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Anesthesia I > Spinal Anesthesia 6/1 > Flashcards

Spinal Anesthesia 6/1 Flashcards

1
Q

Fentanyl dose?

A

1.5 - 3 mcg/kg

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2
Q

How do you prevent pruritis associated w/ neuraxial opioids?

A
  • minimize morphine dose to <300mcg
  • Ondansetron (Zofran) 4mg IV
  • Nubain 2.5-5mg IV
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3
Q

How do you treat pruritis associated w/ neuraxial opioids?

A
  • Benedryl 25-50mg IV
  • Naloxone 0.1mg IV (“best”)
  • Buprenex (mixed agonist/antagonist
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4
Q

How much epi is considered to be in an “epi wash?”

A

0.2-0.3mg

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5
Q

How much Phenylephrine (neosynephrine) is considered to be in a “neo wash”?

A

2-5 mg

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6
Q

What LA when combined w/ a vasoncstrictor is considered to have a profound increase?

A

Tetracaine

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7
Q

What kind of change do you see when epi is added to Lidocaine and bupivacaine?

A

Bupivacaine / Lidocaine have a variable increases

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8
Q

How do you prevent the five and dime reflex?

A

Glycopyrrolate (Robinol) (doesnt cross BBB)
prevents bradycardia!

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9
Q

What’s the dose of clonidine added to spinal anesthetic?
Precedex?

A
  • Clondine: 15-45 mcg
  • Precedex: 3 mcg
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10
Q

Provide the subarachnoid/intrathecal doses for the following opiods:
* Morphine
* Fentanyl
* Sufentanil

A
  • Morphine 0.1-0.4 mg
  • Fentanyl 10-25 mcg
  • Sufentanil 2.5-10 mcg
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11
Q

Describe the factors that contribute to a differential block. Does this apply to Epidural or Spinal?

A

BOTH EPIDURAL AND SPINAL ARE DIFFERENTIAL
* Nerve fibers differ in sensitivity to LA
* Gradual and segmental block of fibers when exposed to LA
* Smaller diameter axons are MORE sensitive
* Unmyelinated fibers are more sensitive that myelinated

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12
Q

Can a SAB have a segmental block? Does Epidural have segmental block?

A

NO. NEVER. ONLY EPIDURAL HAS SEGMENTAL

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13
Q

List the clinical progression of the differential blockade of nerve fibers and include function

B, C, A-(delta,gamma,beta, alpha)

A
  1. B-Fibers (sympathetic)
  2. C and A-Delta (pain and temp)
  3. A gamma (motor tone)
  4. A-beta (touch/pressure)
  5. A-alpha (loss of motor function/proprioception)
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14
Q

What order does the differential blockade recover?

A

The oppositve of the onset

e.g. A-Alpha (motor and proprioception) is first to recover

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15
Q

C-section requires a sensory block at what dermatome level ?

A

T4 (nips)

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16
Q

Motor blockade is how many levels below sensory block?

A

2

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17
Q

What are the cardioaccelerator nerves

A

T1-T4

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18
Q

Elimination of LA from SAB

Would a hydrophilic or lipophilic drug have a longer DOA ?

Hy

A

Lipophilic lasts longer (ex. Bupivacaine)
Lipophilic drugs like to hang out in the epidural fat

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19
Q

Factors affecting LA distribution and block height in SAB

Most important drug factors

A
  • Dose
  • baricity
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20
Q

Factors affecting LA distribution and block height in SAB

Most important patient factors

A
  • CSF volume
  • Advanced Age
  • Pregnancy
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21
Q

Factors affecting LA distribution and block height in SAB

Most important procedure factors

A
  • Patient position
  • Epidural injection post spinal (EVE)
22
Q

What is EVE?

A

Epidural volume expansion (procedural factor that effects LA spread in SAB)

AKA Epidrual injection post spinal

23
Q

What makes up dose?

A

(Volume) x (concentration) = dose

24
Q

What is the most reliable determinant of LA spread (and thus block height) when compared with either volume or concentration

Isobaric and hypobaric solutions

A

Dose!!!

10mg better than 2 mg …. duhhhh

25
Q

For hyperbaric LA , what is the primary influence of spread?

A

Baricity

26
Q

If you are giving 1.5 mL of a LA . You want to make it hypobaric. How much sterile water do you add?

A

4.5 mL (3x volume of the LA)

27
Q

Where are we going to put our spinals when we first start residency?

A

Between L3/L4

28
Q

For a prone hemorrhoidectomy what baricity of LA will be best for SAB?

A

hypobaric

29
Q

With a hyperbaric solution for SAB, how much volume should you give for the following dermatome levels?
* T4
* T10
* Sacral

NON-OB patient

A
  • T4= 2 mL
  • T10= 1.5 mL
  • Sacral= 1mL

this is for HYPERbaric solutions

30
Q

With an isobaric solution it is difficult to obtain a block above what dermatome level?

A

T10

31
Q

With an isobaric solution it is difficult to obtain a block above what dermatome level?

A

T10

32
Q

Hypobaric dose adjustments for LE surgery

A

60% reduction in dose

Ex: 1% 8 mg

33
Q

What patient factors lower CSF volume, and what affect will this have on LA for SAB?

A

pregnancy and obesity ; maximum spread

34
Q

Spread of LA in pregnancy is due to:

A

Low CSF, Lordosis, decreased CSF volume and increased intrabdominal pressures

35
Q

Bradycardia is due to inhibition of what reflexes/fibers?

A
  • Bainbridge reflex
  • SA node atrial stretch
  • Bezold-Jarisch reflex
  • T1-T4 cardioaccelerator block
36
Q

How much can BP decrease before intervention w/ SAB

A

typically 30% in an otherwise healthy patient

37
Q

how do you prevent hypotension associated w/ SAB?

A
  • preloading
  • co-loading (use pressure bag)
  • colloids (OB)
38
Q

Why no glucose in your fluids when you are pre-loading or co-loading ?

A

Makes them pee (counterproductive)

39
Q

If a patient experiences hypotension with a normal/or increased HR what alpha agonist is best?

A

Phenylephrine (Neo-synephrine)

40
Q

If a patient is bradycardic and hypotensive what alpha agonist is best?

A

Ephedrine

41
Q

even with a high T4 dermatome spread, what respiratory physiology/measurements should stay the same?

A

Tidal volume, RR , ABG

42
Q

What is the primary concern with a high (T4) dermatome spread?

A

Blockade of accessory muslces of respiration (intercostal and abdominal muscles)

43
Q

What respiratory factors DO change as a result of neuraxial anesthesia and high dermatome spread?

A

small decrease in VC (d/t loss of abdominal muscle and its role in forced exhalation)

44
Q

Neuraxial and GI

GI sympathetic outflow originates from what spinal levels?

A

T6- L1

45
Q

Neuraxial and GI

Nauseau and vomiting is typically followed by

A

hypotension and bradycardia

46
Q

Neuraxial and GI

how can you help prevent or treat nausea?

A

Alcohol swab

47
Q

Neuraxial and GI

If the HR is tachycardic with a normal BP and patient is complaining of nausea what shoul you do?

A

Grab some phenylephrine (Neo) and get ready. Hypotension and bradycardia is preceded by n/v

48
Q

Sympathetic blockade above T10 causes what change in bladder control?

A

Relaxation of urinary sphincter tone

49
Q

What causes shivering with spinal anesthesia?

A
  • spinal impairs central thermoregulation
  • Hypothermia is due to vasodilation and blood redistributing to peripheral vasculature
50
Q

What interventions help with shivering associated w/ spinal anesthesia?

A
  • Bair hugger
  • Ondensetron (Zofran) 4-8mg

Anesthesia I (8 decks)

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