Prodigy- neuraxials

Question 1

Explain where the spinal cord starts, ends, whats below it

Answer 1

Starts at the foramen magnum → L1-L2
Ends as a tapered segment: conus medullaris
Below that is the cauda equina - bundle of nerve fibers that branch off and extend from L1-S5

Question 2

What is the sacral hiatus?

Answer 2

An opening where the last sacral lamina is which is not completely closed

Question 3

What colums transmit light touch and proprioception

Pain and temp?

What columns contain neurons that eventually enter the sympathetic chain?

Answer 3

dorsal colums

Lateral spinothalmic tract

lateral grey columns

Question 4

What does the ARrtery of Adamkiewicz supply blood to?

Answer 4

The anterior 2/3 of the spinal cord

*Anterior Spinal Artery syndrome can result from clamping of the aorta and results in
→flaccid paralysis of lower extremities and blowel & bladder dysfunction
→ sensation is unchanged

Question 5

where are the posterior spinal arteries derived from?

what do they supply?

Answer 5

the posterior cerebral circulation

posterior 1/3 of the spinal cord

Question 6

Normal CSF production in ml/hr

how much per day

how much at any given time

Answer 6

21ml/hr

over 1/2 L /day

150ml @ any given time

Question 7

What forms CSF?

Answer 7

choroid plexuses in the ventricles

Question 8

What 2 drugs we use increases the absoprtion rate of CSF?

What increases vs decreases CSF secretion (1 each)

Answer 8

isoflurane (no effect on secretion)
→think blood:gas 143 , i love you, i want to absorb you

Fentanyl
→junkies want to absorb all the fentanyl

Des → increases secretion (adds fire to the flame)
Etomidate→ decreases secretion (less CSF pressure, makes your wanna vomit [evomidate]

Question 9

Why can a healthy patient become solument after a spinal?

Answer 9

Bc it reduces the amount of sensory input htat goes to the reticular activating system (responsible for maintaining consciousness)
- less stimulation to that area, less awake

Question 10

Why might you not want to do a spinal in someone who is already in extreme pain or who is under the influence of a lot of opioids or other CNS depressants?

Answer 10

the painful stimulus might be the primary sensory input maintaining their wakefulness and once the spinal takes effect and the pain is eleminated, the effects of their meds could result in CNS depression or unconsciousness

Question 11

Where does the GI tract receive parasympathetic vs sympathetic innervation from?

what happens with neuraxial anesthesia nd the gut?

Answer 11

parasympathatic = vagus nerve
sympathetic = T5- L2

The sympathetic block leads to unopposed parasympahtic stimulation
→ general contraction of bowel
→ increased blood flow to bowel
→ increased peristalsis

Question 12

T/f: neuraxial anesthesia preserves shivering and vasoconstriction in response to heat loss

Answer 12

false- it’s inhibited - throw a damn bair hugger on them

Question 13

What can result from not letting the antiseptic solution dry before puncturing the skin?

Answer 13

Arachnoiditis

Question 14

What are the two pops appreciated with a spinal anesthetic?

Answer 14

1. ligamentum flavum
2. dura

Question 15

Why isnt a confinous spinal infusion used for labor?

Answer 15

risk of dural puncture (PDPH?) like your obviously puncturing the dura for a spinal…

Question 16

T/F: height, weight, and BMI have little effect on the spread of local anesthetics injected into the subarachnoid space

Answer 16

True

i think the exception is if they are really tall or really short; like >6 foot, <5 foot

Question 17

T/F: a pregnant patient will exhibit a higher level of sensory block than a non-pregnant patient with the same dose is adminsitered

Answer 17

True

increased IAP causes a decrease in CSF volume due to increased pressure in the epdiural space.

Question 18

what does adding clonidine to a spinal do?

Answer 18

improves analgesia for about 2 hours for both intermediatea nd long-acting locals
+intensifies motor block

Question 19

Why dont they use clonidine in spinals for obstetrics?

Answer 19

Black box warning! increased hemodynamic instability- hypotension, bradycardia

Question 20

how much dex could you add to a epdiural and what would be the benifit?

Answer 20

1mcg/kg - shown to improve the quality and duration of the block

Question 21

What guage are epidural needles typically?

length?

Answer 21

16-18g

3”

Question 22

What is the purpse of the epidural needle being blunt and curved at the tip?

Answer 22

so it can pass through the ligments but wont pass as easily through the dura

Question 23

What would signify you have a intravenous injection with a test dose

what about intrathecal injection?

time frames?

