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ANESTHESIA > Spinal & Epidural Anesthesia > Flashcards

Spinal & Epidural Anesthesia Flashcards

1
Q

____ provides alternatives to General anesthesia

A

Neuraxial anesthesia

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2
Q

Also used as postoperative analgesia

A

REGIONAL ANESTHESIA NEURAXIAL ANESTHESIA CENTRAL BLOCKS

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3
Q

Principal site of action in SPINAL AND EPIDURAL ANESTHESIA

A

nerve root

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4
Q

Blockade of neural transmission in the ____
interrupts somatic and visceral sensation

A

posterior nerve root fibers

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5
Q

blockade in the ____ prevent efferent motor and autonomic outflow

A

anterior nerve roots fibers

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6
Q

Somatic blockade:
• Interrupts ___ transmission of painful stimuli
• Abolish the ___ impulses responsible for skeletal muscle tone

A

• Interrupts afferent transmission of painful stimuli

• Abolish the efferent impulses responsible for skeletal muscle tone

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7
Q

Interruption of efferent autonomic transmission at the spinal nerve roots produces sympathetic blockade

A

AUTONOMIC BLOCKADE

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8
Q

Cardiovascular manifestations in autonomic blockade:

• Profound hypotension treated with ___

• Extreme bradycardia treated with ___

A

• Profound hypotension treated with alpha adrenergics
• Extreme bradycardia treated with atropine

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9
Q

Cardiovascular manifestations in autonomic blockade:

GI manifestation: ____

A

Active peristalsis

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10
Q

Loss of autonomic bladder control results in ____

A

urinary retention

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11
Q

CONTRAINDICATIONS TO NEURAXIAL BLOCKADE:
absolute

A
  • Infection at the site of injection
  • Patient refusal (e.g. procedure)
  • Coagulopathy or other bleeding diathesis (bleeding
    disorder)
  • Severe hypovolemia (e.g. trauma)
  • Increased intracranial pressure
  • Severe aortic stenosis
  • Severe mitral stenosis
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12
Q

CONTRAINDICATIONS TO NEURAXIAL BLOCKADE:

relative

A
  • Sepsis
  • Uncooperative patient
  • preexisting neurological deficits
  • demyelinating lesions
  • stenotic valvular heart lesions
  • left ventricular outflow obstruction (hypertrophic obstruction cardiomyopathy)
  • severe spinal deformity
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13
Q

CONTRAINDICATIONS TO NEURAXIAL BLOCKADE:

controversial

A
  • prior back surg at site of injection
  • complicated surgery
  • prolonged operation
  • major blood loss
  • maneuvers that compromise respiration
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14
Q

Spinal and Epidural anesthesia fall under the category of ____

A

REGIONAL Anesthesia

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15
Q

Spinal Anesthesia
● Injecting agent into the _____

Epidural Anesthesia
● Injecting agent into the _____

A

Spinal Anesthesia
● Injecting agent into the SUBARACHNOID SPACE

Epidural Anesthesia
● Injecting agent into the EPIDURAL SPACE

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16
Q

Meninges

A

Dura Mater

Arachnoid membrane

Pia

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17
Q

> fibroelastic membrane
prevents displacement of an epidural catheter into the fluid-filled subarachnoid space

A

Dura Mater

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18
Q

> adherent to the inner surface of the dura

> major pharmacologic barrier preventing movement of drug from the epidural to the subarachnoid space

A

Arachnoid membrane

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19
Q

major pharmacologic barrier preventing movement of drug from the epidural to the subarachnoid space

A

Arachnoid membrane

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20
Q

> innermost layer
highly vascular
inner border of the subarachnoid space

A

Pia mater

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21
Q

> inner border of the subarachnoid space

A

Pia mater

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22
Q

Landmarks:

__ – most prominent vertebrae

__ – first palpable spinous process

__ level of iliac crest

__ - PSIS

__ – tip of the scapula

A

• C2 – first palpable spinous process
• C7 – most prominent vertebrae
• T7 – tip of the scapula
• L4 – level of iliac crest
• S2 - PSIS

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23
Q

first palpable spinous process

A

C2

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24
Q

most prominent vertebrae

A

C7

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25
Q

tip of the scapula

A

T7

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26
Q

level of iliac crest

A

L4

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27
Q

Posterior superior iliac spine landmark

A

S2

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28
Q

generally used for surgical procedures involving the lower abdominal area, perineum, and lower extremities.

