Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Principles I summer 2024 > spinal and epidural part 3 > Flashcards

spinal and epidural part 3 Flashcards

1
Q

parasympathetic innervation is primarily via the _______ nerve

A

vagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

parasympathetic afferent GI

A

transmits sensations of satiety dissension and nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

parasympathetic efferent GI

A

tonic contractions, sphincter relaxation, peristalsis and secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

sympathetic afferent GI

A

transmits visceral pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

sympathetic efferent GI

A

inhibit peristalsis and gastric secretion and cause sphincter contraction and vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

sympathetic innervation of GI tract stems from

A

T5-L2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

impact of neuraxial anesthesia on GI (3 discussed in lecture)

A

reduces sympathetic tone
increase parasympathetic activity
changes is unopposed vagal tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the resulting changes in unopposed vagal tone with neuraxial anesthesia in GI

A

relaxes sphincters
increase peristalsis
small contracted gut with active peristalsis
increased GI blood flow
N/V
reduce post op ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

systemic effects of neuraxial anesthesia on GU

A

no change in renal blood flow (if MAP maintained)
sympathetic blockade above T10 affects bladder control
need foley catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is elevated from metabolic/endocrine with neuraxial anesthesia

A

cortisol
epinephrine
norepinephrine
vasopressin
RAAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

which LA is more common to have allergies

A

esters
PABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

is there cross sensitivity in ester

A

yeah

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what does amide contain that can cause an allergic reaction

A

methyparaben

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is onset of action determined by

A

pKa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is potency determined by

A

lipid solubility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is duration of action determined by

A

protein binding
alpha 1 acid glycoprotein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

LA inhibition of peripheral nerves occurs in what order

A

B fibers
C fibers
small diameter A fibers
large diameter A fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the 5 factors influencing vascular uptake and plasma concentration of LA

A

site of injection
tissue blood flow
physiochemical properties
metabolism
addition of vasoconstrictor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

highest blood concentration to lowest blood concentration of LA

A

IV
tracheal
intercostal
caudal
paracervical
epidural
brachial
sciatic
subcutaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

baracity refers to

A

density of a LA solution compared to CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

isobaric

A

density equal of CSF
stays in place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

hyperbaric

A

density greater than CSF (greater than 1)
sinks within CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

hypobaric

A

density less than CSF (less than 1)
rises within the CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

