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Quarter 4 > Regional Exam II > Flashcards

Regional Exam II Flashcards

1
Q

Injection location

(spinal vs. epidural)

A

spinal - lumbar only

epidural - anywhere

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2
Q

duration of block

(spinal vs. epidural)

A

spinal - brief

epidural - longer

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3
Q

Which has a better quality of block, spinal or epidural?

A

spinal

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4
Q

sacral hiatus

A

unfused opening between S4 and S5

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5
Q

T7-T8 Landmark

A

lower limits of scapulae

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6
Q

C7 landmark

A

bony knob at base of neck

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7
Q

L2 Landmark

A

terminal point of 12th ribs

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8
Q

L4 Landmark

A

Iliac crest

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9
Q

S2 Landmark

A

posterior iliac spines

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10
Q

what connects the epidural space with the paravertebral space?

A

foraminae

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11
Q

Maximal depth of epidural space

A

6 mm at L2

(only 4-5 mm in the midthoracic area)

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12
Q

plica mediana dorsalis

A

connect dura mater to the ligamentum flavum

(may not even exist)

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13
Q

(5) complications to discuss with patient

A
  • nerve damage
  • bleeding
  • infection
  • headache
  • failed block
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14
Q

Which type of block would be performed in a perineal surgery?

A

spinal

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15
Q

One should probably not attempt a spinal above _____

A

L3 - L4 interspace

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16
Q

Which type of needles are more likely to cause PDPH?

A

beveled

(Quincke)

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17
Q

Two types of Pencil-point Spinal Needles

A

Whitacre and Sprotte

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18
Q

Which spinal approach is independent of patient flexion?

A

Taylor

  • star 1 cm medial and caudal to PSIS
  • advance cephalad at 55o with medial orientation
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19
Q

Which spinal approach is best suited for narrow interspaces or difficulty with flexion?

A

Paramedian

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20
Q

Level and duration of spinal are primarily determined by _____

A

baricity, contour of spinal canal, and patient position

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21
Q

Epinephrine in spinals

A

vasoconstricts, decreasing the spread, and has some alpha-2 analgesia

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22
Q

Tetracaine in spinals

A

major vasodilation

(vasopressors have a profound effect)

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23
Q

Bupivacaine in spinals

A

decreases spinal and dural blood flow

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24
Q

Dose of Lidocaine for spinals

A

60-75 mg

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25
Q

Dose of Chloroprocaine for Spinals

A

40-60 mg

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26
Q

Dose of Bupivacaine for spinals

A

5 - 20mg

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27
Q

Which one is more profoundly affected by vasoconstrictors?

Tetracaine or Bupivacaine

A

Tetracaine

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28
Q

Opiates in spinals

A

affect the dorsal horn

usually 25 ug of Fentanyl

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29
Q

Dose of Tetracaine for spinals

A

5 - 20 mg

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30
Q

Sensory level for Hemorrhoidectomy

A

S2 - S5

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31
Q

Sensory level for Foot surgery

A

L2 - L3

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32
Q

Sensory level for lower Extremities

A

L1 - L3

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33
Q

Sensory level for Hip, TURP, or vaginal delivery

A

T10

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34
Q

Sensory level for Lower abdomen or Appendectomy

A

T6 - T7

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35
Q

Sensory level for upper abdomen or C-section

A

T4

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36
Q

Anything above ____ inhibits SNS to the GI tract

A

T5

37
Q

First-line drug to treat hypotension in Spinals

A

Ephedrine

38
Q

Blood Patch

A

15 - 20 mL

injected at or below the site, as the blood will travel cephalad

39
Q

Warning sign of hypotension and stroke during spinal

A

nausea

40
Q

Hypotension in Spinals

A

occurs in 1/3 of patients

initially due to decreased SVR

41
Q

Most common epidural needle

A

Tuohy

42
Q

Most common approach for lumbar epidural

A

midline

43
Q

Two techniques to identify epidural space

A

loss of resistance

or

hanging drop

44
Q

Test dose

A

3 cc of 1.5% lidocaine with 1:200,000 Epi

45
Q

Caudal blocks

A

epidural injections placed through the sacrococcygeal ligament and sacral hiatus

46
Q

Sacral Hiatus is absent in ____% of patients

A

10

47
Q

Difference between Lumbar and Thoracic epidurals

A

Lumbar tends to flow cephalad due to negative intrathoracic pressure, whereas thoracic stays in place

48
Q

What will cause spread of local in epidurals?

