Spinal Anesthesia

Question 1

Spinal anesthesia involves injection of LA into the ______ space

Answer 1

subarachnoid

Question 2

Tuffiers line is the line between the (3 words) _______ and corresponds to what vertebra?

Answer 2

Superior iliac crest; L4

Question 3

For boards: The dural sac ends at what vertebrae?

Answer 3

S2

Question 4

For boards: The adult spinal cord ends at what vertebrae? Children?

Answer 4

Adult: L1
Kiddo: L3

Question 5

What are benefits of neuraxial anesthesia

Answer 5

Reduced: narcotic use, postop ileus, thromboembolic events, PONV, Respiratory complications, bleeding

Question 6

Spinal anesthesia onset

Answer 6

5 minutes

Question 7

Epidural anesthesia onset

Answer 7

10-15 minutes

Question 8

The nature of a spinal block is ______, while the epidural is considered to be _________.

Answer 8

Dense; segmental

Question 9

Is hypotension more likely with epidural or spinal anesthesia?

Answer 9

spinal

Question 10

Describe the motor block associated with spinal and epidural neuraxial blocks

Answer 10

spinal is dense; epidural is minimal

Question 11

Duration of spinal anesthesia vs epidural

Answer 11

spinal is fixed (one time dose) while epidural is unlimited (catheter placed for repeat dosing)

Question 12

Which type of neuraxial anesthesia requires more skill?

Answer 12

Epidural

Question 13

How is dermatome spread effected with spinal anesthesia? And in what time frame does it occur?

Answer 13

Position changes, baricity, dose. First 5 minutes

Question 14

How do you manipulate dermatome spread with epidural anesthesia?

Answer 14

Incremental dermatome spread based on volume. 1-2ml per segment

Question 15

The cardio accelerator fibers arise from

Answer 15

T1-T4

Question 16

Neuraxial blockade from _____ to ______ results in a disruption of splanchic sympathetic innervation to GI tract and can result in hyperperistalsis

Answer 16

T6 to L1

Question 17

Name the ABSOLUTE contraindications to neuraxial anesthesia

Answer 17

Localized sepsis, patient refusal, allergy to LA, Coagulopathy, spinal mass/ spinal cord disorder, hypovolemia, AS or MS.

Question 18

The nipples represent what dermatome sensory level

Answer 18

T4

Question 19

The umbilicus represents what dermatome sensory level

Answer 19

T10

Question 20

Middle finger is what dermatome level?

Answer 20

C7

Question 21

Thumb is what dermatome level?

Answer 21

C6

Question 22

The phrenic nerve arises from

Answer 22

C3, C4 and C5

Question 23

Abdominal surgery may require a block as high as _______ due to the peritoneum dermatome level

Answer 23

T4

Question 24

What is the dermatomal level for the bladder and uterus?

Answer 24

T10

Question 25

What are the two most important factors effecting spread of a LA in spinal anesthesia?

Answer 25

Baricity and dose

Question 26

indication for spinal anesthesia

Answer 26

C-section*****, lower abdominal surgery, perineum, and lower extremity procedures.

Question 27

Relative contraindicaitons to neuraxial anesthesia

Answer 27

Spinal column deformities, preexisting disease of spinal cord, chronic headache/backache, inability to perform SAB X3.