Spinal & Epidural Anesthesia Flashcards
Mechanism(s) of local anesthetic action in epidural anesthesia:
A) direct local anesthetic action on nerve roots and spinal cord following local anesthetic diffusion across the dura
B) diffusion of local anesthetic into paravertebral regions through the intervertebral foramina
C) both
D) neither
C. both
what are the absolute indications for spinals or epidurals?
none
what is the purpose of spinals and epidurals?
Blunt the “stress response” to surgery
Decreases intraoperative blood loss
Lower incidence of postoperative thromboembolic events
Decreased morbidity and mortality in high-risk surgical patients
which patient type has instability at the C1 level?
Down’s syndrome
what is the first prominent spinous process?
C7
At what level does the Illiac Crest cross?
L5
what level is the bottom of the scapulae?
T 6-8
list the 5 ligaments that support the spine
Supraspinous Ligamentum Nuchae Interspinous ligament Ligamentum Flavum Longitudinal ligaments
Into what space is a spinal inserted?
Subarachnoid
The epidural space is superficial or deep to the spinal?
Superficial
What are the three layers of protective meninges?
Dura mater
arachnoid mater
Pia mater
What effect does the epidural fat have on opioids and lipid soluble local anesthetics?
Reduces the bioavailability
At what level does the dura mater terminate?
S2 at Filum terminale
What is the purpose of the dentate ligaments?
Anchor the cord in the meninges
At what level does the spinal cord terminate in adults? At birth?
L1 in adults
L3 at birth
What are the two approaches to spinal anesthesia?
Midline and paramedian
What does the paramedian approach bypass?
Supraspinous ligament
What can happen if you inject drugs into an epidural too fast?
It may go too high causing respiratory depression and blunting the cardiac accelerator fibers
What is the technical term for aspiration before injection into an epidural?
Barbitage
What is the treatment for a high spinal?
Supportive and give Epinepherine
Why is there a longer sensory than motor block?
Fiber diameter
motor fibers are thicker and have a longer onset and faster offset
Why do we check coags before performing a spinal?
Because of the risk of a spinal hematoma
Adding epinephrine to a local anesthetic for a spinal would prolong or shorten the duration of action?
Prolong
True or false half of you probably will not look at all of these cards
True
