Regional

Question 1

C/i for neuraxial

Answer 1

Ptt > 40
Inr > 1.5
Clopigrel 7 days

Nsaids and asprin no ci

Question 2

Lovenox guidance for epidural placement removal

Answer 2

Prophylactic :
Place after 12 hrs, ok to restart 6 hrs after placement, remove 12 hiurs after last dose

Therapeutic
Place 12 hours after, dont dose while its in, restart 4 hrs after

Question 3

Minimum discontinuation brfore neuraxial block

Answer 3

Prophylactic hepatin can be done anytime

For therapeutic heparin ptt

Question 4

Lovenox

Answer 4

If therapeutic wait 24 hours before placement and dont use while cather is in place

If prophylactic wait 12 hours
If bid dont give lovenox while catheter is in place
If daily wait six hours

Restart after 4 hrs

Question 5

Normal movement of hyperbaric lidocaine

Answer 5

Kyphosis in the backc auses lidocaine to move to t6

Question 6

Things that lead to decreased csf volume causing a high spinal

Answer 6

Pregnanancy and ascities cause venous engorgement which leads to decreased csf

Advanced age has a decrease in csf volume
Severe kyphoscoliosis can also cause decrease in csf

Question 7

Epinepherine affect on spinal

Answer 7

Minimum affect on tetracaine and bupivicaine but increases tetracaine for an additional hour

Epinepherine and phenyepherine can prolong hlocks by decreasing clearance in the csf

Question 8

Fentanyl in spinal

Answer 8

Intensifies sensory block but not motor.

Leads to a faster onset of surgical anesthesia

Provides post operative pain relief while not delaying pacu discharge

Does not decrease the amount of bupivicaine significantly