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Advanced Anesthesia > spinal > Flashcards

spinal Flashcards

1
Q

How many cervical spine

A

7

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2
Q

How many thoracic spine

A

12

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3
Q

where are cardioaccelerators

A

T1-4 or 5 per PP

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4
Q

s/s cardio accelerators

A

s/s of a high spinal
hypotension
bradycardia

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5
Q

How many lumbar spine

A

5

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6
Q

connus medullaris

A

the tapered end of the spinal cord, which is usually located near the first or second lumbar vertebrae in the back of an adult???
L1 adults
L3 in children

5-6mm deep

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7
Q

Tuffiers Line

A

Body of L4/L5 or the 4-5 interspace.

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8
Q

where does spinal cord begin?

A

foramen magnum base of skull

large, oval-shaped opening in the occipital bone at the base of the skull that allows the central nervous system to pass through and connect the brain to the spinal cord.

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9
Q

Where does spinal cord end in adults

A

L1

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10
Q

Where does spinal cord end in cihldren

A

L3

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11
Q

How many sacral spine

A

5 fused

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12
Q

How deep is epidural space in Lumbar spine?

A

5-6mm deep

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13
Q

The sacral hiatus

A

provides an opening into the sacral canal which is the caudal termination of the epidural space

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14
Q

Anterior spinal artery

A

supplies 2/3 of anterior cord
Artery of Adamkiewicz (arteria radicularis magna)
originates from vertebral artery
terminates along the anterior surface of the cord

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15
Q

why does aortic clamping cause ischemia?

A

stops blood flow to artery of adamkiewics?Paresthesia, paralysis, incontinence.

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16
Q

Two paired posterior spinal artery

A

supply posterior 1/3
originates from vertebral artery
terminates along the anterior surface of the cord

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17
Q

Name Skin to CSF layers

A

skin
subcutaneous tissue
supraspinous ligament
interspinous ligament
ligamentum flavum “pop” then stop for epidural
epidural space
dura mater (subtle pop or click)
arachnoid mater
subarachnoid space CSF

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18
Q

whats layers are deep to the epidural space

A

Dura Mater
Arachnoid
Subarachnoid space (CSF= Spinal)
Pia Mater: On the cord

these are continuous with cranial meninges

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19
Q

neuraxial blocks decrease incidence of

A
  1. Cardiac complications
  2. Bleeding
  3. DVT/Pulmonary embolism
  4. Pneumonia
  5. Respiratory depression
  6. Decreased vascular graft occlusion
  7. Increased peristalsis
  8. Blunt stress response in CAD patients
  9. Decreases opioid use
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20
Q

Absolute contraindications to neuraxial

A

Patient refusal

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21
Q

Relative Contraindications

A

Sepsis
Uncooperative
Preexisting neurological deficits
Coagulopathy / Bleeding diathesis
Severe hypovolemia
Increased ICP
Severe aortic or mitral stenosis
Prior back surgery
Inability to communicate with patient
Complicated surgery
Prolonged operation
Major blood loss
Maneuvers that compromise respiration

Demyelinating lesions seen on cord with MS, Guillain Barre, CIDP Chronic inflammatory demyelinating polyradiculoneuropathy.

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22
Q

what is isobaric

A

1.004-1.009

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23
Q

hyperbaric solution

A

Glucose
>1.009
drops to dependent area

24
Q

hypobaric solution

A

<1.004
sterile water
rises

25
Q

spinal epi wash mg

A

0.1-0.2mg of 1:1000 solution
draw up and squirt out
increases duration of spinal

26
Q

Paramedical approach.. what is the first ligament

A

ligamentum flavum

27
Q

What needle is more likely to cause PDPH?

