Regional

Question 1

Midline Approach

Answer 1

Skin, subq, paraspinous and interspinous ligaments, ligamentum flavum, epidural, dura mater, subdural space, arachnoid membrane, subarachnoid space

Question 2

Nerve Blockade Order

Answer 2

1. Small sympathetic C fibers
2. Small sensory Adelta fibers
3. Large sensory fibers Abeta
4. Large motor fiber Aalpha

Question 3

Cv Effects of Regional

Answer 3

Sympathectomy –> loss of vascular tone –> hypotension and reflex tachy
If supra T4 level, paradox bradycardia

Question 4

Pulmonary effects of regional

Answer 4

Impaired cough reflex

Decreased expiration you function

Question 5

GI effects of regional

Answer 5

Sympathectomy–> hyper peristalsis

N/V

Question 6

GU effects of regional

Answer 6

Sacral blockade –> atomic bladder

Question 7

Neuroendocrine effects of regional

Answer 7

Avoid surgical stress response with with adequate sensory blockade

Question 8

Complications of regional

Answer 8

Back ache
Pruritis 
Infection
Hematoma
Hypotension
Urinary retention
Hypoventilation

Question 9

Spinal Anesthesia

Answer 9

Rapid and reliable onset of lower body anesthesia
Local anesthetic into intrathecal - blocks nerve roots and fibers
Consider IV bolus to prevent hypotension

Question 10

Factors affecting spinal anesthesia spread

Answer 10

Baricity: isobaric - block at level
Hyperbaric (dextrose)- w/ gravity
Hypobaric (water)- against gravity

Question 11

Local Anesthetic in spinal

Answer 11

Procaine 30-50 min, 50-75 w 
Lidocaine 45-60 min, 75-90'w
Mepivacaine 50-70 min, 80-120 w
Bupivacaine 90-120 min, 140 w
Tetracaine 90-150 min, 180-300 w

Question 12

Epidural Anesthesia

Answer 12

Slower onset, more controlled segmental spread (10x dose)

Question 13

Levels of cord

Answer 13

Cord = L1-2/3
Dural Sac = S2/3-4
Kyphosis at T4
Lordosis at L3