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@MY Anesthesia!! > Regional Anesthesia > Flashcards

Regional Anesthesia Flashcards

1
Q

major contraindications for neuraxial anesthesia (6)

A
  • patient refuse
  • bleeding diathesis
  • hypovolemia
  • elevated ICP
  • infection at site of injection
  • severe stenotic valvular heart disease or centric outflow obstruction
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2
Q

reduction of SVR from neuraxial anesthesia ok with WHAT cardiac lesions?

A

regurgitant

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3
Q

what object is continuous cephalic with the brainstem through the foramen magnum?

A

SUBarachnoid

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4
Q

where does the spinal cord terminate distally?

A

conus medullaris

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5
Q

distal termination of spinal cord in INFANTS is where?

A

L3

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6
Q

distal termination of spinal cord in ADULTS

A

lower border of L1

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7
Q

subarachnoid space terminates distally to what level?

A

S2

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8
Q

subarachnoid space also known as?

A

intraTHECAL space

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9
Q

what accounts for 80% of variability in PEAK BLOCK HEIGHT and REGRESSION of sensory and motor blockade

A

CSF volume

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10
Q

PRIMARY tissue layer that serves as primary (90%) barrier to epidural drugs diffusing into the intrathecal space?

A

Arachnoid mater

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11
Q

2 mechanisms of EPIDURAL anesthesia:

A

1) drug translocation into thecal space

2) drug can anesthetize the nerve roots laterally

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12
Q

which layer covering the spinal cord is HIGHLY vascular

A

pia mater

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13
Q

Why do patients with High spinals become apneic (resp arrest)?

A

dropped pressure so much that brainstem isn’t perfused (NOT bc you blocked phrenic nerve)

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14
Q

epidural space bound ANTERIORLY by?

A

posterior longitudinal ligaments

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15
Q

epidural space bound laterally by?

A

pedicles

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16
Q

posterior boundary of epidural space?

A

ligamentum flavum

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17
Q

spinal epidural space extends from where to where?

A

foramen magnum to sacral hiatus (and by virtue of the posterior aspect, the ligamentum flavum does, too)

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18
Q

what VENOUS plexus included in the epidural space?

A

BATSON venous plexus

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19
Q

posterior to the Ligamentum flavum?

A

INTERSPINOUS LIGAMENTs

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20
Q

posterior to the INTERSPINOUS ligament?

A

Supraspinous ligament

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21
Q

Rexed lamina layers in gray matter of spinal cord NOT involved in NOCICEPTION transmission?

A

FOUR (mechanoreceptors)

1,2,5 keep the pain alive

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22
Q

two types of spinal needles?

A

1) cut dura

2) conical tip

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23
Q

needles that cut the dura?

A

Quincke-Babcock

traditional disposable needle

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24
Q

needles that have conical tip (pencil-point)?

A

Whitacre and Sprotte

25
Q

what’s benefit of using conical-tipped needle?

A

decrease in incidence of post-dural puncture headache

26
Q

what things can DECREASE incidence of PDPH?

A
  • small needles

- less punctures of dura

27
Q

which spinal anesthetic (used less frequently than lido) for shorter spinal anesthesia? for what THREE reasons?

A

Procaine (

28
Q

for what THREE reasons was Procaine used less frequently?

A
  • higher NAUSEA
  • higher ANESTHETIC failure rate
  • Slower time to recovery
29
Q

what is one reason some STILL USE procaine vs lidocaine?

A

lower frequ of back and leg pain after its use

30
Q

transient neurologic symptoms are what?

A

back and leg pain following “-caine” use in spinals

NOT neurologic; NO focal neurologic pain; NOT dermatome-specific

31
Q

what’s LONG-acting ester spinal anesthetic used?

A

tetracaine

32
Q

what vasoconstrictor can be used with tetracaine to make it EVEN LONGER lasting?

A
  • epi (2-3hrs)

- PHENYLEPHRINE (5 hours!!!)

33
Q

Ultrasound beam frequency versus depth and resolution?

A

HIGH FREQUENCY - better resolution; less penetration; good for shallow structures

(Deeper needs lower frequency….more than 5cm deep; but get lower resolution)

34
Q

reflected sound waves produce

A

hyperechoic if bounced back; highly reflected tissue

sound waves hypoechoic = tissue not strongly reflect; DARKER on u/s

35
Q

bones on US?

A

dark, acoustic shadow, bone doesn’t absorb many of the sound waves - they’re reflected, so surface may be hyperechoic

36
Q

nerves on US?

  • individual peripheral nn fibers bundled together in ____?
  • -those fibers bundles together into _____ by _____
  • –multiple fascicles bundled together by ______
A

HYPERECHOIC; honey-comb interior

  • endoneurium
  • -fascicles covered by connective tissue called perineurium
  • –Epineurium
37
Q

fascicles covered by?

A

fat, connective tissue, and small vessels; THEN covered by Epineurium around this bundle

38
Q

majority of nerves appear with

A

hyperechoic perineurium

39
Q

how is an ultrasound image formed?

A

electricity applied to a Piezoelectric element in a TRANSDUCER –> vibrates –>emits sound waves –>waves reflected back detected by transducer and converts sound energy into electric signal

40
Q

how fast is transmission/reception cycle repeated in U/s?

A

7,000 times/second

41
Q

how does U/S ENERGY relate to impedance of tissue?

A

Amount of sound energy reflected PROPORTIONAL to difference in acoustic impedance between the tissues (different acoustic impedance, reflects differently, but proportionally)

42
Q

higher frequency affects wavelength how?

A

SHORTER wavelength

43
Q

frequencies good for less than 5cm?

A

8-20 MHz

44
Q

frame rate of U/S machine has what effects?

A

if SLOW –>system not able to produce images to keep up with movement of probe

45
Q

what can decrease frame rate of U/S?

A
  • adding color Doppler

- increasing number of focal zones

46
Q

what is the energy loss from sound waves penetrating tissue?

A

ATTENUATION

47
Q

what is sound energy converted to?

A

heat

48
Q

common attenuation of BONE (relative to h2o)?

A

10,000x

49
Q

attenuation of air (relative to h2o)?

A

5,000x

50
Q

attenuation of muscle(relative to h2o)?

A

500x

51
Q

attenuation of blood (relative to h2o)?

A

100x

52
Q

water–>blood–>muscle–>air–>bone

A

100, 500, 5000, 10000

53
Q

best angle of u/s reflection for getting sound energy back to transducer (probe)

A

90-degree (perpendicular)

54
Q

which type of angle reflects MOST away from probe?

A

acute angles

55
Q

What is anisotropy?

A

angle of sound wave and its effect on the reflection – causes some structures to be VERY sensitive to position of transducer

56
Q

what is the angle at which sound waves strike the surface?

A

Angle of insonation

57
Q

which color are objects moving TOWARDS the transducer?

A

RED (towaR[e]d)

58
Q

color of objects moving AWAY from U/S?

A

Blue - has U - up up, and AWAY

@MY Anesthesia!! (14 decks)

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