Spinal anesthesia

Question 1

Spinal technique: tissues traversed

Answer 1

(Example: L2-L3 interspace) : superior margin of L3 spinous process. Local infiltration to skin and subq. Introducer with spinal needle (24g or smaller).
Skin-subq-supraspinous-interspinous-ligamentum flavum-epidural space and pierce dura/arachnoid. “Pop” after dura penetrated. Advance short distance to ensure bevel/port entirely in SA space.

Question 2

Spinal injection

Answer 2

1. Free flow of CSF from hub confirms SA placement.
2. Secure needle by holding hub between thumb and index fingers and dorsum of hand against patients back.
3. Attach syringe to needle, aspirate CSF to reconfirm.
4. Syringe FIRMLY attached and administer syringe LA
5. Withdraw needle syringe as one unit

Question 3

Hyperbaric solutions

Answer 3

Advantage is ability to achieve greater cephalad spread due to lumbar lordosis in supine position.

Question 4

Isobaric solution

Answer 4

Limited spread in subarachnoid space. Distribution of LA not affected by gravity so patient position will not influence spinal block.

Question 5

Spinal vasoconstrictors

Answer 5

Increase the DOA from a reduction in spinal cord blood flow, which decreases loss of LA from the perfused areas.

Question 6

Spinal epinephrine

Answer 6

0.1mg-0.2mg (0.1-0.2 mL of a 1:1000 solution)

Question 7

Spinal Bupivacaine (0.75%) hyperbaric

Answer 7

1 cc = 7.5 mg
5-20mg recommended dose
DOA: 90-120 minutes

Question 8

Spinal level assessment

Answer 8

Nerve fibers that transmit cold are first to be blocked.

Wet skin with alcohol or ice. In area blocked this produces a warm or neutral sensation rather than cold perceived in unblocked areas.

Sympathetic nervous system block exceeds sensory block which exceeds level of motor block.

Question 9

SNS block

Answer 9

SNS block typically exceeds somatic sensory block by two dermatomes (however sometimes as much as 6 dermatomes)

Question 10

Spinal lidocaine

Answer 10

Associated with increased risk of transient neurological symptoms

DOA: 60-90 minutes

Dose 60-75mg

Question 11

PDPH manifestations

Answer 11

Pain generally at 12-48 hours but can occur immediately

Prominent characteristic* : appears or intensifies with sitting and standing and relieved by recumbent.

Question 12

High Spinal

Answer 12

Tx: *maintenance of airway/ventilation
*Circulatory support
*Tberg to facilitate venous return
*Head up NOT recommended d/t decreased CBF & increase venous pooling
*intubation to prevent aspiration

Question 13

Spinal C Section

Answer 13

12 mg bupivacaine in D10 (heavy bupi) (1.6 ml of 0.75 Bupi)

Fentanyl 15 mcg (0.3 ml)

PF free morphine (150mcg)

Question 14

Blue spinal needle

Answer 14

The ridge pointed upwards (see photo OB album)