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Principles of Anesthesia I - Summer 24 > Neuraxial Complications - Exam 1 > Flashcards

Neuraxial Complications - Exam 1 Flashcards

1
Q

Symptoms of PDPH

A
  1. HA - worse when sitting/standing & better when lying down
  2. 2-3 days post puncture
  3. HA felt frontal to occipital
  4. nausea
  5. light sensitivity, double vision, ringing in ears
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2
Q

Tx for PDPH

A
  1. bed rest
  2. NSAIDs
  3. Caffeine
  4. Epidural Blood patch
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3
Q

What nerves are affected w/ cauda equina syndrome?

A

L2-S5 & coccygeal nerve

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4
Q

Cause of cauda equina syndrome

A

high levels of LA drugs affecting nerve function

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5
Q

Factors that increase risk of cauda equina syndrome

A
  1. high concentration of LA (5% Lido in SAB)
  2. microcatheters - epidural
  3. Whiticare 25/26 = small needles
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6
Q

Signs/symptoms of cauda equina syndrome

A
  1. neuro complication can be permanent
  2. bowel/bladder dysfunction
  3. sensory deficits (feet/legs)
  4. back pain
  5. saddle anesthesia
  6. sexual dysfunction
  7. weakness/paralysis
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7
Q

Tx of cauda equina syndrome

A
  1. supportive care
  2. If compression present (disc, hematoma) - laminectomy needed <6hrs
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8
Q

Causes of Transient Neurological Symptoms

A
  1. improper pt positioning - stretches nerves (sciatic)
  2. myofascial strain & spasms
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9
Q

Factors that increase risk of transient neurological symptoms

A
  1. higher incidence w/ Lidocaine 5%
  2. surgical positions - lithotomy
  3. out pt surgeries - knee arthroscopies
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10
Q

S/S transient neurological symptoms

A
  1. radicular pain in back and buttocks - spreads down both legs
  2. starts w/i 6-36 hours after sx and lasts 1-7 days
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11
Q

Tx for Transient Neurologic Symptoms

A
  1. NSAIDs/opioids
  2. trigger point injections (spasms & pain)
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12
Q

What type of anesthetic is a unilateral block more common with?

A

Epidural

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13
Q

What are 2 common causes for a unilateral Epidural block?

A
  1. catheter inserted too far
  2. cath tip close to a nerve
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14
Q

How do you know there is a unilateral block?

A

Pt states they can still feel one side

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15
Q

What are possible solutions to fix a unilateral block?

A
  1. adjust the cath (pull out 1-2cm)
  2. Reposition pt w/ numb side up
  3. Admin more anesthetic - caution if 9cm dilated
  4. Cath replacement
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16
Q

What is the most common cause of LAST? What type of block is it most common with?

A
  1. Inadvertent intravenous injection
  2. more common w/ peripheral blocks
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17
Q

What is the most common symptom of LAST?

What about w/ Bupivacaine?

A
  1. Seizures
  2. Cardiac Arrest
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18
Q

LA concentrations

1-5 mcg/mL effect:

A

Analgesia

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19
Q

LA concentrations

5-10mcg/mL effect:

A
  1. Tinnitus
  2. Skeletal muscle twitches
  3. numb lips/tongue
  4. restlessness
  5. vertigo
  6. blurred vision
  • hypotension
  • myocardial depression
20
Q

LA concentrations

10-15 mcg/mL effects

A
  1. Seizures
  2. LOC
21
Q

LA concentrations

15-25 mcg/mL effects

A
  1. Coma
  • respiratory arrest
22
Q

LA concentrations

> 25 mcg/mL effect

A
  • cardiovascular collapse
23
Q

LAST

What 3 things increase the risk of CNS toxicity?

A
  1. Hypercarbia (vasodilation)
  2. Hyperkalemia (high Vrm)
  3. Metabolic Acidosis (ion trapping)
24
Q

LAST

What 3 things decrease the risk of CNS toxicity?

A
  1. Hypocarbia (Vasoconstriction)
  2. Hypokalemia (lower Vrm)
  3. CNS depressants (raise seizure threshold)
25
Q

LAST

LA decreases the heart’s ________, ________ ________, ____ ________, & the ________ ________ period.

A
  1. automaticity
  2. conduction velocity
  3. AP duration
  4. Effective refractory period
26
Q

LAST

What determines the extent of cardiotoxicity r/t LA?

A
  1. the LA affinity to the VG Na channel
  2. Rate of dissociation from the receptor in diastole
27
Q

LAST

Why is Bupivacaine so cardiotoxic?

A
  1. it has a high affinity to VG Na channel
  2. slower dissociation rate from receptor in diastole
28
Q

LAST

order of 4 anesthetics in difficult of cardiac resuscitation

A

Bupivacaine > Levobupivacaine > ropivacaine > Lidocaine

29
Q

Tx of LAST

A
  1. Manage the airway
  2. Tx Seizures (Benzos)
  3. Modified ACLS ) < 1 mcg/kg epi
30
Q

LAST

Lipid Emulsion MOA

A
  • 20% lipid molecules
  • sequesters and reduces LA plasma concentration
31
Q

Lipid Emulsion

Metabolic effects (heart):

A
  • boosts myocardial fatty acid metabolism
  • increases heart energy use
32
Q

Lipid Emulsion

Inotropic effect

A

increases myocardial calcium influx & intracellular Ca concentration

33
Q

Lipid Emulsion

Membrane Effect:

A

Impairs LA binding to VG Na Channels

34
Q

Lipid Emulsion

Admin >70kg

A
  1. 100mL bolus (2-3min)
  2. 250mL infusion for 15-20min
  3. repeat or double if unstable
35
Q

Lipid Emulsion

Admin < 70kg

A
  1. 1.5mL/kg bolus (2-3min)
  2. 0.25mL/kg/min infusion
  3. repeat or double if unstable
36
Q

Lipid Emulsion

MAX DOSE

A

12mL/kg

37
Q

LAST

How long do pts need observed after seizure?

after CV instability?

A
  1. 2 hrs - seizures
  2. CV - 4-6hrs
38
Q

LAST ALGORITHM

What 4 meds should we avoid in these pts?

A
  1. LA
  2. BBs
  3. CCBs
  4. Vasopressin - pulmonary hemorrhage
39
Q

What 3 things are an epidural/spinal hematoma associated with?

A
  1. pre-existing clotting/hemostasis abnormalities
  2. traumatic/difficult placement
  3. indwelling catheters & long-term anticoagulation
40
Q

Epidural Hematoma

Cord ischemia is reversible if a ________ is performed in < ________.

A

Laminectomy, 8 hrs

41
Q

What is a major symptom of epidural hematoma?

A

PAIN

42
Q

What is Arachnoiditis

A

Inflammation of the meninges (inflamed arachnoid mater around spinal nerves)

43
Q

Arachnoiditis 1st sign -

A

fever 2-3 days post procedure

44
Q

Arachnoiditis causes -

A
  1. non-approved admin of drug into intrathecal/epidural space (med error)
  2. non-preservative free solutions
  3. betadine contamination
45
Q

Arachnoiditis management

A

pain management & PT

46
Q

What 2 things can arachnoiditis lead to?

A
  1. sclerosis of arachnoid membranes
  2. constriction of vascular supply

Principles of Anesthesia I - Summer 24 (14 decks)

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