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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
spinal epi wash mg
0.1-0.2mg of 1:1000 solution draw up and squirt out increases duration of spinal
26
Paramedical approach.. what is the first ligament
ligamentum flavum
27
What needle is more likely to cause PDPH?
quincke but improve tactile sensation Cause more trauma than pencil point. Cut through dura instead of spread fibers Increased risk of headaches
28
what decreased PDPH
Pencil point (whitachre and sprottle) small needles Spread neural fibers versus cutting them
29
most common site for spinal block
L3-L4
30
where is the largest interspace
L5-S1
31
Bupivacaine 7.5 mg per ml
15 mg = 2 cc spinal 12 mg = 1.75 cc spinal + epi = prolong = vasoconstrict
32
prep for SAB
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
midline approach
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
conduction block
B: slow C: pain/temp/sympathetic A small: pain/temp A large: motor, proprioception
35
Sympathetic block
2-6 dermatomes higher than the sensory block depress secretion decrease the tone and contractility of smooth muscle increase heart rate
36
Motor block
2 dermatomes below
37
large diameter
myelinated sensory and motor
38
Progression of Spinal Blockade
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
If bone (os) encountered superficially
redirect needle cephalad
40
hallmark sign of PDPH
NO HEADACHE WHEN LYING SUPINE
41
If bone (os) encountered deep
redirect needle caudally
42
Complications of neuraxial blocks Immediate complaint of nausea
Hypotension PHENYLEPHRINE Get bp up
43
Epidural blood patch
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
Introducer needle fluid leaking back
Might be lidocaine leaking back → you probably won't reach the CSF with the introducer
45
Cauda Equina syndrome characterized by
1 perineal sensory deficits 2 urinary and fecal incontinence 3 varying degrees of lower extremity motor deficits
46
on your way to total/high spinal
Bradycardia Hypotension Weak cough Drop in O2
47
treat a high spinal
anticholinergics Phenylephrine Fluids ephedrine respiratory support reverse trendelenburg
48
factors influencing high spinal
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
when to check level of spinal after block
4 min
50
spinal block progression
1 temp 2 pinprick 3 light touch
51
why does total/high spinal cause hypotension?
Due to venous/arteriolar vasodilation decreased CO decreased SVR
52
why does total/high spinal cause bradycardia?
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
respiratory failure with high spinal
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
an early sign of high spinal
progressive dyspnea weak hand grip can't touch nose ineffective cough hypotension bradycardia RR 12-15 SpO2 <95% function diminished
55

Advanced Anesthesia (8 decks)

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