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AP II Test 2 > Spinal & Epidural Anesthesia > Flashcards

Spinal & Epidural Anesthesia Flashcards

1
Q

Mechanism(s) of local anesthetic action in epidural anesthesia:

A) direct local anesthetic action on nerve roots and spinal cord following diffusion across the dura

B) diffusion of local anesthetic into paravertebral regions through intervertebral foramina

C) both

D) neither

A

both

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2
Q

What patients will have atlanto-occipital instability at C1?

A

Down’s syndrome pts

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3
Q

The posterior iliac spine corresponds to what level?

A

L4

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4
Q

Factors enhancing bupivacaine (Marcaine) toxicity:

A) pregnancy

B) presence of calcium channel blockers

C) arterial hypoxemia

D) acidosis

E) hypercarbia

A

All of the above

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5
Q

What are the benefits of neuraxial anesthesia? (4)

A
  • 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
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6
Q

All cervical, thoracic, and lumbar vertebrae have:

Body anteriorly
Two pedicles posterior
Two Laminae connecting pedicles

EXCEPT:

A

C1 (atlas)

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7
Q

What types of patients are contraindicated to receive neuraxial anesthesia?

A

HONDA

HTN

Obese

Non-compliant Diabetes

Alcoholics

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8
Q
A
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9
Q

What vertebrate does not have a body or spinous process?

What is the first prominent spinous process?

A

C1

C7

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10
Q

What 5 ligaments support the spine?

A

supraspinous

ligamentum nuchae above T7

interspinous ligament

ligamentum flavum

longitudinal ligaments

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11
Q

What is the space between the spinal meninges and vertebral canal?

A

epidural space

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12
Q

What bounds the epidural space:

Cranially?

Caudally?

Anteriorly?

Laterally?

Posteriorly?

A

Cranial:foramen magnum

Caudal: sacrococcygeal ligament

Anterior: posterior longitudinal ligament

Lateral: pedicles

Posterior: flavum and lamina

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13
Q

What occurs when epidural fat receives LA and opioids?

A

reduces bioavailability by sequestering the medicine

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14
Q

What is injection/withdrawal/injection of LA called?

A

barbitage

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15
Q

Where does the dura terminate?

A

S2 at filum terminale

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16
Q

What fuses laterally along nerve roots with the epineurium?

A

dura mater

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17
Q

What is the principle physiologic barrier for drugs between epidural space and spinal cord?

A

arachnoid mater

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18
Q

What meninge adheres to the spinal cord?

A

pia mater

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19
Q

Where does the spinal cord terminate?

A

filum terminale

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20
Q

What anchors the spinal cord in the meninges?

A

denticulate ligaments

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21
Q

Where does the spinal cord terminate in adults?

In children?

A

L1

L3

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22
Q

How many pairs of spinal nerves are there?

A

31 pairs

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23
Q

What do the anterior root innervate?

Posterior?

A

motor

sensory

24
Q

Intermediolateral gray matter of ___-___ contain cell bodies of preganglionic sympathetic neurons

A

T1-L2

25
Q

What dermatome are epidurals placed?

A

T4-T5

T4 is nipple level

T6 is xiphoid

26
Q

What layers will you pentetrate in midline approach during a spinal? (8)

A

Skin
subQ
supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space
dura mater
arachnoid mater

27
Q

In a paramedian approach to a spinal, what layers will you bypass? (2)

A

supraspinous ligament

interspinous ligament

28
Q

Smaller than a ___ gauge needle has been associated with great PDPH.

A

25

29
Q

What technique is associated with less CSF leakage and decreased PDPH?

A

paramedian

30
Q

Two techniques make it possible to determine when the tip of the needle has entered the potential ______ space:

loss of resistance

hanging drop

A

epidural

31
Q

How much blood is injected for a blood patch for PDPH?

A

20-30 cc

32
Q

In what space do you inject the blood for blood patch?

A

epidural space

33
Q

What can occur as a result of a high spinal?

What do you do to treat this?

A

blunt cardiac baroreceptors and cause TACHYCARDIA and hypotension

give epi!

34
Q

What can occur if you inject LA too quickly?

A

high spinal

35
Q

There is considerable interindividual variability especially with _____ spinal block.

A

hypobaric

36
Q

Dose influences the height of block. True or false?

A

false, does not

37
Q

______ is the LA that is most dramatically prolonged by addition of adrenergic agonists.

A

Tetracaine

38
Q

______ is the shortest-acting LA for subarachnoid use.

A

Procaine

39
Q

_____ has good motor and sensory blocking ability–excellent motor/sensory discrimination.

A

Bupivicaine

40
Q

_______ fibers are the most dense. They take the longer to be affected by first to return.

A

Motor

41
Q

______ has profound motor block.

A

Etidocaine

42
Q

Baricity

Hyper moves ____.

Hypo moves ____.

A

down

up

43
Q

Density of CSF about _____ g/mL

A

1.0003 like water

44
Q

For thoracic kyphosis patient, what would you do to give a spinal?

A

Place a hyperbaric solution in, elevate patient’s head and place in trendelenberg.

45
Q

What is the definition of a differential block?

A

Motor block at level of injection,

2 dermatomes levels up, sensory block

2 dermatomes levels up, sympathetic (temp. sensed)

46
Q

What are the cardiovascular effects of spinal?

_____ preload

_____ CO

_____ SVR/afterload

A

decreases all

47
Q

_____ dependent CO.

First less preload because of venous pooling.

CO decreases as result.

HR will increase to compensate.

A

HR

48
Q

GI systemic effects result from a sympathetic block of levels ____-_____.

What will occur as a result?

A

T6-L2

Unopposed vagal parasympathetic

increased secretion

sphincters relax

constricted bowel

49
Q

What are complications to spinal? (3)

A

backache

transient hearing loss for 1-3 days, more in females

PDPH

50
Q

The neurologic complications of spinals (3)

A

cauda equina syndrome (poor CSF mixing)

transient neuro symptoms (pain radiating to legs, especially with lithotomy)

chlorprocaine, preservatives add issues

51
Q

Coagulations defects are the principle cause of this spinal complication:

A

spinal hematoma

52
Q

Neurotoxicity associated with LA: sensory anesthesia, bowel and bladder sphincter dysfunction, paraplegia, may be caused by nonhomogeneous LA distribution:

A

cauda equina syndrome

53
Q

True or False

Important factors influencing the distribution of LA in the subarachnoid space include:

Density of the LA
Shape of the spinal canal
Position of the patient
Site of injection

A

true

54
Q
A
55
Q

Zone of differential motor blockade may average up to four segments below the sensory level in spinal or epidural?

A

epidural

56
Q
A

quincke for spinal

57
Q

What epidural spreads caudally and cranially?

A

block spread epidural

AP II Test 2 (7 decks)

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