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Flashcards > Spinal and Epidural > Flashcards

Spinal and Epidural Flashcards

0
Q

What is the ligamentum flavum also known as?

A
  • “yellow ligament”
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1
Q

Ligamentum flavum extends:

A

-extends from foramen magnum to sacral hiatus

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2
Q

Pia mater:

A

-adheres to the spinal cord

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3
Q

Dura mater:

A
  • begins at foramen magnum and ends at S2

- abuts arachnoid mater (subdural space)

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4
Q

Arachnoid mater

A
  • physiological barrier for drugs moving btw the epidural space and spinal cord
  • abuts pia mater- gives rise to subarachnoid space
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5
Q

Subarachnoid Space:

A
  • contains CSF- cont with cranial CSF

- houses spinal nerve roots and rootlets

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6
Q

Spinal cord extends from:

A

-foramen magnum to conus medullaris (terminates at L1 or L2)

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7
Q

Termination of dural sac occurs at what level?

A

S2

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8
Q

What is a dermatome?

A

-the area of skin innervated by a spinal nerve and its segment

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9
Q

What is a segment?

A
  • rootlets of a single spinal nerve coming from the spinal cord
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10
Q

CSF is found in what space?

A

-subarachnoid space

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11
Q

CSF is produced by:

A

-choroid plexus

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12
Q

Where is spinal anesthesia delivered?

A
  • subarachnoid space
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13
Q

Where is epidural anethesia delivered?

A
  • epidural space
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14
Q

Principal site of a neural blockade is:

A
  • the nerve root
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15
Q

T/F: Blockade can occur at any point AND all points along the neural pathways extending from the site of the drug admin to the interior of the cord.

A

True

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16
Q

In a centroneuraxial blockade what fiber types are blocked?

A
  • nociceptive
  • motor
  • proprioceptive
  • autonomic
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17
Q

The purpose of the centroneuraxial blockade is to block?

A
  • the nociceptive impulses

- but ANS and motor are blocked too

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18
Q

Considerations for regional techniques:

A
  • anatomy
  • age
  • pregnancy
  • pathophysiology
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19
Q

What procedures would you give GA and an epidural/SAB?

A
  • major abdominal procedure

- lower extremity vascular cases

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20
Q

When would a SAB/epidural block be indicated for analgesia?

A
  • postoperative

- labor and delivery

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21
Q

Major absolute contraindication for a neuroaxial block

A

-patient refusal

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22
Q

Cardiovascular effects of neuroaxial blocks depend on:

A
  • spread and blockade of the ANS
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23
Q

What changes would be seen if CV effects occurred with a neuroaxial block?

A
  • decreased BP, HR, MAP, CO and SVR

- decreased CO is typically d/t venous dilation/pooling

24
Q

Major pulmonary side effects of a neuroaxial block:

A
  • as block ascends, accessory muscle paralysis occurs

- perception of ineffective breathing and decreased ability to cough

25
Q

Phrenic nerve associated with what level of the spine? What is the first sensation that this nerve may be seeing LA?

A
  • C3 to C5

- pinky finger tingling may indicate block is ascending

26
Q

Effect of neuroaxial block on GI/renal:

A
  • hyperperistalsis
  • N/V
  • bladder dysfunction
27
Q

Effect of neuroaxial block on metaolic/endocrine:

A
  • decrease stress response r/t surgery
  • decrease cortisol release
  • catecholamine release may be decreased
28
Q

Lateral decubitus position:

A
  • forehead to knees
29
Q

Which SAB needle will be more likely to cause a Postdural Puncture Headache- Sprotte (pencil point needle) or Quincke (cutting needle)?

A
  • Quincke (cutting needle)
30
Q

Most common technique for a spinal block?

A
  • median approach
31
Q

Why would you do a paramedian approach for SAB?

A
  • for pts who cannot adequately flew b/c of pain or whose ligaments are ossified
  • spinal needle is pace 1.5 cm laterally and caudad
32
Q

What layers do you go through to place and epidural?

A
  • skin
  • subq tissue
  • supraspinous ligament
  • infraspinous ligament
  • ligamentum flavum
  • EPIDURAL SPACE
33
Q

What layers do you go through to place a SAB?

A
  • skin
  • subq tissue
  • supraspinous ligament
  • infraspinous ligament
  • ligamentum flavum
  • (epidural space)
  • dura mater
  • (dural space)
  • arachnoid mater
  • SUBARACHNOID MATER - CSF
34
Q

Landmarks for SAB?

A
  • identify superior iliac crests and L4
35
Q

Epidural placement uses what kind of technique?

A
  • loss of resistance technique (air filled glass syringe)
36
Q

The epidural space is located directly after which ligament?

A
  • ligamentum flavum
37
Q

Typically, how far is the ligamentum flavum from the skin in a normal sized adult?

A
  • 4 to 6cm
38
Q

How much do you advance your epidural catheter once in the epidural space?

A
  • 2 to 3 cm
39
Q

For SAB/epidural needle placement position the needle bevel needs to be inserted:

A
  • needle bevel is inserted parallel to longitudinal fibers
40
Q

In PARTURIENTS the epidural catheter is advanced:

A
  • 4 to 6 cm
41
Q

The density of a solution to the density of another substance.

A

Baracity

42
Q

What is hyperbaric solution mixed with and why? What is the SG?

A
  • dextrose
  • allows LA to settle in dependent areas
  • SG greater than 1.11
43
Q

What is hypobaric solution mixed with and why? What is the SG?

A
  • sterile water
  • allow LA to go upward (broken right hip ex)
  • SG less than 1.005
44
Q

What is isobaric solution mixed with? What is the SG?

A
  • mixed with CSF

- less than 1.006

45
Q

Factors influencing block height

A
  • dose
  • site of injection
  • baracity
  • position of patient
46
Q

When can a patient go to the floor after a spinal?

A
  • PACU to the floor after 4 dermatome regression less than T10, stable and comfortable
47
Q

When can a patient be discharged home after a spinal?

A

SDS to home after ambulation without orthostatic changes, + void

48
Q

Delivery of LA to the epidural space via injection through the sacral hiatus

A
  • Caudal block
49
Q

Major complications of spinal/epidural/caudal blocks:

A
  • hypotension
  • sudden cardiac arrest
  • post dural puncture HA
  • epidural hematoma
50
Q

Post dural puncture headache, treatment?

A

-epidural blood patch, bedrest, hydration, oral analgesics, epidural saline injection

51
Q

Why does post dural puncture HA occur?

A
  • d/t intracranial pressure with compensatory cerebral vasodilation
52
Q

Epidural hematoma is primarily caused by:

A
  • a coagulation defect

- can cause paralysis

53
Q

S/S of LA toxicity:

A
  • neuro changes
  • seizure followed by CNS depression, apnea, hypotension
  • transient radicular irritation
  • cauda equina syndrome
54
Q

Dural mater/sac extends from where to where?

A

-foramen magnum to S2

55
Q

T1 to T4 is known as the:

A

-cardioaccelerators, unopposed vagal response

56
Q

The continuous catheter technique for epidural placement, what needle is used?

A

Tuohy needle

57
Q

Specific gravity of CSF

A

-1.004 to 1.008

58
Q

What is the primary cause of an epidural hemotoma?

A

-coagulation defect

Flashcards (5 decks)

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