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principles of anesthesia i - summer 24 > Neuraxial Technique - E1 > Flashcards

Neuraxial Technique - E1 Flashcards

1
Q

What are the 6 reasons we should be set up to do a GETA w/ every neuraxial case?

A
  1. Failed block
  2. High Spinal - knock out resp. drive
  3. LAST - cardiac arrest/seizures
  4. Anaphylaxis
  5. Severe CV collapse
  6. Case exceeds duration of LA
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2
Q

Spinal Block

Kit Contents Spinal

A
  1. 3.5’’ styleted needle
  2. Introducer
  3. LA (skin, SAB)
  4. Betadine Prep
  5. Sterile drapes
  6. needles (22g for skin, 18g)
  7. filter needle - to draw up SA LA
  8. gauze
  • also need sterile gloves, hats, mask
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3
Q

SAB

Why is the needle styleted?

A

To avoid microclots - the spinal needle is so small if it clots then you can’t push med in

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4
Q

Why does the spinal kit have an introducer needle?

A

so the spinal needle does not bend

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5
Q

SAB

What is the LA used for skin numbing?

A

1%

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6
Q

SAB

What is the volume of med we inject w/ a spinal?

A

2 mL

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7
Q

SAB

What are the cutting needles & when would we use them?

A
  1. Quincke
  2. Pitkin
  • use if it is all we have - they cause PDPH
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8
Q

SAB

What are the non-cutting needles?

A
  1. Sprotte
  2. Whitacre
  3. Pencan
  4. Green
  5. Gertie Marx
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9
Q

SAB

What are 3 advantages of using a pencil-point tip needle?

A
  1. they drag fewer contaminants into subnormal tissue
  2. click or pop can be sensed
  3. less risk of PDPH
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10
Q

How often should we take v/s w/ neuraxial blocks?

A

Q 3-5 min

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11
Q

SAB

When will you see a swirl in your syringe?

A

If you are using a hyperbaric LA (mixed w/ dextrose) & you aspirate CSF

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12
Q

SAB

When would we use a pelvic tilt?

A
  1. in OB pts w/ a pillow to prevent HoTN caused by compression of the vena cava
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13
Q

SAB

If the pt starts to tell you their hand is getting numb, what are we concerned for??

A

High migration of the LA

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14
Q

SAB

Common Problems

A
  1. lack of free flow CSF
  2. resistance w/ injection
  3. No swirl
  4. Paresthesia - hard stop!
  5. blood instead of CSF
  6. No block - check expiration
  7. Partial block - give pain meds
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15
Q

Epidural

Epidural Kit Contents

A
  1. sterile prep/drapes
  2. LA
  3. Tuohy needle - 17/18g
  4. Needles (22g & 18g)
  5. 3ml, 5ml, 20ml syringes
  6. filter needle
  7. line filter
  8. LOR syringe
  9. epidural cath
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16
Q

Epidural

What LA is in the kits?

A
  1. 1% Lido - skin
  2. 1.5% Lido (15mg/kg) w/ 1:200,000 Epinephrine
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17
Q

Epidural needles

Tuohy

A
  1. most curvature (30 degrees)
  2. blunt tip less likely to puncture SA space
18
Q

Epidural needles

Hustead Curvature

A

15 degrees

19
Q

Epidural needles

When do we use the Crawford needle?

A
  1. catheter placement difficult
  2. steep angle (thoracic)
    * has 0 degrees curvature
20
Q

Epidural Needles

Weiss Curvature

A

15 degree curve
* has wings

21
Q

Is the epidural needle styleted? What size is it?

A
  • yes
  • 17-18g
22
Q

What size should the epidural cath be compared to needle?

A

2 gauges smaller

23
Q

How many cm of the epidural cath should be in the epidural space?

A

3-5cm

24
Q

Epidural Catheter

Multi-orifice cath

A

mutliple holes down the catheter length
* lower incidence of inadequate anesthesia - better spread
* most common one used
* higher incidence of inadvertent intravascular placement

25
Q

Epidural Block

Determining Distance in cm

A
  1. measure skin to epidural space
    - needle length is 9cm (subtract the visible cm from skin)
    - 9cm needle - 4cm visible = 5cm from skin to epidural space
  2. Skin Marking
    - cath should be secured @ 10cm at the skin = 5cm from skin to epidural, 5cm in epidural space
26
Q

Epidural Block

What are potential concerns w/ lumbar tattoos?

What is the recommendation?

A
  1. ink could be carried into the spine - leading to chemical arachnoiditis
  2. Paramedian approach
27
Q

Epidural Block

What direction should the epidural tip be?

A

Up - opening cephalad

28
Q

What is the test dose for an epidural catheter?

A
  • 3 mL of 1.5% Lidocaine w/ epi (1:200,000)
  • 1.5% = 15mg/mL = 45mg
  • 1:200,000 = 5mcg/mL
29
Q

Epidural Catheter

What important #s do we need to record?

A
  1. depth to epidural space (LOR)
  2. Catheter marking @ skin - 10cm
  3. Cath depth/length in epidural space (#cm in space)
30
Q

What are the 2 ways to identify the epidural space?

A
  1. LOR syringe w/ saline (could do air or both)
  2. Hanging drop method - don’t use anymore
31
Q

Epidural

What are the symptoms of accidental IV placement?

A
  1. HR increase by >20%
  2. Tinnitus
  3. metallic taste in mouth - first one usually
  4. circumoral numbness
  • in pts on heart meds - BP increase of >20mmHg = IV placement
32
Q

Epidural

What are the symptoms of accidental spinal injection?

A
  1. dense motor block w/i 5 min of test dose
  2. pt says feet are numb
33
Q

When should we give the Epidural test dose in pregnant women?

A

After a contraction = clearer results

34
Q

Epidural Dosing

1st dose

A

1-2mL/segment
* Epidural placed L4/L5 - need T10 blocked = 6 segments
* 6-12mL

35
Q

Epidural Dosing

Top-up Dose

A
  • give before “two-segment regression”
  • give 1/2 - 3/4 of initial dose
  • could also start drip
36
Q

Top-Up times

Lidocaine

A

60 min from initial

37
Q

Top-up Times

2-Chloroprocaine

A

45 min from initial dose

38
Q

Top-up Times

Mepivacaine

A

60 min from initial dose

39
Q

Top-up Times

Bupivacaine & Ropivacaine

A

120 min from initial dose

40
Q

Epidural

Common Problems

A
  1. CSF “wet tap” (through dura)
  2. Paresthesia
  3. can’t thread catheter (PLICA)
  4. Aspirate blood
  5. Positive Test dose
  6. False positive test dose - OB contractions

principles of anesthesia i - summer 24 (14 decks)

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