A

negative intrathoracic pressure

49
Q

Intermediate duration LA

A

lidocaine

50
Q

Which LA is not effected by Epinephrine?

A

Bupivacaine

51
Q

Epinephrine in Epidurals

A

prolongs duration

(especially if chloroprocaine or lidocaine)

  • may accentuate the fall in blood pressure
52
Q

Sodium Bicarbonate with Epidurals

A

promotes more rapid onset

53
Q

If epidural anesthesia has “partially failed, “ consider ____

A

injecting small doses of chloroprocaine

54
Q

Which LA has a higher risk of absorption or intravascular injection?

A

Bupivacaine

55
Q

Major site of action for an epidural

A

nerve roots

56
Q

Neuraxial blocks results in a sympathectomy ____ dermatomes above the sensory block

A

2 - 6

57
Q

Bainbridge Reflex

A

stimulation of right atrial stretch receptors leads to vagal afferent stimulation of medulla and subsequent inhibition of parasympathetic activity

(increase HR)

58
Q

(3) mechanisms that effect heart rate

A
  • bainbridge reflex
  • direct effect on the SA node elicited by atrial stretching
  • anesthesia of T1-4 cardioaccelerator fibers
59
Q

Cardiovascular effects of Neuroaxial Anesthesia

A

arterial and venous dilation

and

decreased preload and HR

60
Q

Which drug should be considered in parturients instead of Epi or ephedrine

A

phenylephrine

61
Q

Risk of headache after accidental dural puncture with an epidural needle is ____

A

about 50%

62
Q

(6) Risk Factors for PDPH

A
  • beveled needle (quinke)
  • larger needle
  • female
  • pregnant
  • young
  • history of headaches
63
Q

Order of block sensitivty

A

temperature > SNS > pain > touch > motor

(first to last to go)

64
Q

Anesthetic effects of central blocks

A
  • decrease MAC
  • produce sedation
  • potentiate hypnotics
65
Q

location of cardioaccelerators

A

T1-4

66
Q

Epidural with epinephrine seems to cause _____ hypotension than without Epi

A

more

67
Q

What are two major factors affecting block height?

A

baricity and patient position

68
Q

Spinal blocks wear off in a ______ direction

A

cephalad to caudad

(thus sacral lasts longer than thoracic)

69
Q

Higher blocks usually wear off _____ than lower blocks

A

faster

70
Q

_____ agonists can prolong a spinal block

A

adrenergic

71
Q

Reduce anesthetic dose by _____ if working on upper dermatomes

A

30-50%

(rksk of cephalad spread is increased)

72
Q

Caudal is more similar to an epidural or spinal?

A

epidural

73
Q

Spinal is injected into the ___

A

subarachnoid space

74
Q

subarachnoid space is a continuous space that contains _____

A

CSF, spinal cord, and conus medullaris

75
Q

Where does the subarachnoid space end?

A

conus medullaris at the sacral hiatus

76
Q

termination of spinal cord

A

usually at L1

(L3 in pediatrics)

77
Q

Dorsal (posterior) roots are responsible for ____

A

sensory blockade

78
Q

Anterior (ventral) roots are responsible for _____

A

motor blockade

79
Q

total CSF in adults

A

100 - 150 mL

80
Q

CSF volume in subarachnoid space

A

25 - 35 mL

81
Q

specific gravity of CSF

A

1.0003 - 1.0006

82
Q

Supraclavicular Nerves

A

branches of the superficial cervical plexus (C3-C4)

  • provides cutaneous innervation at the shoulder
83
Q

Suprascapular Nerves

A

C5 and C6 provides sensory innervation to posterior/superior shoulder and anterior axilla

84
Q

Intercostobrachial Nerves

A

T2

  • often used to treat tourniquet pain
85
Q

Axillary Block

A
86
Q

Infraclavicular Block

A
87
Q

Interscalene Block

A
88
Q

Supraclavicular Block

A
89
Q
A

Quarter 4 (15 decks)

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