 7

T10

Question 8

What is the dermatome at the level of the vaginal introitus?

Answer 8

S2/S3

Question 9

True or false: sensory pathways can ascend up to two levels higher than the organ there innervating

Answer 9

True

Question 10

Name the five factors that you can alter in an epidural?

Answer 10

Location
Rate
Drug
Concentration
Adjuncts

Question 11

What is the therapy index?

Answer 11

When more anesthesia is required to have a complete motor and sensory block instead of just finding the comfort zone

Question 12

Rate of infusion is determined by what?

Answer 12

Distribution of the local!

Question 13

In what order do local anesthetics affect the nerves?

Answer 13

Sympathetic
Sensory
Motor

Question 14

The patient is complaining that they are too numb and cannot move, which should you address? the concentration or the rate?

Answer 14

Concentration

Question 15

What is preload?

Answer 15

The act of administering a bolus of 1 to 2 L immediately prior to placing a neuraxial block

Question 16

What is coload?

Answer 16

The administration of 1 to 2 L of fluid as a block is in the process of setting up

Question 17

What is the purpose of coload?

Answer 17

It lowers the rate of hypotensive events

Question 18

What type of needle is used for epidurals?

Answer 18

Touhy needle

Question 19

What is the difference between a cutting needle and a splitting needle?

Answer 19

A cutting needle creates space via a semi-lunar cut

A splitting needle is more of a “shotgun” approach and creates an inflammatory response

Question 20

The loss of resistance method is used for epidurals or spinals?

Answer 20

Epidurals

Question 21

What do you do when you’ve dosed the catheter and no block is seen?

Answer 21

Replace it

Question 22

The patient is complaining that they’re only feeling the block on one side what may have happened?

Answer 22

The catheter may be in too far
Patient may have been lying on one side too long
They may have a septated epidural space

Question 23

What are some possible causes of a patchy block?

Answer 23

There is a window caused by air around the nerve root
There could be an anomaly in the epidural space preventing local anesthetic penetration
The malpresentation could be resulting in compression of a single nerve root

Question 24

Following the placement and bolus of the epidural the patient’s blood pressure has fallen to 80s / 30s. What should you do?

Answer 24

Check for decreased fetal heart tones and other signs of inadequate perfusion
Left uterine displacement
Pressers and a fluid bolus

Question 25

True or false: Both ephedrine and phenylepherine cross the fetal blood barrier

Answer 25

False only ephedrine crosses the fetal blood barrier

Question 26

What is the Valsalva maneuver?

Answer 26

The act of “pushing” the baby out

Question 27

Which receptor is the cause of pruritis?

Answer 27

μ receptor

Question 28

What are some possible treatments for post opioid pruritus?

Answer 28

Zofran can possibly reduce
Nubain
Narcan drip