Spinal/Epidural Blocks Flashcards
Where is CSF contained?
B/w the Pia and arachnoid maters in the subarachnoid space
The spinal cord normally extends from ______ to the level of ___ in adults
foramen magnum; L1
In children, the spinal cord ends at ___ and moves up with age
L3
Lower spinal nerves form the _____
cauda equina
One of the radicular arteries is typically large, the _______, or ______, arising form the aorta
artery of Adamkiewicz; arteria radicularis magna
Absolute contraindications for neuraxial anesthesia
infxn at site of injection lack of consent coagulopathy or other bleeding diathesis severe hypovolemia increase ICP
Relative C/I for neuraxial anesthesia
sepsis uncooperative pt preexisting neurological deficits demyelinating lesions stenotic valvular heart lesions LV outflow obstruction (Hypertrophic obstructive CM) severe spinal deformity
Controversial C/I for neuraxial anesthesia
prior back sx at the site of injection complicated surgery prolonged operation major blood loss maneuvers that compromise respiration
Rivaroxaban should be discontinued ____ before a neuraxial block
72 hrs
Rivaroxaban should be administered at least ______ hours after catheter removal
22-26
Dabigatran requires a _____ discontinuation period prior to neuraxial anesthesia
96 hr
Hold subQ heparin for ___ hrs for catheter removal
12
___ & ____ do NOT increase the risk of spinal hematoma from neuraxial anesthesia or epidural catheter removal
aspirin & NSAIDs
Waiting period for ticlopidine
10 days
Waiting period for clopidogrel
5-7 days
Waiting period for prasugrel
7-10 days
Waiting period for ticagrelor
5-7 days
Waiting period for abciximab
24-48 hrs
Waiting period for eptifibatide
4-8hrs
The _____ the dosage or more _____ the site of injection, the more cephalad the level of anesthesia that will be obtained
larger; cephalad
When a pt is in a head-down position, a hyperbaric solution spreads ______, and a hypobaric solution moves ______
cephalad; caudad
A head-up position causes a hyperbaric solution to ____ and a hypobaric solution to _____
settle caudad; ascend cephalad
When a pt remains in a lateral position, a hyperbaric spinal solution will have a greater effect on the _____ side whereas a hypobaric solution will achieve higher levels on the _____ side.
dependent (down); nondependent (up)
An _____ solution tends to remain at the level of injection
isobaric
Only what type of local anesthetic solutions are used for spinal anesthetics?
preservative-free
What is the hallmark of postdural puncture headache?
its association with body position. (increased by sitting or standing, relieved by lying down flat)
________ needles are a/w a higher incidence of PDPH than ______ needles of the same gauge
cutting-point; pencil-point
Tx for PDPH
laying flat, dark room, Tylenol, NSAIDs, caffeine, opioids, epidural patch