A

quincke
but improve tactile sensation

Cause more trauma than pencil point.
Cut through dura instead of spread fibers
Increased risk of headaches

28
Q

what decreased PDPH

A

Pencil point (whitachre and sprottle)
small needles

Spread neural fibers versus cutting them

29
Q

most common site for spinal block

A

L3-L4

30
Q

where is the largest interspace

A

L5-S1

31
Q

Bupivacaine 7.5 mg per ml

A

15 mg = 2 cc spinal
12 mg = 1.75 cc spinal
+ epi = prolong = vasoconstrict

32
Q

prep for SAB

A

Sterile procedure
GIve IV fluid bolus of 500 cc prior to SAB and epidural dose
If it’s not labor epidural or c/s, give versed, fentanyl, and oxygen prior to neuraxial anesthesia
LA to the skin, deep tissues
IV, O2, ECG, BP, emergency airway, drugs, hat, mask, gloves, glown, spinal kit with local top be used.

33
Q

midline approach

A

Localize the skin
Needle should be directed slightly cephalad 30°
Needle will pass through three ligaments
Supraspinous
Interspinous
Ligamentum flavum
Dura mater (thecal sac)
Feel for “small pop”
CSF flows thru once stylet is removed

34
Q

conduction block

A

B: slow
C: pain/temp/sympathetic
A small: pain/temp
A large: motor, proprioception

35
Q

Sympathetic block

A

2-6 dermatomes higher than the sensory block

depress secretion
decrease the tone and contractility of smooth muscle
increase heart rate

36
Q

Motor block

A

2 dermatomes below

37
Q

large diameter

A

myelinated sensory and motor

38
Q

Progression of Spinal Blockade

A

S- sympathetic
T-temperature
P- pain
T- touch
P-pressure
M-motor
V-vibratory
P-proprioception

Some times penny tries pressing me very politely

39
Q

If bone (os) encountered superficially

A

redirect needle cephalad

40
Q

hallmark sign of PDPH

A

NO HEADACHE WHEN LYING SUPINE

41
Q

If bone (os) encountered deep

A

redirect needle caudally

42
Q

Complications of neuraxial blocks
Immediate complaint of nausea

A

Hypotension
PHENYLEPHRINE
Get bp up

43
Q

Epidural blood patch

A

10-15 ml autologous blood is injected att he site of the meningeal tear
Seals dural rent by forming a thrombus
1st patch 60-90% effective
Second 98% effective

44
Q

Introducer needle fluid leaking back

A

Might be lidocaine leaking back → you probably won’t reach the CSF with the introducer

45
Q

Cauda Equina syndrome characterized by

A

1 perineal sensory deficits
2 urinary and fecal incontinence
3 varying degrees of lower extremity motor deficits

46
Q

on your way to total/high spinal

A

Bradycardia
Hypotension
Weak cough
Drop in O2

47
Q

treat a high spinal

A

anticholinergics
Phenylephrine
Fluids
ephedrine
respiratory support
reverse trendelenburg

48
Q

factors influencing high spinal

A

1 Local dose
2 Patient position especially if a hyperbaric solution is used.
3 Height
4 Age ???? old or young
5 Gender
6 Intra Abdominal pressure: compression: 7 Obese/ Obstetric
8 Anatomic configuration of SC

49
Q

when to check level of spinal after block

A

4 min

50
Q

spinal block progression

A

1 temp
2 pinprick
3 light touch

51
Q

why does total/high spinal cause hypotension?

A

Due to venous/arteriolar vasodilation
decreased CO
decreased SVR

52
Q

why does total/high spinal cause bradycardia?

A

Widespread sympathetic blockade leading to unopposed vagal (parasympathetic) tone and blockade of T1-T4- the cardioaccelerator fibers.
Also may be due to decreased right atrial filling

Treatment involves anticholinergic Rx (atropine) or B1 agonists, i.e. ephedrine

53
Q

respiratory failure with high spinal

A

Paralysis of intercostals leading to decreased chest wall sensation
If blockade reaches C3-C5, diaphragmatic innervation lost with rapid, progressive respiratory failure

Early warning signs:
1 poor resp effort, whispering and inability to cough
Acute respiratory arrest is due to hypoperfusion of the brainstem

Treatment depends on severity:
O2, BVM vent, and most likely intubation

54
Q

an early sign of high spinal

A

progressive dyspnea
weak hand grip
can’t touch nose
ineffective cough
hypotension
bradycardia
RR 12-15
SpO2 <95%
function diminished

55
Q
A

Advanced Anesthesia (8 decks)

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