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APEX > Neuraxial Blocks > Flashcards

Neuraxial Blocks Flashcards

1
Q
A

Superior articular process

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2
Q

The vertebral column is formed by ____ vertebrae?

A

33
Cervical = 7
Thoracic = 12
Lumbar = 5
Sacral = 5-fused
Coccygeal = 4-fused

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3
Q

What does letter D represent?

A

Spinous process

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4
Q

What does A represent?

A

Transverse process

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5
Q

What does C represent?

A

Lamina

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6
Q

Cervical and thoracic spinous processes angle in a ____ direction. This requires a more ____ approach with the needle.

A

Caudal; cephalad

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7
Q
A

Vertebra prominent C7

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8
Q
A

Spine of scapula T3

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9
Q
A

Inferior angle of scapula T7

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10
Q
A

Rib margin 10cm from midline L1

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11
Q
A

Superior aspect of iliac crest L4

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12
Q
A

Posterior superior iliac spine S2

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13
Q

The intercristal line (aka ________) is a horizontal line drawn across the superior aspects of the iliac crests that correlates with the ____ vertebra.

A

Tuffier’s line; L4

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14
Q

In infants up to 1 year, the intercristal line (Tuffier’s line) correlates with the ____ interspace.

A

L5-S1

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15
Q
A

Pedicle

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16
Q

What does A represent?

A

Superior articular process

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17
Q

What does B represent?

A

Transverse process

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18
Q

What does C represent?

A

Lamina

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19
Q

What does D represent?

A

Inferior articular process

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20
Q

What does E represent?

A

Spinous process

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21
Q

In the adult, which anatomic structure correlates with the termination of the dural sac?

A

Superior iliac spines (S2)

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22
Q

Conus medullaris is at which vertebral level?

A

L1

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23
Q

The sacral hiatus and sacrococcygeal ligament is at which level?

A

S5

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24
Q

Cauda equina is comprised of nerves and nerve roots from the ____ nerve pairs and the ____ nerve.

A

L2-S5;
Coccygeal

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25
Q

The subarachnoid space terminates at the ______ in an adult _____ & infant ____

A

Dural sac
S2
S3

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26
Q

Anchors the spinal cord to the coccyx

A

Filum terminale

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27
Q

The filum terminale is fixated at which two points?

A
  1. Conus medullaris
  2. Coccyx
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28
Q

Order the spinal ligaments from superficial to deep

A

1.Supraspinous ligament
2. Interspinous ligament
3. Ligamentum flavum
4. Posterior longitudinal ligament
5. Anterior longitudinal ligament

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29
Q

What does A represent?

A

Supraspinatus ligament

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30
Q

What does B represent?

A

Interspinous ligament

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31
Q

What does C represent?

A

Ligamentum flavum

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32
Q

What does D represent?

A

Posterior longitudinal ligament

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33
Q

What does E represent?

A

Anterior longitudinal ligament

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34
Q

What does A represent?

A

Supraspinous ligament

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35
Q

What does B represent?

A

Interspinous ligament

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36
Q

What does C represent?

A

Ligamentum flavum

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37
Q

What does D represent?

A

Posterior longitudinal ligament

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38
Q

What does E represent?

A

Anterior longitudinal ligament

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39
Q

Piercing the ______ contributes to the loss of resistance when the needle enters the epidural space.

A

Ligamentum flavum

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40
Q

The needle passes through what 3 ligaments during the midline approach?

A
  1. Supraspinous ligament
  2. Interspinous ligament
  3. Ligamentum flavum
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41
Q

What ligament does the needle pass through during the paramedian or Taylor approach?

A

Ligamentum flavum

42
Q

The paramedian approach involves inserting the needle ____ degrees off the midline or _________ to the interspace

A

15 degrees;
1cm lateral and 1cm inferior

43
Q

Which statements about the epidural space are true?

A. Batson’s plexus passes through the lateral region.
B. Its volume is increased during the third stage of pregnancy
C. It neighbors the pia mater
D. It ends at the sacrococcygeal ligament

A

A & D

44
Q

_______ is the network of epidural veins that drain the spinal cord and the meninges. It typically passes through the lateral and anterior regions of the epidural space

A

Batson’s plexus

45
Q

Transection of the C6 posterior nerve root will cause?

A

Sensory block of the thumb

46
Q

The ____ roots are sensory, and the _____ roots are motor and autonomic.

A

Posterior (dorsal); anterior (ventral)

47
Q

Diaphragmatic paralysis occurs with injury to ______

A

C3-5

48
Q

What dermatome block height level is required for upper abdominal surgery, cesarean section, & cystectomy?

A

T4 nipple line

49
Q

What dermatome block height level is required for lower abdominal surgery and appendectomy?

A

T6-T7 (xiphoid process)

50
Q

What dermatome block height level is required for total hip arthroplasty, vaginal delivery, & TURP?

A

T10 (umbilicus)

51
Q

What dermatome block height level is required for lower extremity surgery?

A

L1-L3 (inguinal ligament)

52
Q

What dermatome block height level is required for foot surgery?

A

L2-L3

53
Q

What dermatome block level is required for Hemorrhoidectomy?

A

S2-S5

54
Q

Blockade of cardio accelerator nerves occurs at which levels?

A

T1-T4

55
Q

In the ______ space, the primary site of local anesthetic action is not eh myelinated preganglionic fibers of the spinal nerve roots

A

Subarachnoid

56
Q

What is the most reliable determinant of intrathecal spread when using hypo- or isotonic solution?

