neuraxial blocks part 2 Flashcards

1
Q

4 key SE of neuraxial opioids

A
  1. pruritis
  2. urinary retention
  3. resp depression
  4. n/v
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2
Q

MOA of pruritis during neuraxial blockade

A

stimulation of opioid receptors in trigeminal nucleus or some other type of opioid triggered neural process

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3
Q

MOA of early versus late stage resp depression (most often both in hydrophilic)

A

early (<6h) results from systemic absorption
late (>6h) results from tendency of hydrophilic opioids to ascent towards brainstem where they can inhibit resp center

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4
Q

resp depression is more common with (6)

A

high opioid doses
co administered sedatives
low lipid solubility
advanced age
opioid naivety
increased ITP

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5
Q

urinary retention from neuraxial opioids MOA

A

inhibition of sacral PSNS tone aka SNS tone is winning

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6
Q

n/v from neuraxial opioids MOA

A

caused by activation of opioid receptors in the area postrema of medulla and vestibular apparatus

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7
Q

transfer of opioids from epidural space to breast milk

A

minimal

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8
Q

which LA decreases efficacy of neuraxial opioids

A

2 chlorprocaine

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9
Q

neuraxial blocks are contraindicated if platelet count is what and coags are

A

platelet count <100,000
coags are 2x normal value (aPTT, PT, or bleeding time)

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10
Q

contraindications to neuraxial opioids include

A

-increase in ICP
-sepsis
-infection at puncture site
-hypovolemia
-valve lesions with fixed SV
-scoliosis, arthritis, spinal fusions, osteoporosis
-full stomach
-peripheral neuropathy (theory that patients are more susceptible to injury)
-MS
-spina bifida

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11
Q

ID this type of spinal needle

A

quincke

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12
Q

ID this type of spinal needle

A

sprotte

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13
Q

ID this type of spinal needle

A

whitacre

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14
Q

ID this type of spinal needle

A

green

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15
Q

ID 3 types of spinal needles

A

cutting tip (quincke)
pencil point (sprotte, whitacre)
rounded bevel (green)

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16
Q

ID these 3 types of epidural needles

17
Q

how deep is epidural space

A

3-5cm from skin surface

18
Q

absolute contraindications to caudal anesthesia

A

spina bifida
myelomeningocele of sacrum
meningitis

19
Q

relative contraindications to caudal anesthesia

A

pilondial cyst
abnormal superficial landmarks
hydrocephalus
intracranial tumor
progressive degenerative neuropathy

20
Q

caudal block technique
position of patient
landmarks
needle type

A

-performed in lateral or prone position
-in lateral position (Simms) top leg flexed more than bottom leg
-in prone position, small roll should be placed under iliac crests with legs in frog position
-using PSIS and sacral hiatus as land marks, envision equilateral triangle with apex of triangle at sacral hiatus
-use 22 or 25g needle or 20g IVC at 45 degree angle angling cephalad
-advance until you hear a pop then drop the angle and advance

21
Q

you should not use ______ for loss of resistance in children during epidurals

A

air (risk of air embolism)

22
Q

resistance to injection during caudal block suggests needle is in

A

subperiosteal area

23
Q

what feeling may patient experience as a caudal epidural is setting up

A

feeling of fullness in sacrum

24
Q

placing the needle tip beyond ______ increases the risk of of dural puncture during caudal block

25
during a caudal block, how to you angle the needle
once you feel a pop, drop the angle from 45 degrees
26
how to dose a caudal block pediatric adult
peds: .5mL/kg adult 12-15mL
27
how to dose a sacral to low thoracic block (T10) pediatric adult
peds: 1mL/kg adult: 20-30mL
28
how to dose a sacral to mid thoracic anesthetic pediatric adult
peds: 1.25mL/kg adult: n/a
29
peds dose maximums for caudal block
dont exceed total dose of 2.5-3mg/kg
30
common procedures where a caudal block is useful
circumcision hypospadias repair anal surgery inguinal herniorrhaphy low thoracic surgery
31
presenting symptoms of epidural hematoma
LE weakness, numbness, low back pain, bowel and bladder dysfunction surgical decompression within 8 hours is the best chance of recovery risk of epidural hematoma is similar during block placement and catheter removal