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Anesthesia Concepts > spinal and epidural > Flashcards

spinal and epidural Flashcards

1
Q

vertebral curves in supine position

A

high C5 L3

low T5 S2

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2
Q

ligamentum flavum

A

extends from foramen magnum to sacral hiatus
tough wedge shaped ligament compused of elastin
thickest in midline 3-5mm at L3 adults
“yellow ligament”

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3
Q

termination of spinal cord and dural sac

A 
spinal cord (conus medullaris) L1-2
dural sac S2
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4
Q

T4

A

nipple

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5
Q

T6

A

xiphoid

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6
Q

T8

A

last rib

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7
Q

T10

A

umbilicus

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8
Q

CSF

A

150cc subarachoid space
volume replaced 3-4 times a day
production - 21 ml/hr by choroid plexus
spec gravity 1.004-1.008

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9
Q

blood supply

A

anterior spinal artery 2/3 blood flow
posterior spinal arteries
radicular artery

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10
Q

advantages of neuroaxial anesthesia

A

decreased metabloic stress response compared with GA
avoids airway instrumentation
decreased incidence post op N/V
less intraoperative sedation
post op pain relief
allows patient to remain awake for C section

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11
Q

disadvantages of neutoaxial anesthesia

A

hypotention
slower case start if challenging placeemnt
failure rate depends on experience
urban legends

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12
Q

considerations for choosing regional technique

A

anatomy (BMI, scoliosis, contractures)
age
pregnancy (reduced vol in epi space compression vena cava, L uterine displacement
patho (CV disease) - maybe unable to tolerate profound autonomic response

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13
Q

absolute CA

A

1) patient refusal
2) infection at inj site
3) increased ICP
4) clotting defects/anticoag therapy
5) severe hemorrhage/hypovol (autonomic response)
6) CNS disease, meningitis
7) hysteria/inability to remain still
8) bacteremia
9) septicemia

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14
Q

cardiovascular autonomic responses

A

blockade of autonomics

venous dilation > arterial dilation
SVR decreases 15-25%
CO decreases 10-15%

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15
Q

pulmonary SE

A

as block ascends, accessory muscle paralysis occurs, perception ineffective breathing
C3-5 phrenic nerve - tingling in pinky

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16
Q

GI SE

A 
N/V
hyperperistaliss, unopposed parasympathetic activity
slow to liver
renal lood lod autoreg
bladder dysf unc
17
Q

pencil point needle

A

spread dural fibers
reduces chances post epi HA
“pop”
greater tip strength

18
Q

cutting (quince)

A

less likely to have “pop” bc sharper tip

increased risk post epi HA

19
Q

tissue layers

A 
skin
subcutaneous tissue
supraspinous ligament
intraspinous ligament
ligamentum flavum
(epidural space)
dura mater
arachnoid mater
(subarachnoid space)
pia mater
spinal cord
20
Q

lumbar epidural

A

needle to LF, perpendicular angle
3.5-6cm
LOR
advance 2-3cm into epi space

21
Q

hyperbaric solution

A

spec gravity > 1.11

mix with dextorose

22
Q

hypobaric solution

A

spec gravity < 1.005

mix with sterile water

23
Q

isobaric solution

A

spec gravity < 1.006

mix with CSF

24
Q

factors affecting spread local in SAB

A 
baricity
position
concentration and volume inj
level injection
barbotage/rage inj
direction of needle and bevel
25
Q

when can you be discharged?

A

spinal - pacu to floor after 4 dermatome regression < T10 stable and comfortable
SDS to home after ambulate w/o orthostatic and can void

26
Q

caudal block

A

epidural space through sacral hiatus
sacrococcygeal ligament and sacral hiatus
22 or 23g needle and syringe

27
Q

complications

A 
hypotension
brady
cardiac arrest
N/V
intravascular inj
intrathecal inj
cathater shearing
headach
high blockade
inadequate blockade
neurological comp
backache
infection
uriniry retention
epidural hematoma
28
Q

post dural puncture headache

A 
younger
female
caucasian
larger needle size
pregnancy
dehydration
cutting tipped needle
multiple puncture attempts

1-4% incidence
1 day to 1 week

bedrest ,hydrationm, oral analgesics, abd binder, caffiene, blood patch, saline inj

Anesthesia Concepts (6 decks)

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