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► Med Misc 44 > Regional- Spinal (subarachnoid) Neural Blockade > Flashcards

Regional- Spinal (subarachnoid) Neural Blockade Flashcards

1
Q

what is the front of the spinal cord called?

A

Anterior

Ventral

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2
Q

what is the back of the spinal cord called

A

Posterior

Dorsal

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3
Q

what is the area where the spinal nerves exit called

A

Facet joint

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4
Q

cervical nerves exit where?

A

above the vertebrae

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5
Q

all other nerves exit where?

A

below the vertebrae

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6
Q

what is the 1st and 2nd cervical vertebrae

A
  1. Atlas
  2. Axis

Remember “t” comes before “x”

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7
Q

In a supine pt where are the high points of the spine

A

C3

L3

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8
Q

In the supine pt where are the low spots of the spine

A

T6

S2

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9
Q

the spinal cord extends from the ____ _____ to the Lumbar level ___ in the adult and ____ in the newborn

A

Foramen Magnum

L1 (adult)

L3 (newborn)

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10
Q

by what age should the newborns Spinal cord be at the adult level

A

2 yo

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11
Q

the cord terminates where?

A

conus medullaris

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12
Q

how many cervical vertebrae are there?

A

7

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13
Q

how many thoracic vertebrae are there?

A

12

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14
Q

how many lumbar vertebrae are there?

A

5

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15
Q

how many sacral vertebrae are there?

A

5

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16
Q

how many coccygeal vertebrae are there?

A

4

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17
Q

how many pairs of spinal nerves are there

A

31

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18
Q

where is the spinal cord the wideest

A

L2

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19
Q

where is the spinal cord the narrowest

A

C5

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20
Q

what is the nerve group in the lower dural sac L1- S5 termed

A

Cauda Equiuna (horses Tail)

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21
Q

what is the area between S4 and S5 termed and what do we use it for?

A

Sacral Hiatus

Caudal Block

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22
Q

is a caudal block grouped as a spinal or epidural?

A

Epidural

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23
Q

what is total CSF volume

A

100-150ml (go with 150mL)

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24
Q

how much CSF is in the subarachnoid

A

25-30mL (1/5)

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25
Q

How much CSF is produced daily?

A

500mL

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26
Q

what is normal CSF pressure?

A

10-20 cmH20

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27
Q

what are the layers of the spinal meninges form outer to inner?

A

Dura matter

Arachnoid matter

Pia matter

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28
Q

what 2 things absorb CSF

A

arachnoid villi

arachnoid granuloma

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29
Q

the subarachnoid space lies where?

A

between the arachnoid and pia matter

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30
Q

the principle site of actin for neuraxial blockade is where

A

the nerve root

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31
Q

where is CSF found

A

the subarachnoid space (b/t the arachnoid matter and pia matter)

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32
Q

the sacral coccygeal membrane is an extension of what?

A

ligamentum flavum

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33
Q

pic of the layers of the meninges

A
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34
Q

vasoconstrictors prolong duration of spinal block how? who’s law?

A

decreased absorption

ficks law

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35
Q

what are 10 factors that effect the distribution of the drug in a spinal

A
  • Site
  • Anatomical shape of spinal column
  • Height
  • Angilation of needle
  • Volume of CSF
  • LA (dnesity/specific gravity/baracity)
  • Dose
  • Volume
  • Position of pt during injection
  • position of pt after injection
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36
Q

so volume of CSF affects the distribution of spinal anesthesia.. what happens to speed with inccreased CSF? and Decreased CSF

A

Increased CSF = Decreased speed

Decreased CSF= Increased speed

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37
Q

what is the specific gravity of CSF

A

1.004 - 1.009

think of james bond 007 (and your in the middle)

38
Q

SG of CSF is 1.004-1.009

what is isobaric?

Hyperbaric?

Hypobaric?

A

Iso- SG = CSF SG

Hyper SG > CSF SG (follows gravity)

Hypo SG

39
Q

what % of the bodies blood is in the venous side? arterial side?

A

75% venous

25% arterial

40
Q

with a spinal you get venodilation… what does that do to preload?

A

decreases it

41
Q

although sympathetic preganglionic neurons send signals to smooth muscles of both arteries and veins, the predomiant action of sympathetic blockade d/t LA is what?

A

Venodilation

42
Q

if the sympathetic outflow from T1- T4 is blocked by LA, unapposed vagus stimulation will produce what? and what is this reflex termed?

A

bradycardia

Bainbridge reflex

43
Q

the best means for treating hypotension during spinal anesthesia is what

A

physiologic not pharmacologic

AKA give fluids

44
Q

if pt is normovolemic and still has hypotension what is the best pressor

A

ephedrine

45
Q

volume for initail treatment of hypotension is from balanced salt solutions that do NOT contain glucose. administer volume in increments of how much?

A

5 mL/kg

46
Q

why would you not want to replace volume with glucose in the hypovolemic hypotensive pt

A

glucose is a diuretic and can worsen the hypovolemia

47
Q

if apnea occurs with a high spinal it is often d/t hypoperfusion of the repiratory centers in the medulla secondary to severe hypotension. what should u do?