A

Spinal anesthesia

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29
Q

Used for abdomen and lower extremities

A

Epidural anesthesia

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30
Q
  • Control of labor pain
  • Supplement anesthetic for thoracic and upper abdominal procedures
A

Epidural anesthesia

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31
Q

supplement anesthetic for thoracic and upper abdominal procedures

A

Epidural anesthesia

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32
Q

Agent injected into the subarachnoid space

A

Spinal Anesthesia

33
Q

Spinal Anesthesia agent is injected into the ____

A

subarachnoid space

34
Q

Spread by CSF which bathes the spinal cord and nerve roots

A

Spinal Anesthesia

35
Q

Patient Positioning for spinal anesthesia

A

● Lateral Decubitus

● Sitting

● Jack-knife or Prone

36
Q

➢ Patient lies on his side with back and legs flexed

➢ More comfortable for the ill and frail

A

Lateral Decubitus

37
Q

➢ Encourages flexion and recognition of midline
➢ Patient bends his back to a “C” shape

A

Sitting position

38
Q

In sitting position:

Lumbar CSF is __ in this position, the dural sac is __, thus providing a larger target for the spinal needle.

A

Lumbar CSF is elevated in this position,
the dural sac is distended,
thus providing a larger target for the spinal needle.

39
Q

For perineal procedures position

A

Jack-knife or Prone

40
Q

For Jack-knife or Prone position there is

__ flexion, the __ dural sac, and the __ CSF pressure

A

Limited flexion,
the contracted dural sac,
and the low CSF pressure

41
Q

Spinal needles gauge

A

Gauge 22-25

42
Q

Free flow of CSF confirms correct placement

A

Induction technique

43
Q

Needle is secured by holding the hub between the thumb and the index
finger

A

“pencil like manner” in
Induction technique

44
Q

In midline approach— Needle inserted at the ____ of the selected interspace, easily identified by visual inspection and palpation

A

top margin of the lower spinous process

45
Q

In midline approaches — Needle is progressively advanced with a slight ____

A

cephalad orientation

46
Q

In midline approaches: The patient should NOT BE HEAVILY SEDATED because successful spinal and epidural anesthesia requires patient participation to maintain good position, evaluate block height, and indicate to the anesthesiologist about paresthesias if the needle contacts neural elements.
T/F?

A

True

47
Q

The presence of __ confirms that the needle encountered a cauda equina nerve root in the subarachnoid space and the needle tip is in __ position

A

The presence of CSF confirms that the needle encountered a cauda equina nerve root in the subarachnoid space and the needle tip is in good position.

48
Q

__ insertion is prone to bleeding since one can encounter a lot of vasculatures

A

Paramedian

49
Q

Paramedian insertion surpasses the suprasinous and interspinous ligament and the _____ will be the first resistance encountered

A

ligamentum flavum

50
Q

widest approach/insertion but inaccessible from midline

A

LUMBOSACRAL
Taylor (L5-S1 interspace)

51
Q

Layers traversed by the Spinal Needle:

A
  1. Skin
  2. Subcutaneous tissue
  3. Supraspinous ligament 4. Interspinous ligament
  4. Ligamentum flavum
  5. Epidural Space
  6. Dura
  7. Subarachnoid space
52
Q

FACTORS FOR DISTRIBUTION OF ANESTHETIC:

