SPINAL AND EPIDURAL ANAESTHESIA

Question 1

Spinal anesthesia/_______________ :
the injection of small amounts of LAs into the (______) at the level ____________ ,where the ________________ , anaesthesia of the _____________ part below the __________ is achieved

Answer 1

Subarachnoid block

CSF; below (L1)

spinal cord ends

lower body; umbilicus

Question 2

SAB produces (few or many?) adverse effects on the respiratory system as long as ________________ are avoided.

Answer 2

Few

unduly high blocks

Question 3

The costs associated with SAB are (minimal or maximal?) .

Answer 3

Minimal

Question 4

In SAB, As ________________ is not compromised, there is a reduced risk of airway obstruction or the aspiration of gastric contents.

Answer 4

control of the airway

Question 5

SAB provides _______ muscle relaxation for __________ and __________ surgery.

Answer 5

excellent

lower abdominal and lower limb

Question 6

With SAB, Blood loss during operation is (more or less ?)than when the same operation is done under general anaesthesia.

Answer 6

Less

Question 7

Splanchnic blood flow.
Because of its effect on ____easing blood flow to the gut, spinal anaesthesia reduces the incidence of ________________.

Answer 7

incr

anastomotic dehiscence

Question 8

Visceral tone. The bowel is ________ by SAB and sphincters ______ although ________ continues. Normal gut function rapidly returns following surgery.

Answer 8

contracted ; relaxed; peristalsis

Question 9

Coagulation.

Post-operative deep vein thrombosis and pulmonary emboli are (more or less?) common following spinal anaesthesia.

Answer 9

Less

Question 10

Indications for SAB

Operations below the ______________ : hernia repairs, gynaecological and urological operations

Any operation in the _________ or __________

Answer 10

umbilicus

perineum or genitalia

Question 11

Indications for SAB

All operations on the _____ except for _____________ which is possible but an unpleasant experience for an awake px so here the px is anaesthetized with _______ and sedation with _____

Answer 11

leg

limb amputation

SAB

GA

Question 12

Indications of SAB

Special indications
—________
_______________ dx hepatic, renal and endocrine dx ( DM )
— Most patients with ________ diseases except for ______________ dxs and _______________.

Answer 12

Elderly

— Chronic systemic

mild cardiac

stenotic valvular

uncontrolled HTN.

Question 13

Contra-indications
Patient _________

_____________ patients: like young children and psychiatric or mentally handicapped pxs
________ diseases : as bleeding from ________________ is common , pxs with low platelet count or those on anticoagulant drugs (heparin + warfarin ) are at high risk of __________ formation.

Answer 13

refusal

Uncooperative

Clotting; ruptured peridural vein

hematoma

Question 14

Contra-indications for SAB

Hypovolaemia: As SAB has marked _____tensive effects, hypovolaemic patients must be adequately __________ and __________

Septicemia: leading to __________ and ________

Answer 14

hypo; rehydrated and resuscitated

CSF infection and meningitis

Question 15

Contra-indications for SAB

_____________ (relative contraindication)
as it will probably only serve to make the dural puncture more difficult.

Answer 15

Anatomical deformities

Question 16

Contra-indications for SAB

______________ disease. Any worsening of the dx postoperatively may be blamed erroneously on the SAB.

Inadequate ____________ and ______________

Answer 16

Neurological

resuscitative drugs and equipment for GA

Question 17

No regional anaesthetic technique should be attempted if ___________________________________ are not immediately available

Answer 17

drugs and equipment for resuscitation and GA

Question 18

Local anaesthetics for SAB

LA agents are either ______ ,_______, or __________

Answer 18

hyper- ,hypo- or isobaric.

Question 19

Hyperbaric agents tend to spread (above or below?) the level of injection and they are _____________, that’s why they are preferred over iso- and hypobaric agents.

Answer 19

Below

easier to predict

Question 20

Local anesthetics for SAB
—
Bupivacaine ( ___________ ): ____% _______________________ is the best
—
____% _____________________ is also popular

Answer 20

Marcaine; 0.5

hyperbaric bupivacaine

0.5; isobaric bupivacaine

Question 21

Local anaesthetic for SAB (Lidocaine)
—
Lidocaine ([___________): ___% _____baric lidocaine lasts ____________
—
——% lidocaine can be used but as a much (shorter or longer ?)duration of action
—
0.2mls of ————- 1:1000 + lidocaine will _______ the duration of action
—

Answer 21

Xylocaine; 5; hyper

45-90 mins

2; shorter; adrenaline; prolong

Question 22

Lidocaine from ( multi dose vials ) should not be used ___________ally as they contain ___________________________.

