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Principles I summer 2024 > spinal and epidural part 1 > Flashcards

spinal and epidural part 1 Flashcards

1
Q

what is regional anesthesia divided into

A

spinal
epidural
caudal
combined spinal and epidural

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2
Q

what 2 meds discussed in lecture CANNOT be given via spinal

A

zofran
reglan

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3
Q

what are clinical indications of regional

A

sx involving lower abdomen, perineum, lower extremities
orthopedic surgery
vascular surgery on legs
thoracic surgery -epidural
c-section

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4
Q

neuraxial anesthesia reduces

A

narcotic usage
post op ileus
thromboembolic events
bleeding
PONV
respiratory complications
urinary retention

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5
Q

benefits of neuraxial anesthesia

A

great mental alertness
quicker to eat, void, and ambulate
avoid unexpected overnight admission from complications of general anesthesia
quicker PACU discharge
blunts stress response from surgery

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6
Q

relative contraindications of neuraxial anesthesia

A

deformities of spinal column
preexisting disease of spinal cord (MS, post polio)
chronic headache/backache
inability to perform SAB/ epidural after 3 attempts

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7
Q

absolute contraindications of neuraxial anesthesia

A

INR>1.5
plts <100,000 (trends)
nagelhout 2x normal
coagulation disorders or anticoagulants
pt refusal
evidence of dermal site infection
severe or critical valvular heart disease
HSS
operation>duration of LA
increased ICP
severe CHF

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8
Q

normal PT and what pathway

A

12-14 seconds
extrinsic

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9
Q

normal INR and pathway

A

0.8-1.1
extrinsic

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10
Q

aPTT normal and pathway

A

25-32 seconds
intrinsic

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11
Q

bleeding time normal

A

3-7 minuets
plt function

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12
Q

when would valvular heart disease be considered severe? critical?

A

severe- valve area 0.7-1.0 cm2
critical- valve area <0.7cm2

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13
Q

why is aortic stenosis a absolute contraindication for regional

A

decrease in SVR

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14
Q

in valvular aortic stenosis what is the life expectancy for a patient with angina? syncope? failure?

A

5 years
3 years
2 years

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15
Q

what is the death spiral

A

hypotension causes myocardial ischemia
ischemic contractile dysfunction
decreased CO
worsening hypotension
increased ischemia

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16
Q

severe CHF contraindication for regional would be when EF is

A

<30-40%
normal is 60

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17
Q

what is the onset for spinal? epidural?

A

spinal-rapid (5 min)
epidural-slow(10-15min)

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18
Q

what is the spread for spinal? epidural?

A

spinal- higher than expected may extend extracranially
epidural- as expected can be controlled with volume of LA

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19
Q

what is the nature of block for spinal? epidural?

A

spinal-dense
epidural-segmental

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20
Q

what is the motor block for spinal? epidural?

A

spinal-dense
epidural- minimal

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21
Q

hypotension is more likely in which regional anesthetic

A

spinal

22
Q

what is the difference in duration for spinal and epidural

A

spinal is limited and fixed
epidural is unlimited

23
Q

dosing of LA in spinal and epidural is based on

A

spinal- dosage
epidural- volume

24
Q

in what type of regional is LA toxicity more common in

A

epidural

25
Q

what is the anterior segment of the vertebra known as? posterior?

A

anterior-body
posterior - vertebral arch

26
Q

what 2 structures link the anterior and posterior segments

A

lamina and pedicle

27
Q

what is used as the landmark to find the middle line of the back

A

spinous process

28
Q

cervical and thoracic spinous process require needle approach from

A

cephalic (above)

29
Q

what are the symptoms of a facet joint injury

A

pain and muscle spasm in the area of skin severed by that nerve (dermatome)

30
Q

inferior angle of scapula is located at

A

T7

31
Q

superior aspect of iliac crest is located at

A

L4

32
Q

posterior superior iliac spine is located at

A

S2

33
Q

what is tuffiers line

A

intercristal line
horizontal line runs across the top edge of the hip bones and matches the L4 vertebra

34
Q

in infants the intercristal line corresponds to

A

L5-S1

35
Q

what is located at the base of the sacrum and aligns with S5 vertebra

A

sacral hiatus

36
Q

what does the sacral hiatus act as an access point for

A

caudal anesthesia

37
Q

what is the sacral cornua

A

landmark for caudal anesthesia

38
Q

what is the conus medullaris and where does it end

A

spinal cord tapers off at the end
ends between L1 and L2
infants L3

39
Q

what is the cauda equina

A

bundle of spinal nerves extending from conus medullaris to dural sac

40
Q

where does the subarachnoid space end

A

dural sac
S2 in adults S3 in infants

41
Q

filum terminale is

A

structure that continues downward from the end of spinal cord
continuation of pie mater
functions to anchor the spinal cord to the coccyx

42
Q

where is the internal filum terminale

A

begins at the conus medullaris extending to dural sac
L1-S2

43
Q

where is the external filum terminale

A

starts from the dural sac and extends into the sacrum
S2-S5

44
Q

blood supply to the spinal cord includes

A

one anterior spinal artery originating from vertebral artery
two posterior spinal arteries originating from vertebral artery

45
Q

anterior spinal artery syndrome can lead to

A

motor paralysis
loss of pain and temperature sensation below affected area

46
Q

what are the 4 causes of ischemia discussed in lecture

A

low BP
mechanical blockage
blood vessel disease
bleeding

47
Q

what supplies the lower 2/3 of spinal cord

A

artery of adamkewicz
arises from T7-9 and L2 regions

48
Q

name the ligaments in ordered from posterior to anterior

A

supraspinous ligament
intraspinous ligament
ligamentum flavum
posterior longitudinal ligament
anterior longitudinal ligament

49
Q

what ligaments are not included in a paramedic approach that would be in a midline

A

suprospinous ligament
intraspinous ligament

50
Q

what is the order of layers in a midline approach for a spinal

A

skin
subq fat
supraspinous ligament
interspinous ligament
ligamentum flavum
dura mater
subdural space
arachnoid mater
subarachnoid space

51
Q

when is a paramedian approach favorable

A

interspinous ligament calcified or patient cannot flex their spine

Principles I summer 2024 (7 decks)

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