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Principles I summer 2024 > spinal and epidural part 2 > Flashcards

spinal and epidural part 2 Flashcards

1
Q

order of meningeal layers posterior to anterior

A

dura mater
arachnoid mater
pia mater

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2
Q

epidural space is located_________ and contains

A

located outside the dura mater
contains fat ,lymphatics and small blood vessels

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3
Q

subdural space is a ________ space between the

A

potential space between the dural and arachnoid mater

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4
Q

subarachnoid space is between _______ and is filled with ____________

A

between arachnoid and pia
filled with CSF which cushions and protects the spinal cord

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5
Q

the epidural space starts at the ___________ and goes to _______

A

foramen magnum and goes to S5

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6
Q

what are the borders of the epidural space

A

cranial border
caudal border
anterior border- lined by posterior longitudinal ligament
lateral borders-marked by bony projections of the vertebrae
posterior borders- framed by ligaments flavum and the bony plates or the vertebrae

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7
Q

what is the batson’s plexus

A

valveless and from a plexus draining blood from the cord and its linings

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8
Q

density of epidural veins increases _______

A

laterally

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9
Q

epidural veins are engorged under conditions like

A

obesity or pregnancy

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10
Q

what is the significance of engorged epidural veins

A

increased risk of bleeding

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11
Q

What is the plica mediana dorsalis

A

thought to be a band of connective tissue located between the ligamentum flavum and the dura mater

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12
Q

what is the potential impact of the plica

A

barrier formation: might act as a barrier within the epidural space
medication spread: this barrier could affect how medications spread when injected into the epidural space

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13
Q

what is the clinical relevance of plica

A

catheter insertion
unilateral blocks

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14
Q

what does the subarachnoid space contain

A

CSF, nerve roots, spinal cord

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15
Q

what is the characteristic felt when passing through the dura mater during a spinal

A

pop

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16
Q

what happens is an epidural dose is injected into subdural space

A

high spinal meaning the medication affects a larger area than intended

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17
Q

spinal dosing into the subdural space can result in

A

failed spinal

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18
Q

which meningeal layer should never be punctured

A

pia mater
directly attached to spinal cord

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19
Q

how many pairs of spinal nerves do we have

A

31

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20
Q

which nerve root brings sensory information from the body back to spinal cord

A

posterior (dorsal)

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21
Q

what does the anterior (ventral) nerve root carry

A

motor and autonomic body processes

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22
Q

anterior and inner surface of lower limb dermatomes

A

L1-4

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23
Q

foot dermatomes

A

L4,5 S1

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24
Q

medial side of great toes dermatome

A

L4

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25
Q

posterior and outer surface of lower limbs dermatomes

A

S1,2 L5

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26
Q

lateral margin of foot and little toe dermatome

A

S1

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27
Q

Perineum dermatomes

A

S2-4

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28
Q

level of umbilicus dermatome

A

T10

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29
Q

inguinal or groin regions dermatome

A

T12

30
Q

clavicles dermatome

A

C5

31
Q

lateral parts of upper limbs dermatome

A

C5-7

32
Q

medial sides of the upper limbs dermatomes

A

C8 T1

33
Q

thumb dermatome

A

C6

34
Q

hand dermatome

A

C6-8

35
Q

ring and little fingers dermatome

A

C8

36
Q

level of nipples dermatome

A

T4

37
Q

what surgery relates to dermatomes S2-S5

A

peri-anal/ anal surgery

38
Q

what surgery relates to dermatome L2

A

foot/ ankle surgery

39
Q

what surgery related to dermatome L1

A

thigh/ lower leg/ knee

40
Q

what surgery relates to dermatome T10

A

vaginal delivery/ uterine/ hip procedure/ tourniquet/TURP

41
Q

what surgery relates to dermatome S3

A

scrotum

42
Q

what surgery relates to dermatome S2

A

penis

43
Q

what surgery relates to dermatome T8

A

testicular procedure

44
Q

what surgery relates to dermatome T6

A

urologic/gynecologic. lower abdominal

45
Q

what surgery relates to dermatome T4

A

C section/ upper abdominal

46
Q

what are controllable factors that affect spread of LA in spinal

A

Baricity
patient position
dose
site of injection

47
Q

what are non controllable factors that affect spread of LA in spinal

A

volume of CSF
increased intra-abdominal pressure
age

48
Q

what does not affect the spread of LA in spinal

A

barbotage
speed of injection
orientation of bevel
addition of vasoconstrictor
gender

49
Q

what are controllable factors in an epidural that significantly affect spread

A

LA volume
level on injection
dose

50
Q

what are non controllable factors that significantly affect the spread of LA in epidural

A

pregnancy
old age

51
Q

what are controllable factors in an epidural that have a small effect of spread

A

LA concentration
patient position

52
Q

what are non controllable factors in an epidural that have a small effect on spread

A

height of patient

53
Q

what are controllable factors of an epidural that does not affect spread

A

additives in the anesthetic (might change onset time or duration but not spread)
direction of the bevel
speed of injection

54
Q

list the nerve fiber blocked in order

A

B
C
A-delta
A-gamma
A-beta
A-alpha

55
Q

what do B fibers do

A

autonomic preganglionic fibers

56
Q

what do C fibers do

A

pain and temperature

57
Q

what to A delta fibers do

A

pain and temperature

58
Q

what do A gamma fibers do

A

motor tone

59
Q

what do A beta fibers do

A

tough and pressure

60
Q

what do A alpha do

A

motor and proprioception

61
Q

what fibers are sensation

A

A beta
A delta
c

62
Q

what fibers are motor

A

A alpha
A gamma

63
Q

order of nerve block recovery

A

reverse of onset
a alpha
a beta
a gamma
C and A delta
B fibers

64
Q

what fiber is blocked the longest

A

B fibers

65
Q

what does the modified bromage scale evaluate

A

function of lumbosacral nerves, which are the lower spine and sacral nerve area and does not assess movement above these regions
scale 0-3 (3 complete block)

66
Q

neuraxial CV effects in healthy vs diseased patients

A

healthy decrease in SVR by 15%
elderly or cardiac patients SVR can decrease up to 25%

67
Q

what is the bezold jarisch reflex

A

response to ventricular underfilling potentially leading to a significant bradycardia and systole
mediated by 5-HT3 receptors in the vagus nerve and ventricular myocardium

68
Q

what is the reverse bainbridge reflex

A

triggered by reduced stretching of hearts right atrium

69
Q

what are the 4 preventative measures for hypotension related to spinal anesthesia discussed in class

A

vasopressors
5-HT3 antagonists (ondansetron)
fluid management (co-loading)
positioning (slight pelvic tilt)

70
Q

failure to treat or delay treatment will increase

A

mortality

71
Q

what is the phrenic nerve supplied by

A

C3,4,5

Principles I summer 2024 (7 decks)

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