Spinal & Epidural Anesthesia Flashcards by Cindy Ehret

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

both

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What patients will have atlanto-occipital instability at C1?

Down’s syndrome pts

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The posterior iliac spine corresponds to what level?

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Factors enhancing bupivacaine (Marcaine) toxicity:

A) pregnancy

B) presence of calcium channel blockers

C) arterial hypoxemia

D) acidosis

E) hypercarbia

All of the above

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What are the benefits of neuraxial anesthesia? (4)

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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All cervical, thoracic, and lumbar vertebrae have:

Body anteriorly
Two pedicles posterior
Two Laminae connecting pedicles

EXCEPT:

C1 (atlas)

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What types of patients are contraindicated to receive neuraxial anesthesia?

HONDA

HTN

Obese

Non-compliant Diabetes

Alcoholics

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What vertebrate does not have a body or spinous process?

What is the first prominent spinous process?

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What 5 ligaments support the spine?

supraspinous

ligamentum nuchae above T7

interspinous ligament

ligamentum flavum

longitudinal ligaments

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

epidural space

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What bounds the epidural space:

Cranially?

Caudally?

Anteriorly?

Laterally?

Posteriorly?

Cranial:foramen magnum

Caudal: sacrococcygeal ligament

Anterior: posterior longitudinal ligament

Lateral: pedicles

Posterior: flavum and lamina

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What occurs when epidural fat receives LA and opioids?

reduces bioavailability by sequestering the medicine

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What is injection/withdrawal/injection of LA called?

barbitage

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Where does the dura terminate?

S2 at filum terminale

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What fuses laterally along nerve roots with the epineurium?

dura mater

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

arachnoid mater

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What meninge adheres to the spinal cord?

pia mater

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Where does the spinal cord terminate?

filum terminale

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What anchors the spinal cord in the meninges?

denticulate ligaments

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Where does the spinal cord terminate in adults?

In children?

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How many pairs of spinal nerves are there?

31 pairs

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What do the anterior root innervate?

Posterior?

motor

sensory

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

T1-L2

What dermatome are epidurals placed?

T4-T5 T4 is nipple level T6 is xiphoid

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

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

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

supraspinous ligament interspinous ligament

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

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

paramedian

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

epidural

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

20-30 cc

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

epidural space

What can occur as a result of a high spinal? What do you do to treat this?

blunt cardiac baroreceptors and cause TACHYCARDIA and hypotension give epi!

What can occur if you inject LA too quickly?

high spinal

There is considerable interindividual variability especially with _____ spinal block.

hypobaric

Dose influences the height of block. True or false?

false, does not

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

Tetracaine

\_\_\_\_\_\_ is the shortest-acting LA for subarachnoid use.

Procaine

\_\_\_\_\_ has good motor and sensory blocking ability--excellent motor/sensory discrimination.

Bupivicaine

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

Motor

\_\_\_\_\_\_ has profound motor block.

Etidocaine

Baricity Hyper moves \_\_\_\_. Hypo moves \_\_\_\_.

down up

Density of CSF about _____ g/mL

1.0003 like water

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

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

What is the definition of a differential block?

Motor block at level of injection, 2 dermatomes levels up, sensory block 2 dermatomes levels up, sympathetic (temp. sensed)

What are the cardiovascular effects of spinal? \_\_\_\_\_ preload \_\_\_\_\_ CO \_\_\_\_\_ SVR/afterload

decreases all

\_\_\_\_\_ dependent CO. First less preload because of venous pooling. CO decreases as result. HR will increase to compensate.

GI systemic effects result from a sympathetic block of levels \_\_\_\_-\_\_\_\_\_. What will occur as a result?

T6-L2 Unopposed vagal parasympathetic increased secretion sphincters relax constricted bowel

What are complications to spinal? (3)

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

The neurologic complications of spinals (3)

cauda equina syndrome (poor CSF mixing) transient neuro symptoms (pain radiating to legs, especially with lithotomy) chlorprocaine, preservatives add issues

Coagulations defects are the principle cause of this spinal complication:

spinal hematoma

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

cauda equina syndrome

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

true

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

epidural

quincke for spinal

What epidural spreads caudally and cranially?

block spread epidural