A

treat the pressure and usually it will fix it self

48
Q

what are the 3 groups with the least reserve and at the highest risk for hemodynamic compromise with regional anesthesia?

A

peds

elderly

Very sick

49
Q

what are 3 symptoms of cauda equina syndrome?

A

lower extremity weakness

bowel and bladder dysfunction

50
Q

what are the 2 cutting needles used

A

QuinKe BadcocK

PitKin

“k” for th C sound in Cutting

51
Q

Picture of cutting needles

A
52
Q

what are 3 non cutting needles for spinals

A

Greene

whitacre

sprotte

(Pecan also used not shown here)

53
Q

picture of NON cutting

A
54
Q

how should you inseert the needle with a cutting needle

A

Turn tip paralle to fibers

never caudal or cephalad

55
Q

how long should a pt be off ASA before getting a spinal

A

no need to be off ASA for spinal!

56
Q

Pts receiving heparin IV before sx should not receive spinal untill what?

A

normal aPTT documented

57
Q

when using a spinal and intraop heparin will be used . how long post spinal should u wait until you should give heparin

A

1 hour

58
Q

what is the magical number for INR with coumadin therapy to either place a spinal or remove a catheter?

A
59
Q

pts receiving fibrinolytics or thrombolytic drug therapy should not receive neuraxial for how many days

A

10 days

60
Q

Anterior dermatome: name landmark

C4

A

clavicle

61
Q

Anterior dermatome: name landmark

T4-T5

A

Nipples

62
Q

Anterior dermatome: name landmark

T6 (to T8)

A

Xiphoid

63
Q

Anterior dermatome: name landmark

T8

A

Lower border of rib cage

64
Q

Anterior dermatome: name landmark

T10

A

Umbilicus

65
Q

Anterior dermatome: name landmark

L1

A

inguinal ligament

66
Q

Anterior dermatome: name landmark

L2-L3

A

Knee and below

67
Q

Anterior dermatome: name landmark

S2-S5

A

Perineal

68
Q

Posterior dermatome: name landmark

C7

A

most prominant cerivial spinous process

69
Q

Posterior dermatome: name landmark​

T7

A

inferior boarder of scapula (lower tip)

70
Q

Posterior dermatome: name landmark​

L4

A

Iliac crest (superior)

Tuffier’s line

Intercristal line

71
Q

Posterior dermatome: name landmark​

S2

A

Posterior superior iliac spine

72
Q

Name Indications for spinal anesthesia

A
  • Full stomach
  • Anatomic distortions of upper airway
  • TURP
  • OB
  • Decreased Post op pain
  • Continuous infusion
73
Q

Name some ABSOLUTE contraindications to spinal

A
  • Infection at site of injection
  • Patient Refusal
  • Severe Aortic stenosis
  • Dematologic conditions
  • Shock or severe hypovolemia
  • Increased ICP
  • Blood clotting abnormalites
74
Q

name all the structures the needle passes through for a Subarachnoid block (midline) from posterior to interior

A
  • ​Skin
  • subcutaneous tissue
  • SupraSpinous Ligament
  • Intraspinous ligament
  • Ligamentum Flavum
  • (epidural space)- not a real space
  • Dura matter
  • arachnoid matter
75
Q

the lateral approach for a SA block will not pass through what 2 structures just listed for the midline approach?

A

Supraspinous ligament

intraspinous ligament

76
Q

how many vertebraes does the spinal column have

A

33

77
Q

what is the purpose of the stylet in the spinal needle

A

gives structure

does NOT allow tracking of cells from skin into CSF

78
Q

what is the most common complication of Spinal

A

back ache

79
Q

what is the 2nd most common complication of spinal

A

headache

80
Q

whendoes the spinal headache usually set up

A

12-72 hours later

81
Q

what are some of the risk factors for spinal headache

A

Large needles

Cutting needles

Female

Young

OB

Bevel perpendicular

82
Q

Complications w/ spinal: infection

what are some predisposing factors to infectio

A

advanced age

DM

Alcoholism

Cancer

AIDS

83
Q

Complications w/ spinal: infection

what are the classic signs of infection

A

High fever

nuchal rigidity

Severe Headache

84
Q

Complications w/ spinal: infection

what does the s/s of infection from spinal resemble

A

Meningitis

85
Q

Complications w/ spinal: infection

what is the most common causative organism

A

staphylococcus aureus

86
Q

Complications w/ spinal: infection

with a PDPH why do you get diplopia

A

d/t traction on cranial nerves

87
Q

what are s/s of PDPH

A
  • nausea (loss of appetite)
  • Photophobia
  • Changes in auditory acuity
  • tinnitus
  • Depression
  • “feel miserable”
  • tearful
  • bed-ridden
  • diplopia
  • cranial nerve palsies
88
Q

what causes a PDPH

A

decreased amount of CSF in SA space, causes medulla and brainstem to drop into the foramen magnum, stretching the menengies, vessels, and nerves

89
Q

what is a fix for PDPH

A

Blood patch

90
Q

what comfirms PDPH versus all other potential diagnosis

A

the postural element

91
Q

what is conservative therapy for PDPH?

A

Caffeine (cerebral vasoconstriction)

Lying flat

Hydration

► Med Misc 44 (72 decks)

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