Regional anaesthesia Flashcards
What procedures do we use spinal anesthetic?
- C-section
- TURP
- Hip fractures
What is the name of the landmark L4/L5
Tuffiers line
What are the layers we pass when performing a central nueraxial anesthesia
- Skin
- Subcutaneous tissue
- Supraspinous
- interspinous
- ligamentum flavum
- dura mater
- subdural space
- arachnoid matter
- subarachnoid
What are some of the absolute contraindications
Inadequate drug/ equipment
Severe hypovolemia
Increased ICP
Patient refusal
Infection at puncture site
What are the relative contraindications?
Sepsis
Coagulopathy
Uncooperative patient
Spinal deformity
Preexisting neurological deficit
In pregnancy when administering spinal anesthesia the dose is decreased why ?
Mechanical factor- compression(compression of IVC causes shunting of blood to the veous plexus in the vertebral canal- decreased can l space adn CSF volume
hormanal factors( progesterone increases the sensitivity of neuronal membrane to LA)
how would you manage hypotension
oxygen therapy
vasoconstrictor drugs
↑rate of I.V
treat bradycardia
What is High and total spine
the spread of LA beyond t4 and intracranium respectively
whare some of the factors that increase the incidence of post-spinal puncture headache
age
gender
needle size
pregnancy
dural punctures ( number)
what causes post dural puncture headache
due to leak of csf from dural defect leads to traction in supporting structure especially in dura
What is the treatment plan for post dural puncture ?
supine position
hydration
NSAIDs
Epidural blood patch
List examples of amino ester LA
- cocaine
- procaine
- benzocaine
- tetracaine
- chloroprocaine
List examples of Amino amides
- Lidocaine
- mepivacaine
3.bupivacaine
What is the MOA of LA
block conduction of electrical impulse of peripheral nerves by targeting the Na channels
All LA are vasodilators except?
Cocaine
To counteract the vasodilator effects of LA which adjuvant drug is given?
Epinephrine
Why is clonidine sometimes given as an adjuvant?
to prolong duration of sensory analgesia
Why are opioids given as adjuvants
prolongs sensory block,reduces local anesthetic requirements,reduces duration of motor blockade and improves haemodynaemic stability.
