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Anesthesia Principles 1 > Neuraxial (Epidural, Spinal) Anesthesia > Flashcards

Neuraxial (Epidural, Spinal) Anesthesia Flashcards

1
Q

Vertebra prominens landmark

A

C7

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2
Q

Spine of Scapula landmark

A

T3

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3
Q

Inferior angle of scapula

A

T7

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4
Q

Rib margin 10 cm from midline

A

L1

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5
Q

Superior aspect of iliac crest

A

L4

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6
Q

Posterior superior iliac spine

A

S2

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7
Q

Horizontal line drawn across the superior aspects of the iliac crests that correlate with L4

A

Intercristal line (Tuffier’s line)

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8
Q

the interspace ABOVE the intercristal line correlates with…

A

L3-L4

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9
Q

The interspace BELOW the intercristal line correlates with….

A

L4-L5

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10
Q

Infants up to 1 year, intercristal line correlates with…

A

L5-S1

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11
Q

Conus medullaris

A

L1

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12
Q

Dural sac ends at….

A

S2 (correlates with superior iliac spines)

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13
Q

Sacral hiatus and sacrococcygeal ligament landmark

A

S5

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14
Q

Provides and entry point to the epidural space useful in peds

A

sacral hiatus

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15
Q

Used as landmarks for caudal anesthesia

A

Sacral cornua

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16
Q

Conus medullar is in adults? Peds?

A

Adults= L1-L2
Peds= L3

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17
Q

Cauda equina extends from ______ to the ________.

A

from conus medullaris to the dural sac

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18
Q

The subarachnoid space terminates at the ________.

A

Dural Sac (Adult= S2, Peds= S3)

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19
Q

Anchors the spinal cord to the coccyx

A

Filum Terminale

The internal portion extends from the conus medullaris to the dural sac, and the external portion extends from dural sac into the sacrum.

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20
Q

Where does the epidural space end?

A

The sacrococcygeal ligament

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21
Q

Risk for obese and pregnant patients when performing epidural

A

Batson’s plexus (epidural veins) are engorged which increases risk of vascular injury

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22
Q

What does the subarachnoid space contain?

A

CSF, Nerve roots, rootlets, and spinal cord

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23
Q

The terminal end of the subarachnoid space is called the ________.

A

Dural Sac (S2 in adult, S3 in infant)

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24
Q

Cranial border

A

Foramen magnum

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25
Q

Caudal border

A

Sacrococcygeal ligament

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26
Q

Anterior border

A

Posterior longitudinal ligament

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27
Q

Lateral border

A

vertebral pedicles

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28
Q

posterior borders

A

ligamentum flavus and vertebral lamina

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29
Q

What does the epidural space contain?

A

nerve roots, fat pads, blood vessels

30
Q

What reduces the bioavailability of lipophilic drugs?

A

epidural fat (acts as a sink)
(bupivicaine > lidocaine and fentanyl > morphine)

31
Q

The _______ nerve roots carry sensory information.

A

posterior (dorsal)

32
Q

The ________ nerve roots carry motor and autonomic information.

A

anterior (ventral)

33
Q

C6 innervates ——-

A

1st digit (thumb)

34
Q

C7

A

2nd and 3rd fingers

35
Q

C8

A

4th and 5th fingers

36
Q

T4

A

nipple line

37
Q

T6

A

Xiphoid process

38
Q

T10

A

umblilicus

39
Q

T12

A

pubic symphysis

40
Q

L4

A

anterior knee

41
Q

T4 (nipple line) surgery?

A

upper abdominal
C-section
Cystectomy

42
Q

T6-7 (xyphoid process)

A

lower abdominal surgery
appendectomy

43
Q

T10 (umbilicus)

A

total hip arthroplasty
vaginal delivery
TURP

44
Q

L1-3 (inguinal ligament)

A

lower extremity surgery

45
Q

L2-3

A

foot surgery

46
Q

S2-S5

A

Hemorrhoidectomy

47
Q

Benefits of well-executed thoracic epidural compared to lumber

A

-superior analgesia
-minimize surgical stress response
-reduce incidence of post op respiratory issues
-allow for early ambulation

48
Q

What is the primary site of local anesthesia in the subarachnoid space?

A

myelinated preganglionic fibers of the spinal nerve roots

49
Q

Order of which nerve fibers are blocked?

A

Autonomic —> Sensory —–> Motor
come back the opposite way

50
Q

How many dermatomes higher is autonomic than sensory?

A

2-6

51
Q

How many dermatomes higher in sensory than motor?

A

2

52
Q

Factors that will affect spread in spinal anesthesia?

A

baricity, site of injection, patient position

53
Q

factors that don’t affect spinal anesthesia spread?

A

barbotage, speed, bevel orientation, body habitus, gender

54
Q

What are the 2 primary determinants of spread for epidurals?

A

Volume and level of injection

55
Q

Sensory blockade is ______ dermatomes higher than motor in epidural anesthesia.

A

2-4
there’s not autonomic differential

56
Q

_______ is the most reliable determinant of intrathecal spread when using hypo- or isobaric solution

A

DOSE

57
Q

_________ is the most reliable determinant of intrathecal spread when using a hyperbaric solution.

A

Baricity

58
Q

What is the 1st, 2nd and 3rd sensory modalities that are blocked in order?

A
  1. temperature
  2. pain
  3. touch or pressure
59
Q

Heavy myelination
skeletal muscle and proprioception

A

a alpha (blocked 4th)

60
Q

heavy myelination
touch and pressure

A

a beta (blocked 4th)

61
Q

medium myelination
muscle tone

A

a gamma (blocked 3rd)

62
Q

medium myelination
fast pain, temp, touch

A

a delta (blocked 3rd)

63
Q

light myelination
preganglionic ANS fibers

A

B type (blocked 1st!)

64
Q

0 myelination
slow pain, temp, touch
postganglionic ANS fibers

A

C type fiber (blocked 2nd)

65
Q

primary drug-related determinant of block height (epidural)

A

LA volume

66
Q

primary procedure related determinant of block height (epidural)

A

level of injection

67
Q

primary determinant of block density

A

LA concentration

68
Q

Greatest points of lordosis (hump)

A

C5 and L3

69
Q

Greatest points of kyphosis (dip)

A

T5-7 and S2

70
Q

Neuraxial opioids do NOT cause:

A

sympathectomy
skeletal muscle weakness
changes in proprioception

71
Q

What LA reduces the efficacy of epidural opioids?

A

2-Chloroprocaine

72
Q
A

Anesthesia Principles 1 (11 decks)

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