A

Dose

57
Q

What is the most reliable determinant of intrathecal spread when using a hyperbaric solution?

A

Baricity

58
Q

Sensory blockade is ___ dermatomes above the motor block. (Spinal)

A

2

59
Q

Autonomic blockage is ___ dermatomes above the sensory block. (Spinal)

A

2-6

60
Q

What are the primary determinants of spread in epidural anesthesia?

A

Volume and level of injection

61
Q

What structure must be traversed by epidural LAs and what is their primary target?

A

LA in the epidural space must first diffuse through the dural cuff before they can anesthetize the nerve roots

62
Q

What type of fiber is blocked first after a spinal anesthetic?

A

Type B- preganglionic ANS fibers

63
Q

Skeletal muscle- motor
Proprioception

A

A alpha

64
Q

Touch
Pressure

A

A beta

65
Q

Skeletal muscle- tone

A

A Gamma

66
Q

Fast pain
Temperature
Touch

A

A delta

67
Q

Preganglionic ANS fibers

A

B

68
Q

Postganglionic ANS fibers

A

C (sympathetic)

69
Q

Slow pain
Temperature
Touch

A

C (dorsal root)

70
Q

_____ is the determinant of epidural block height

A

Volume

71
Q

____ is the primary determinant of epidural block density

A

Concentration

72
Q

What are the 3 most important factors that determine local anesthetic spread in the subarachnoid space?

A

Baricity, patient position, & LA dose

73
Q

In the supine position:
The greatest points of lordosis are ___ & ___
The greatest points of kyphosis are ___ & ___

A

C5 & L3;
T5-T7 & S2

74
Q

In the supine position, how will a hypobaric solution spread in the intrathecal space?

A

It will concentrate in the lower lumbar region

75
Q

After administering a hyperbaric solution, the block is not as high as expected. What can you do?

A

If the block hasn’t set, you can place the pt in the trendelenburg position

76
Q

Define baricity

A

The ratio is the density of local anesthetic solution to the density of CSF

77
Q

The gut receives parasympathetic innervation from ____ and sympathetic innervation from ____

A

Vagus nerve (CN 10);
Sympathetic chain (T5-L2)

78
Q

What reflex contributes to asystole that occurs with spinal anesthesia?

A

Bezold-Jarisch reflex. The heart slows to allow it adequate time to fill

79
Q

What is the most likely cause of apnea due to spinal anesthesia?

A

Brainstem hypoperfusion

80
Q

Neuraxial opioids inhibit afferent pain transmission in the ______ (lamina _ of the dorsal horn)

A

Substantia gelatinosa; 2

81
Q

List 3 valvular lesions that are generally regarded as contraindications for neuraxial anesthesia

A

AS, MS, hypertrophic cardiomyopathy

82
Q

For a T10 sensory caudal block, how much LA should be administered?

A

1ml/kg

83
Q

What are absolute C/I to caudal anesthesia?

A

Spina bifida
Meningomyelocele
Meningitis

84
Q

What are the relative C/I to caudal anesthesia?

A

Pilonidal cyst
Abnormal superficial landmarks
Hydrocephalus
Intracranial tumor
Progressive degenerative neuropathy

85
Q

What ligament is punctured when performing a caudal block?

A

Sacrococcygeal ligament

86
Q

To remove an epidural catheter, hold lovenox for ___ and restart in ____

A

12 hrs; 4 hrs

87
Q

Surgical decompression of epidural hematoma within ___ offers the best chance of recovery

A

8 hours

88
Q

A patient presents with lower extremity weakness, numbness, low back pain, and bowel and bladder dysfunction after neuraxial anesthesia. What is the most likely cause?

A

Epidural hematoma

89
Q

How long must clopidogrel be discontinued before doing a neuraxial block?

A

7 days

90
Q

How long must Enoxaparin be discontinued before performing a neuraxial block

A

Prophylactic dosing = 12 hrs
Therapeutic dosing = 24 hrs

91
Q

What are the most common side effects of an epidural blood patch?

A

Backache & radicular pain

92
Q

Transient neurological symptoms respond to what?

A

NSAIDs, opioids, trigger point injection

93
Q

______ is the most common cause of TNS

A

Lidocaine

94
Q

What medication can be given to prevent the Bezold-Jarisch reflex during spinal anesthesia?

A

Ondansetron (5-HT3 receptor antagonists)

95
Q

What factors increase risk of cauda equina syndrome? Why?

A

5% lidocaine & microcatheters.

Microcatheters focus LA on a small area of the cord, exposing this region to a high concentration of LA

96
Q

Neurotoxicity is the result of exposure to high concentrations of LA leading to?

A

Cauda equina syndrome

97
Q

Bowel and bladder dysfunction, sensory deficits, weakness, & paralysis are symptoms of what?

A

Cauda equina syndrome

98
Q

Patient positioning, stretching of the sciatic nerve, myofascial strain, and muscle spasm can lead to what?

A

Transient neurologic symptoms

99
Q

What factors increase the risk of TNS?

A

Lidocaine, lithotomy position, ambulatory surgery, & knee arthroscopy

100
Q

Sever back & butt pain that radiates to both legs. Usually within 6 - 36 hrs of neuraxial anesthesia and persists for 1 - 7 days

A

TNS (transient neurologic symptoms)

101
Q

What is the BEST course of action when an epidural catheter breaks during its removal?

A

Leave it inside the patient

102
Q

How does neuronal anesthesia cause hypotension?

A

The primary mechanism is anesthetic blockade of the preganglionic B fibers in the sympathetic chain (sympathectomy)

APEX (29 decks)

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