Answer 22

intrathecally

potentially harmful preservatives

Question 23

Factors affecting the spread of local anaesthetic solutions in CSF

The ________ of the local anesthetic solution The _________ of the patient
The _________ of injection
The _________ of injection

Answer 23

baricity

position

level

speed

Question 24

Factors affecting the spread of local anaesthetic solutions in CSF

Obesity: as increase in ____________ decreases the ________________ , so doses must be ________

Pregnancy: increase in ____________ leading to increase in ______________ leading to less _________________ and _____ doses.

Answer 24

intra-abdominal pressure

subarachnoid space; reduced

intra-abdominal pressure; peridural veins filling

subarachnoid space; less

Question 25

How to perform the spinal injection It is a ________ procedure! _______ the patient’s back with ________ Locate a suitable _____________________ Raise an ____________________ at proposed puncture site Insert the needle When ——— appears then slowly inject the local anaesthetic

Answer 25

sterile; Clean; antiseptic inter-spinous space intradermal wheal of LA agent CSF

Question 26

Spinal anaesthesia Insert the needle: the structures that will be passed: List them all!!

Answer 26

skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater

Question 27

Complications of spinal anaesthesia ______tension: due to vaso_______ and a functional _____ease in the effective circulating volume. ___________ (PDPH): within ______ and may last for __________

Answer 27

Hypo; dilatation; decrease Headache 12-24hrs; 1 week

Question 28

Fix for hypotension in spinal anesthesia By giving ———- and oxygen mask _______ the ______: simple and effective Increase the _______ of IV infusion: until the blood pressure is restored Vaso____________ – _________ , ________ With concomitant ______cardia, give ________

Answer 28

fluids ;Raising ; legs speed; Vasoconstrictor phenylephrine ; ephedrine bradycardia ; atropine

Question 29

Fix for Headache (PDPH) in Spinal Anaesthesia Occurs following use of ___________ needles and ______ gauge spinal needles It is __________ and it is often ________ associated with a _____________, nausea, vomiting, dizziness and photophobia Ask to ___________ and give simple analgesics

Answer 29

Quincke spinal wide; postural occipital; stiff neck lying flat in bed

Question 30

Complications of SAB Urinary ____________ : the ____________ fibers are among the last to recover. __________ complications (rare): meningitis, arachnoiditis, peridural abscess __________________ : from direct injury of the spinal cord — —

Answer 30

retention ; sacral autonomic Neurological; Permanent paralysis

Question 31

Epidural Anaesthesia — Local anaesthetic solutions are deposited in the _______ space between the __________ and the _____________ lining the vertebral canal. The injected local anaesthetic solution produces ___________ by ————— at the _____________ nerve roots

Answer 31

peridural dura mater; periosteum analgesia blocking conduction intradural spinal

Question 32

Epidural Anaesthesia — Technique: ________________ technique to identify the epidural space.

Answer 32

Loss of resistance

Question 33

Epidural Anaesthesia ______ % ______ ———— (mainly) or ———— (——-%) is usually used to produce epidural anaesthesia

Answer 33

0.5% plain Bupivacaine lidocaine (2.0%)

Question 34

Epidural Anaesthesia contd. Indications and Contraindications: Same as spinal anaesthesia. Additional indication is the __________________ using the epidural catheter technique

Answer 34

post operative pain management

Question 35

Epidural Anaesthesia Complications: the same of spinal anaesthesia, except the ____________________.

Answer 35

post dural puncture headache

Question 36

Differences between Spinal and Epidural Anesthesia Lebel Injection Hypotension

Answer 36

below L1/L2, where the spinal cord ends at any level of the vertebral column. subarachnoid space i.e. puncture of the dura mater epidural space (between ligamentum flavum and dura mater) i.e without puncture of the dura mater Rapid ; slow

Question 37

Differences between Spinal and Epidural Anesthesia Identification of the subarachnoid space Headache Density of block

Answer 37

When CSF appears( Using the loss of resistance technique. Probable complication; not probable More dense; less dense

Question 38

Differences between Spinal and Epidural Anesthesia Doses Onset of action

Answer 38

Doses: 2.5- 3.5 ml bupivacaine 0.5% heavy Doses: 15- 20 ml bupivacaine 0.5% plain Onset of action: rapid (2-5 min) Onset of action: slow (15-20 min)