Answer 23

10BMP increase in HR or 15mmHg increase in BP

Question 24

With an epidural, the first signs of sensory alteration typically occur at the dermatome level where the drug was injected within how many minutes?

when will the full extent of the block typically be reached?

Answer 24

5-10 mins

20-30mins

Question 25

T/F: the additionan of epi to a local anesthetic is associated with an increase in the indicdenceof nausea?

Answer 25

True- epi and morphine

Question 26

T/F: Fentanyl added to LA does isnt shown to increase the incidence of nauesa ## Footnote does clonidine?

Answer 26

true ## Footnote nope

Question 27

Which syndrome causes persistent paralysis of the nerves, resulting in lower extremity weakness and bladder and bowel dysfunction? A. Cauda equina syndrome B. Horner's syndrome C. Postdural puncture headache syndrome D. Transient neurologic syndrome

Answer 27

A

Question 28

hich drug class would be least likely to increase the risk for postoperative urinary retention? A. intravenous anesthetics B. anticholinergics C. opioids D. sympatholytics

Answer 28

A

Question 29

Which condition would you most expect to see in a patient with a midthoracic neuraxial anesthetic? A. Significantly decreased tidal volume B. Normal PaCO2 C. Significantly increased respiratory rate D. Significantly decreased minute ventilation

Answer 29

B

Question 30

Which local anesthetic would be prolonged the most by adding an adrenergic agonist? A. Lidocaine B. Procaine C. Tetracaine D. Ropivacaine

Answer 30

Not B ## Footnote idk bc it says alpha 2 agonist prolong intermediate and long acting spinals equally Ropi and tetracaine are long acting and lido is intermediate soooo

Question 31

Which of the following statements regarding neuraxial anesthesia level is true? A. Pinprick sensation is inhibited at a higher dermatome level than kinesthetic sensation B. Cold sensation is blocked at the same dermatome level as pinprick sensation C. Cold sensation is left intact by neuraxial anesthesia D. Light touch sensation is blocked at a higher level than pinprick sensation

Answer 31

D

Question 32

The coccyx is made up of four small bone segments that become fused into two bones by the age of: A. 5-10 years B. 25-30 years C. 16-20 years D. 11-15 years

Answer 32

Not D

Question 33

You are preparing to place an epidural catheter in an obstetric patient who is taking metoprolol. Which of the following would be the best formulation for an epidural test dose? A. Lidocaine and fentanyl B. Lidocaine and phenylephrine C. Lidocaine and metoprolol D. Lidocaine and esmolol

Answer 33

Not D

Question 34

The classic 3 mL test dose for epidural anesthesia contains A. epinephrine 15 mcg B. lidocaine 30 mg C. epinephrine 30 mcg D. lidocaine 15 mg

Answer 34

A

Question 35

Which nerve fiber is responsible for transmitting pain, cold temperature, and touch? A. A-alpha B. A-delta C. A-gamma D. A-beta

Answer 35

B

Question 36

The incidence of transient neurologic symptoms following a tetracaine spinal anesthetic is increased by A. increasing the glucose concentration in the anesthetic B. early ambulation C. the addition of phenylephrine to the anesthetic D. local anesthetic baricity

Answer 36

C

Question 37

Following administration of a spinal anesthetic, a patient exhibits severe bradycardia. What is the first line of treatment you should employ? A. Ephedrine 25 mg IV B. Propofol 20 mg IV C. Intravenous fluids 15 mL/kg IV D. Atropine 0.4-0.6 mg IV

Answer 37

D

Question 38

After administering a neuraxial anesthetic to a patient who has received large doses of opioids to treat the pain of a hip fracture, you would observe the patient most closely for A. hyperventilation B. decreased level of consciousness C. urinary retention D. bradycardia

Answer 38

B

Question 39

A patient has experienced loss of consciousness due to an inadvertent total spinal block during epidural placement. The patient's loss of consciousness is most likely due to A. local anesthetic blockade of the cerebrum B. local anesthetic systemic toxicity C. supraventricular tachycardia D. hypoperfusion of the cerebrum and brainstem

Answer 39

D

Question 40

Which patient factor would have the most impact on the spread of an epidural block? A. Height = 1.7 meters B. Weight = 230 lbs C. BMI = 30 D. Age = 74

Answer 40

D

Question 41

Which effect would you be most likely to see as a result of thoracic epidural anesthesia? A. Increased renal blood flow B. Increased hepatic blood flow C. Hyperperistalsis D. Increased vital capacity

Answer 41

not D