high points for hyperbaric

A

C3 L3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
low points for hyperbaric
T6 and S2
26
lipophilic drugs have ______ reuptake and _______ affinity for epidural fat
slow reuptake high affinity
27
bupivacaine 0.5-0.75% spinal dose for t10, T4, onset and duration
10-15mg T10 12-20mg T4 onset 4-8 min duration 130-220min (add 20-50% with epi)
28
levobupivacaine 0.5% dose T10, T4 onset, duration
10-15mg 12-20 mg 4-8 min 140-230min
29
ropivicaine 0.5-1% dose T10, T4 , onset, duration
12-18mg 18-25mg 3-8min 80-210 min
30
2 chloroprocaine 3% dose t10, t4, onset, duration
30-40mg 40-60mg 2-4 min 40-90min
31
tetracaine 0.5-1% dose t10, t4, onset, duration
6-10mg 12-16mg 3-5min 90-120min (epi add 20-50%)
32
which drugs can you add epi to
bupivacaine tetracaine
33
which drug has shortest onset for spinal
2-chloroprocaine
34
which drug has longest duration
levobupivacaine
35
which drug has highest dose
2 chloroprocaine
36
which drug has lowest dose
tetracaine
37
how do you dose epidural
1-2mL/segment incremental dosing with 5mL
38
what is the concentration of 2-chloroprocaine used for surgical
3%
39
what is a popular drug for OB epidural
2-chloroprocaine
40
what does alkalization do
speed up onset of block increase rate of diffusion increase pH of LA
41
what is a top up dose
50-75% of the initial dose used to maintain the block without letting it wear off too much
42
what is the timing of the top up dose
administer before the block decreases more than 2 dermatomes
43
epidural space variation
thoracic is smaller than lumbar so use 1mL/segment
44
place the epidural drugs from fastest to slowest onset/shortest to longest duration
2-cloroprocaine lidocaine ropivacaine bupivacaine levobupicaine
45
what are the typical concentrations of the following drugs 2-cloroprocaine lidocaine ropivacaine bupivacaine levobupicaine
3% 2% 0.75% 0.5% 0.5%
46
which drugs improve density, duration and analgesia
alpha 2 agonists dexmedetomidine clonidine
47
which drugs extends duration only
vasopressors
48
which drugs improves density and analgesia
opioids sufent fent morphine
49
which opioids are hydrophilic
morphine hydromorphone meperidine
50
which opioids are lipophilic
fentanyl sufentanil
51
characteristics of hydrophilic drugs
spreads widely in CSF stays longer in CSF longer onset longer duration less systemic absorption respiratory depression occurs late
52
lipophilic drug characteristics
shorter duration limited spread quicker onset more systemic absorption respiratory depression earlier
53
sufentanil intrathecal, epidural, epidural infusion dose
5-10mcg 25-50mcg 10-20mcg/hr
54
fentanyl intrathecal, epidural, epidural infusion dose
10-20mcg 50-100mcg 25-100mcg/hr
55
hydromorphone intrathecal, epidural, epidural infusion dose
no intrathecal dose 0.5-1mg 0.1-0.2mg/hr
56
meperidine intrathecal, epidural, epidural infusion dose
10mg 25-50mg 10-60mg/hr
57
morphine intrathecal, epidural, epidural infusion dose
0.25-0.3mg 2-5mg 0.1-1mg/hr
58
pruritis occurs in what % of population
30-100%
59
what is the treatment of pruritis
benadryl 25-50mg naloxone 0.1mg buprenex
60
prophylaxis of pruritis
minimize dose of morphine <300mcg ondansetron 4mg nubain 2.5-5mg
61
what are common side effects of A2 agonist
hypotension bradycardia
62
dose of dexmedetomidine
3mcg
63
dose of clonidine
15-45mcg
64
dose of epinephrine
0.2-0.3mg epi wash
65
phenylephrine dose
2-5mg
66
symptoms of epidural hematoma
lower extremity weakness, numbness lower back pain bowel and bladder dysfunction
67
high risk and intermediate risk procedures hold aspirin for
4-6 days
68
precautions for aspirin for central neuraxial blocks
no additional precautions
69
NSAIDS for high risk procedures
hold for 5 half lives
70
Glycoprotein IIB/IIIA antagonists for regional anesthesia
tirofiban and eptifibatide 4-8 hours abciximab 24-48 hours
71
thienopyridine for regional anesthesia
clipidogren 5-7 days prasugrel 7-10 days ticlopidine 10 days
72
unfractionated heparin regional anesthesia
low dose <5000U hold 4-6 hours higher dose hold 12 hours therapeutic dose >20000U hold 24 hours greater than 4 days have plt count checked
73
low molecular weight heparin regional anesthesia
delay at least 12 hours for prophylactic dose delay 24 hours after therapeutic dose
74
Vit K antagonists regional anesthesia
hold for 5 days and verify INR
75
thrombolytic agents
absolute contraindication
76
direct oral anticoags
discontinue 72 hours before antifactor 10a check
77
postural puncture headache is caused by
failure of a dura puncture site to properly seal over once breeched by a needle leak of CSF causes reduction in CSF volume
78
symptoms of PDPH
headache that worsens when sitting or standing; felt from forehead to back of head nausea sensitivity to light double vision ringing in ears
79
what are patient factors contributing to PDPH
younger female pregnant
80
what are practitioner factors contributing to PDPH
cutting tip needle large diameter needle air for LOR positioning needle perpendicular to spines long axis
81
treatment for PDPH
bed rest NSAIDs Caffeine epidural blood patch sphenopalatine ganglion block
82
what is the common bacteria involved in infection with regional
streptococcus viridans
83
what is the recommended skin prep for regional anesthesia
alcohol and chlorhexidine
84
what nerves are affected in cauda equine syndrome
L2-S5 and coccygeal nerves
85
what causes cauda equina syndrome
neurotoxicity due to high levels of LA drugs affecting nerve function
86
factors that increase risk of cauda equina syndrome
using 5% lidocaine in SAB micro catheters whiticare 25/26 needle
87
s/s of cauda equina syndrome
serious neurologic complication can be permanent bowel and bladder dysfunction sensory deficits (loss of feeling in the legs or feet) back pain saddle anesthesia sexual dysfunction weakness or paralysis paraplegia (late sign)
88
treatment of cauda equina syndrome
supportive care laminectomy <6hours if compression
89
transient neurologic symptoms causes
patient positioning myofascial strain and spasms
90
factors that increase risk of transient neurologic symptoms
higher incidence when using lidocaine 5% surgical positions (lithotomy position) outpatient surgeries (knee arthroscopy)
91
factors that do not increase risk of transient neurologic symptoms
early ambulation LA concentration ad baricity
92
s/s of transient neurologic symptoms
pain: severe radicular pain the the back and buttocks that spreads down both legs starts w/in 6-36 hours and last 1-7 days
93
treatment of transient neurologic symptoms
NSAIDS and opioids trigger point injections (muscle spasms and pain relief)
94
how do you prevent retained catheter fragments in epidural
withdraw needle and catheter at the same time to prevent the pathetic from sheering
95
risk factor for epidural vein cannulation
multiple attempts pregnancy stiffer catheters trauma to epidural vein during block procedure

Principles I summer 2024 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions