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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
For hyperbaric LA , what is the primary influence of spread?
Baricity
26
If you are giving 1.5 mL of a LA . You want to make it hypobaric. How much sterile water do you add?
4.5 mL (3x volume of the LA)
27
Where are we going to put our spinals when we first start residency?
Between L3/L4
28
For a prone hemorrhoidectomy what baricity of LA will be best for SAB?
hypobaric
29
With a hyperbaric solution for SAB, how much volume should you give for the following dermatome levels? * T4 * T10 * Sacral | NON-OB patient
* T4= 2 mL * T10= 1.5 mL * Sacral= 1mL | this is for HYPERbaric solutions
30
With an isobaric solution it is difficult to obtain a block above what dermatome level?
T10
31
With an isobaric solution it is difficult to obtain a block above what dermatome level?
T10
32
Hypobaric dose adjustments for LE surgery
60% reduction in dose | Ex: 1% 8 mg
33
What patient factors lower CSF volume, and what affect will this have on LA for SAB?
pregnancy and obesity ; maximum spread
34
Spread of LA in pregnancy is due to:
Low CSF, Lordosis, decreased CSF volume and increased intrabdominal pressures
35
Bradycardia is due to inhibition of what reflexes/fibers?
* Bainbridge reflex * SA node atrial stretch * Bezold-Jarisch reflex * T1-T4 cardioaccelerator block
36
How much can BP decrease before intervention w/ SAB
typically 30% in an otherwise healthy patient
37
how do you prevent hypotension associated w/ SAB?
* preloading * co-loading (use pressure bag) * colloids (OB)
38
Why no glucose in your fluids when you are pre-loading or co-loading ?
Makes them pee (counterproductive)
39
If a patient experiences hypotension with a normal/or increased HR what alpha agonist is best?
Phenylephrine (Neo-synephrine)
40
If a patient is bradycardic and hypotensive what alpha agonist is best?
Ephedrine
41
even with a high T4 dermatome spread, what respiratory physiology/measurements should stay the same?
Tidal volume, RR , ABG
42
What is the primary concern with a high (T4) dermatome spread?
Blockade of accessory muslces of respiration (intercostal and abdominal muscles)
43
What respiratory factors DO change as a result of neuraxial anesthesia and high dermatome spread?
small decrease in VC (d/t loss of abdominal muscle and its role in forced exhalation)
44
# Neuraxial and GI GI sympathetic outflow originates from what spinal levels?
T6- L1
45
# Neuraxial and GI Nauseau and vomiting is typically followed by
hypotension and bradycardia
46
# Neuraxial and GI how can you help prevent or treat nausea?
Alcohol swab
47
# Neuraxial and GI If the HR is tachycardic with a normal BP and patient is complaining of nausea what shoul you do?
Grab some phenylephrine (Neo) and get ready. Hypotension and bradycardia is preceded by n/v
48
Sympathetic blockade above T10 causes what change in bladder control?
Relaxation of urinary sphincter tone
49
What causes shivering with spinal anesthesia?
* spinal impairs central thermoregulation * Hypothermia is due to vasodilation and blood redistributing to peripheral vasculature
50
What interventions help with shivering associated w/ spinal anesthesia?
* Bair hugger * Ondensetron (Zofran) 4-8mg

Anesthesia I (8 decks)

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