Distribution of local anesthetic solution in CSF is influenced by

A

Baricity of the solution

Contour of the spinal canal

Position of the patient

Dose, volume and concentration

Patient characteristics

53
Q

RATIO OF local anesthetic solution’s density relative to the density of CSF

A

Baricity

54
Q

In hyperbaric solutions (>1.007) - principal advantage is the ability to achieve ____ of anesthesia

A

greater cephalad spread

55
Q

HYPERBARIC SOLUTIONS (>1.007)

GRAVITATES TOWARD THE ____ PORTION

HEAD DOWN POSITION FOR ____

A

GRAVITATES TOWARD THE DEPENDENT PORTION

HEAD DOWN POSITION FOR CEPHALAD SPREAD

56
Q

Reserved for patients undergoing perineal procedures in jackknife position

A

HYPOBARIC SOLUTIONS (<0.997)

57
Q

Distribution not affected by gravity, not influenced by patient position

A

ISOBARIC SOLUTIONS

58
Q

For perineal or lower extremity procedures, lower part of the trunk (hip arthroplasty, inguinal hernia repair)

A

ISOBARIC SOLUTIONS

59
Q

__ does not influence the long acting anesthesia

A

Epinephrine

60
Q

Opioids and Other Analgesics — Effect is mediated at the dorsal horn of the spinal cord where opioids mimic the effect of endogenous __

A

enkephalins

61
Q

Side effects and complications in Opioids and Other Analgesics

A

• Hypotension
• Bradycardia
• Post spinal headache
• Nausea
• Urinary Retention
• Backache
• Neurologic sequelae
• Hypoventilation

62
Q

• Injection of local anesthetic into the epidural space

A

Epidural Anesthesia

63
Q

• Anesthesia occurs more slowly (30 mins -1hour) and develops in a segmental manner

• Major site of action: spinal nerve roots

A

Epidural Anesthesia

64
Q

Major site of action in epidural anesthesia:

A

spinal nerve roots

65
Q

Epidural Kit gauge

A

LARGER GAUGES

• 17- or 18-gauge needle which permits passage of a 19- or 20- gauge catheter

66
Q

Layers Traversed by Epidural Needle

A
  1. Skin
  2. Subcutaneous tissue
  3. Supraspinous ligament 4. Interspinous process
  4. Ligamentum flavum
67
Q

In Lumbar and Low Thoracic areas&approaches —
Both __ and __ approaches are used

A

Both midline and paramedian approaches are used

68
Q

____ approach is more popular due to:
- Simpler anatomy and easier orientation
- Passage of needle through less sensitive structures

A

Midline approach

69
Q

Generally uses a paramedian approach

A

Thoracic

70
Q

LOSS OF RESISTANCE TECHNIQUE:

A syringe containing ____ is attached to the needle

A

air/saline or both

71
Q

A small drop of saline is placed at the hub of the epidural needle

The drop is retracted into the needle by the negative pressure in the epidural space

A

HANGING DROP TECHNIQUE

72
Q

Things To Remember With Epidural Placement:
Thread the catheter __cm

A

3-5 cm

73
Q

Adjuvants:
To prolong the duration

A

EPINEPHRINE

74
Q

Adjuvants

A

Epinephrine
Opioids
Sodium bicarbonate

75
Q

Because local anesthetics are weak bases, they exist largely in the ionic form, adding sodium bicarbonate favors the non-ionized form of local anesthetic and favors _____ onset of anesthesia

A

faster

76
Q

Local anesthetics used for epidural anesthesia

A
  • chloroprocaine
  • lidocaine
  • bupovacaine
  • ropivacaine
77
Q

Side Effects of local anesthetics used for epidural anesthesia

A

• Backache
• Postdural puncture headache
• Hearing loss
• Systemic toxicity
• Total spinal
• Neurologic injury
• Spinal Hematoma

78
Q

Table spinal vs. epidural

A

Slide 50

79
Q

As you pass ligamentum flavum, the resistance will increase.
T/F?

A

True

ANESTHESIA (2 decks)

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